Dysmenorrhoea

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Definition: It means the painful menstruation incapacitating in woman. Incidence: Probably 5-10% girls in their late teens and women in early twenties suffer from spasmodic dysmenorrhoea. This can interrupt patient’s educational, social and economic life. The incidence of spasmodic dysmenorrhoea is falling. Types:

  1. Spasmodic Dysmenorrhoea: It is also called intrinsic, primary or functional dysmenorrhoea.

Symptoms:

  1. It is found in young patients, usually 18-24 yrs. It is rarely found after 30 yrs of age.
  2. Painful menses occur usually years after menarche.
  3. Pain starts 1-2 hours before the onset of mens, usually continues for the first 12-24 hours and then gradually gets less.
  4. Pain is colicky and cramp like, occurs in the hypo gastric region and radiates to the thighs. There may be low backache.
  5. The intermenstrual period is free from any pain.
  6. Constitutional symptoms like nausea, vomiting, diarrhea, sometimes fainting may be present along with painful mens.

Signs:

  1. Patient may be in poor state of health and anxious state of mind.
  2. Per-abdomen examination is done and nothing is detected.
  3. Vaginal and rectal examinations in young virgins are done and uterus is usually felt normal.
  4. Congestive Dysmenorrhoea:

Symptoms:

  1. Patient is usually elderly usually beyond 30 yrs.
  2. Painful mens occurs after a period of painless menstruation.
  3. Pain starts 3-5 days before the inset of mens after which the pain usually gets less. Pain is menstrual in pelvic endometriosis.
  4. Pain is a dull ache in the back or lower abdomen without any radiation.
  5. The intermenstrual period may have backache and lower abdominal discomfort.
  6. Other symptoms due to primary cause in the pelvis are predominating viz., menorrhagia, white discharge, infertility.

Signs:

  1. Patient is otherwise healthy except being slightly anemic.
  2. On per-abdomen examination, there may be primary lesion felt like uterine fibroid.
  3. On per vaginal examination, there is any type of pelvic pathology in uterus or its adnexae

Causes of Pain: In Primary Dysmenorrhoea: The definite cause of pain is unknown but the following are some important factors which are held to be responsible. The condition is probably multifactorial.

  1. Any obstruction to the outflow of blood due to pinhole os.
  2. Hypoplasia
  3. Muscle ischaemia
  4. There may be neurogenic cause if autonomous nervous system of uterus is upset.
  5. Psychological and social disturbances
  6. Hormonal disturbances

Secondary Dysmenorrhoea:

  1. Uterine condition such as interstitial or submucoid fibroid interferes with the normal rhythmic contractions of the uterus which may be spasmodic from attempts to expel the foreign body.
  2. Pelvic inflammatory condition.
  3. Pelvic endometriosis.

Treatment:

  1. Adequate bed rest.
  2. Laxatives
  3. Analgesics and antispasmodics.
  4. Hormonal Therapies
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