Primary dysmenorrhea (painful menstruation)

Pelvis | Gynecology | Primary dysmenorrhea (painful menstruation) (Disease)


Description

Primary dysmenorrhea is painful menstrual cramps without any evident pathology to account for them, and it occurs in up to 50% of menstruating females and causes significant disruption in quality of life and absenteeism.

Causes and Risk factors

Current understanding implicates an excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation. The uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure.

Diagnosis and Treatment

Uterine hypercontractility, reduced uterine blood flow, and increased peripheral nerve hypersensitivity induce pain. Diagnosis rests on a good history with negative pelvic evaluation findings.

For treatment of primary dysmenorrhea, most doctors prescribe antiprostaglandin drugs or NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, ketoprofen, or naproxen. These drugs inhibit synthesis of prostaglandins, lessen the contractions of the uterus and reduce the menstrual flow. These drugs should be started at the onset of bleeding to avoid inadvertent use during early pregnancy and taken for 2-3 days.

Oral contraceptives are another alternative. By stopping ovulation and decreasing prostaglandin levels, they may eliminate cramps.

Treatment of secondary dysmenorrhea depends on the cause. Endometriosis is the most common cause of secondary dysmenorrhea. Depending on the stage of this disease and the womans age and desire to have children, the treatment methods vary from conservative drug therapy (androgens, progestins, oral contraceptives and gonadotropin-releasing hormone agonists) to surgical procedures.

If the problem is adenomyosis, a hysterectomy may be necessary. Pelvic inflammatory disease may be treated with antibiotics. Uterine fibroids, fibroid tumors and pelvic tumors are often treated surgically. Cervical narrowing can be corrected with surgery as well. ...