Dysmenorrhoea for Undergraduates Max Brinsmead MB BS Ph

Dysmenorrhoea for Undergraduates Max Brinsmead MB BS Ph. D May 2015

Primary Dysmenorrhoea – Definition Pain with menstruation in the absence of any pelvic pathology n Secondary dysmenorrhoea is associated/secondary to pelvic pathology n Primary dysmenorrhoea is associated only with ovulatory cycles n Correlates with luteal Progesterone and intrauterine generation of Prostaglandins n

Dysmenorrhoea – Differential Diagnosis Endometriosis n Adenomyosis n PID n Fibroids n Uterine obstruction problems n Clot colic n Irritable bowel syndrome n Musculoskeletal problems n

Clinical Clues n n Pain that begins with or before menstruation and eases as the flow reduces is often PRIMARY Pain that begins after the onset of menses or gets worse as the flow reduces is often SECONDARY t t n Primary dysmenorrhoea may get better after 1 st pregnancy and childbirth t n Endometriosis PID But not always Ask about pre menstrual spotting (PMS) “ t Do you go straight into a full flow or do your periods t t muck about for a few days” PMS has a high likelihood of endometriosis And luteal phase defects

Dysmenorrhoea – The Psychogenic Component The Problem is worse for: u Emotional/Vulnerable u Work dissatisfaction u School problems u Sexual dysfunction u Smokers u Drug dependent

10 Dysmenorrhoea - Treatment n n n n n Rest, Relaxation, Local heat Psychotherapy Diet – weight reduction Smoking cessation NSAIDs – in the correct dose/mode Combined oral contraceptive t Cyclical t Continuous Depo Provera Mirena BUT there is still a 20 – 25% rate of incomplete control of symptoms using these treatments

Any Questions or Comments? Please leave a note on the Welcome Page of this website