- Spasmodic Dysmenorrhoea: It is also called intrinsic, primary or functional dysmenorrhoea.
- It is found in young patients, usually 18-24 yrs. It is rarely found after 30 yrs of age.
- Painful menses occur usually years after menarche.
- Pain starts 1-2 hours before the onset of mens, usually continues for the first 12-24 hours and then gradually gets less.
- Pain is colicky and cramp like, occurs in the hypo gastric region and radiates to the thighs. There may be low backache.
- The intermenstrual period is free from any pain.
- Constitutional symptoms like nausea, vomiting, diarrhea, sometimes fainting may be present along with painful mens.
- Patient may be in poor state of health and anxious state of mind.
- Per-abdomen examination is done and nothing is detected.
- Vaginal and rectal examinations in young virgins are done and uterus is usually felt normal.
- Congestive Dysmenorrhoea:
- Patient is usually elderly usually beyond 30 yrs.
- Painful mens occurs after a period of painless menstruation.
- Pain starts 3-5 days before the inset of mens after which the pain usually gets less. Pain is menstrual in pelvic endometriosis.
- Pain is a dull ache in the back or lower abdomen without any radiation.
- The intermenstrual period may have backache and lower abdominal discomfort.
- Other symptoms due to primary cause in the pelvis are predominating viz., menorrhagia, white discharge, infertility.
- Patient is otherwise healthy except being slightly anemic.
- On per-abdomen examination, there may be primary lesion felt like uterine fibroid.
- 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.
- Any obstruction to the outflow of blood due to pinhole os.
- Muscle ischaemia
- There may be neurogenic cause if autonomous nervous system of uterus is upset.
- Psychological and social disturbances
- Hormonal disturbances
- 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.
- Pelvic inflammatory condition.
- Pelvic endometriosis.
- Adequate bed rest.
- Analgesics and antispasmodics.
- Hormonal Therapies