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Dysmenorrea!!!

05 Aug Dysmenorrea!!!

Posted at 13:05h in Articles by
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It was a day to the beginning of her much anticipated final examinations, the four years struggle was almost coming to an end. Tonia was filled with so much excitement while flipping her books trying to cover as much ground as she could with her dear friend sitting not too far, they occasionally took a while to exchange happy giggly looks and sighs of relief, it was almost over, they were almost kissing the finishing ribbon. While they continued their revision Tonia changed her
position from sitting to leaning over the table and later to lying on the chair her friend watched her and asked what
the problem was and she said it was the Red Robot again. She kept on whimpering and grinding for a while but later called out to her friend indicating her intention of going back to the hostel. On getting to the hostel she grabbed her pillow as the whimpering turned into low groans.
“God please,” she muttered, “I can’t deal with this. Not now.”

Earlier that day before leaving her hostel, she took 2 tablets of felvin but the relief had just lasted for 2 hours before the pain came back with vengeance.
She couldn’t lie still on the bed and 3 hours later, her friend found her on the floor, body covered in sweat and teeth tightly locked as she tried to fight d pain.
“Tonia this is really scary,” she shouted on seeing her friend in that position, “you don’t need this now. At all. Not now. I’m taking you to the hospital immediately,” she declared, dropping her bag of books beside the bed.
“No. No,” Tonia groaned, fists firmly clenched and resting on her abdomen. “Its going to pass. No hospital. Please.”
“We are going to the hospital now,” her friend said emphatically, “except you want to come back for spill over because I don’t see you being able to finish your revisions or even sit for the exam.”
She succeeded in dragging her to the hospital but then, there was only one Doctor available, and he was really busy.
“I told you I will be fine, please let’s go,” Tonia pleaded in a weak voice.
‘You hush,” her friend said, “We will not leave here without seeing a Doctor.”
30 minutes later, they walked into the doctors call room. He listened to Tonia describe her symptoms, her words were slow and punctuated with groans but he was patient with her.
“You just described the symptoms of dysmenorrhea,” he said.
“Dys-what?” her friend asked…….

Dysmenorrhea!!!

Dysmenorrhea happens to be one of most common medical complaints amongst females of reproductive age, although not life threatening it is psychologically taxing and responsible for a significant level of work and school absenteeism among this age group.

Dysmenorrhea is defined as difficult menstrual flow or painful menstruation. While some of those affected choose to self-medicate and never seek medical attention, optimal management of this condition lies in understanding of the underlying cause and informed decision making on management options following definitive cause.
Menstrual pain in the past were often dismissive. Pain was often attributed to women’s emotional or psychological states or to misconceptions about sex and sexual behaviors. Although the etiology and pathophysiology of dysmenorrhea have not been fully elucidated, research has led to data supporting concrete physiologic explanations for dysmenorrhea, which discredit these prior dismissive theories.
Studies have shown the following risk factors to be associated with dysmenorrhea:

  • Earlier age at menarche
  • Long menstrual periods
  • Heavy menstrual flow
  • Smoking
  • Positive family history
  • Obesity
  • Alcohol

Dysmenorrhea can be divided into 2 broad categories:

·       Primary dysmenorrhea (Spasmodic type): defined as menstrual pain that is not associated with underlying pelvic pathology (i.e. occurs in the absence of any obvious pelvic disease). It typically occurs in the first few years after menarche and affects as many as 50% of post pubertal females.
·       Secondary dysmenorrhea (congestive): defined as menstrual pain resulting from anatomic or macroscopic (Obvious) pelvic pathology, as seen in women with endometriosis or chronic pelvic inflammatory disease.
Primary dysmenorrhea
In primary dysmenorrhea, there is a highly complex interplay between hormones, mediators and the central nervous system (CNS), the extent of which is not completely understood.
The key point of note here is in primary dysmenorrhea there is no obvious physical anomaly to point to.
Secondary dysmenorrhea
Elevated mediators such as prostaglandins may also play a role in secondary dysmenorrhea, but by definition, concomitant pelvic pathology must be present such as stated below.

  • Pelvic inflammatory disease (PID)
  • Endometriosis
  • Ovarian cysts and tumors
  • Cervical stenosis or occlusion
  • Adenomyosis
  • Fibroids
  • Uterine polyps
  • Intrauterine adhesions
  • Congenital malformations (eg, bicornuate uterus or subseptate uterus)
  • Intrauterine contraceptive device (IUCD), or intrauterine device (IUD)
Almost any process that can affect the pelvic viscera can produce cyclic pelvic pain
The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea.
Laboratory Investigations
No tests are specific to the diagnosis of primary dysmenorrhea. The diagnosis is made on the basis of clinical findings.
Laboratory studies may be indicated to elucidate the cause of secondary dysmenorrhea. Noninvasive studies may include abdominal and transvaginal ultrasonography. Other more invasive studies, including hysterosalpingography, may be required. Further investigation might include hysteroscopy or laparoscopy; the latter is usually indicated when initial interventions fail to relieve symptoms.
Treatment Approach Considerations
Treatment of dysmenorrhea is aimed at providing symptomatic relief as well as inhibiting the underlying processes that cause symptoms. Medications used may include NSAIDs and opioid analgesics, as well as oral contraceptives (OCs). In addition to pain relief, mainstays of treatment include reassurance and education.
Treatment of primary dysmenorrhea is directed at providing relief from the cramping pelvic pain and associated symptoms (eg, headache, nausea, vomiting, flushing, and diarrhea) that typically accompany or immediately precede the onset of menstrual flow. The pelvic pain can be distressing and occasionally radiates to the back and thighs, often necessitating prompt intervention.
To date, pharmacotherapy has been the most reliable and effective treatment for relieving dysmenorrhea. Because the pain results from uterine vasoconstriction (blood vessel narrowing) , anoxia (Oxygen deprivation), and contractions mediated by prostaglandins, symptomatic relief can often be obtained by using agents that inhibit prostaglandin synthesis and possess anti-inflammatory and analgesic properties.
NSAIDs and combination OCs are the most commonly used therapeutic modalities for the management of primary dysmenorrhea. These agents have different mechanisms of action and can be used adjunctively in refractory cases. Lack of response to NSAIDs and OCs (or a combination thereof) may increase the likelihood of a secondary cause for dysmenorrhea.
Treatment of secondary dysmenorrhea involves correction of the underlying organic cause. Specific measures (medical or surgical) may be required to treat pelvic pathologic conditions (eg, endometriosis) and to ameliorate the associated dysmenorrhea. Periodic use of analgesic agents as adjunctive therapy may be beneficial.
Many women never seek medical attention for dysmenorrhea. Self-medication with analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) and direct application of heat are common effective strategies and this is a major reason for the prolong affectation.
It would be of great benefit if anyfemale with such condition visit her General Practitioner.
Prevention
Various measures have been used to manage dysmenorrhea in the outpatient setting, including the following:
  • Lifestyle modification seems to be helpful.
  • Smoking cessation should be encouraged, in that smoking may be a risk factor for dysmenorrhea.
  • Exercise has been shown to alleviate symptoms of dysmenorrhea, though the mechanism is not well understood.
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