. DYSMENORRHEA Primary menstrual pain not caused by organic disease may be due to prostaglandin-induced uterine cont...
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DYSMENORRHEA
Primary
- menstrual pain not caused by organic disease
- may be due to prostaglandin-induced uterine contractions and ischemia
- begins 6 months - 2 years after menarche (ovulatory cycles)
- colicky pain in abdomen, radiating to the lower back, labia and inner thighs
- begins hours before onset of bleeding and persists for hours or days
- associated nausea, vomiting, altered bowel habits, headaches
Treatment
- PG synthetase inhibitors (e.g. naproxen)
- must be started before/at onset of pain
- BCP to suppress ovulation and reduce menstrual flow
Secondary
- menstrual pain due to organic disease
- begins in women who are in their 20Ãs
- worsens with age
- associated dyspareunia, abnormal bleeding, infertility
Etiology
- endometriosis
- adenomyosis
- fibroids
- PID
- ovarian cysts
- IUD
PREMENSTRUAL SYNDROME
Definition
- variable cluster of symptoms that appear to occur on a regular basisprior to each menstrual episode
- more correctly called OVARIAN CYCLE SYNDROME since symptoms depend on ovulation
- etiology is unknown
Symptoms
- occur 7-10 days before menses and relieved by onset of menses
- 7 day symptom-free interval must be present in first half of cycle
- physical - see Progestin Deficiency and Estrogen Excess Symptoms
- psychological
- irritability
- anxiety
- depression
- sleep disturbance
- appetite change
- libido change
- fatigue
- suicidal ideation
Treatment
- no proven beneficial treatment, only suggested treatment
- psychological support
- diet
- decreased sodium, fluids, carbohydrates
- increased protein
- avoidance of caffeine and alcohol
- medications
- vitamins - B6 (pyridoxine)
- BCP
- progesterone suppositories
- diuretics for severe fluid retention
- NSAIDs for discomfort, pain
- evening of primrose oil (linoleic acid)
- danazol (Danocrine)
- SSRI antidepressants in selected cases
- regular exercise
