Dysmenorrhea - PMS

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					Dysmenorrhea

   Magdy Ibrahim Mostafa
  Ass. Prof. Obstet. Gynecol.,
       Cairo University




        Dr. Magdy Ibrahim
          Definitions & Classification

   Dysmenorrhea: Abnormally painful menstruation. The pain
    may be before, during or after the flow .

   Primary dysmenorrhea: Dysmenorrhea without
    demonstrable organic pelvic pathology (Essential,
    spasmodic, idiopathic)

   Secondary dysmenorrhea: Dysmenorrhea caused by an
    underling pelvic pathology (congestive).




                           Dr. Magdy Ibrahim
Primary dysmenorrhea




       Dr. Magdy Ibrahim
               Primary dysmenorrhea
   Definition: It is spasmodic colicky pain started with
    menstrual flow, peaks within 24 hours and resolve thereafter.
    Pain is usually referred to the back and upper thigh.

   Incidence: ~ 50% experience, but only 1-3% complain.

   Etiology: Unknown
     – Prostaglandin theory.
     – Uterine ischemia theory.
     – Anomalies: Bicornuate uterus, cervical stenosis.
     – Psychological factors.


                           Dr. Magdy Ibrahim
                 Primary dysmenorrhea
   Diagnosis:
    – Patient characteristics:
       »   1-2 years after menarche.
       »   Disappears after labor.
       »   Tense with sedentary life.
       »   +ve family history.
    – Symptoms:
       »   Colicky uterine pain.
       »   Starts just before or just with the flow and lasts for 24-72 hours.
       »   Nausea and vomiting (Prostaglandin effect).
       »   Diarrhea (Prostaglandin effect).
       »   Fainting (Vasomotor instability).
       »   Headache.
       »   Fatigue.

                                Dr. Magdy Ibrahim
                  Primary dysmenorrhea
   Diagnosis:
    – Signs:
          » Healthy female.
    – Special investigations:
          » None.
   Prevention:
    – Avoid tension, constipation & sedentary life.
   Treatment:
    –   Reassurance.
    –   AntiPGs.
    –   OCs
    –   Surgery:
         » Cervical dilatation.
         » PSN or LUNA.

                                  Dr. Magdy Ibrahim
Secondary dysmenorrhea




        Dr. Magdy Ibrahim
                Secondary dysmenorrhea
   Definition: Dull ache pelvic & backache related to menses
    in women having pelvic congestion.


   Incidence: According to the etiology.

   Etiology: Pelvic congestion
     –   Endometriosis.                        - Adenomyosis.
     –   Pelvic tumors.                        - Chronic PID.
     –   Genital displacement.                 - Constipation.
     –   Unsatisfied sex.                      - IBD.
     –   IUD.                                  - Postoperative pelvic adhesion.



                                 Dr. Magdy Ibrahim
               Secondary dysmenorrhea
   Diagnosis:
    – Patient characteristics:
       » Any age.
       » Parous.
    – Symptoms:
       »   Dull aching pain.
       »   Starts before menses.
       »   Relieved by menstruation.
       »   Other symptoms for the etiology.
    – Signs:
       » Of the etiology.
    – Special investigations:
       » Of the etiology.


                              Dr. Magdy Ibrahim
             Secondary dysmenorrhea

   Prevention:
    – Of the etiology.

   Treatment:
    – Of the etiology.
    – Avoid constipation.
    – Avoid coitus interruptus.
    – Avoid hot weather and hot food.
    – Anti-congestive drugs as icthyol glycerin pessaries.




                          Dr. Magdy Ibrahim
            Secondary dysmenorrhea

   Dysmenorrhea of endometriosis:
    – Dull ache start before menses, increase with menses
      then decrease over many days after.
    – Occurs in endometriosis with responsive endometrium.
    – Diagnosis, prevention & treatment  endometriosis

   Ovarian dysmenorrhea:
    – Excessive hemorrhage in c.luteum.
    – Peritonism & hemorrhage.
    – Resembles ectopic.
    – Treatment:
       » Observe, symptomatic treatment and support.
       » Surgery.
                            Dr. Magdy Ibrahim
Premenstrual syndrome
       (PMS)




        Dr. Magdy Ibrahim
                             PMS
   Definition: An ill-defined collection of physical,
    psychological, and behavioral manifestations that occur in the
    late luteal phase and improve menses.

   Incidence: 1% mostly between 25 & 45 years old.

   Etiology: Unknown
     –   Psychogenic.
     –   Genetic.
     –   Hormonal.
     –   Dietary.




                           Dr. Magdy Ibrahim
                                    PMS
   Manifestations:
    – Somatic manifestations:
       » Pain (cramps, backache, breast pain).
       » Water retention (weight gain, swelling, bloating).
       » Hypoglycemia (headache, fatigue, cold sweat, dizziness, fainting).
    – Psychological manifestations:
       » Depression.
       » Anxiety.
    – Behavioral changes:
       »   Decreased efficiency.
       »   Lack of concentration.
       »   Decreased motor skill.
       »   Antisocial behavior.
                                Dr. Magdy Ibrahim
                           PMS
   Diagnosis:
    – Rule out pelvic pathology.
    – Daily symptom diary for 2 months.
    – Screening for psychiatric problems.

   Prevention:
    – None.

   Treatment:
    – Diet control.
    – Suppression of ovulation.
    – Symptomatic treatment.
    – Psychotherapy.
                         Dr. Magdy Ibrahim
Dr. Magdy Ibrahim

				
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Description: Dysmenorrhea (or dysmenorrhoea) is a gynecological medical condition of pain during menstruation that interferes with daily activities