PRIMARY DYSMENORRHEA

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PRIMARYDYSMENORRHEA

• Kanadi Sumapraja

Division of Reproductive Immuno-endocrinology
Department of Obstetrics and Gynecology Faculty
of Medicine University of Indonesia
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DEFINITION
Painful menses in women with normal pelvic anatomy
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ETIOLOGY
Smooth muscle contraction
PGF2a PGE2
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ETIOLOGY
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ETIOLOGY
Phospholipid from the death cells
Prostaglandin Prostacyclin Thromboxane
Arachidonic acid
PGG2 PGH2
Phospholipase A2
Isomerase
COX
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RISK FACTORS
Age lt 20 years Attempts to lose weight Depression
/ anxiety Disruption of social networks Heavy
menses Nulliparity Smoking
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CLINICAL PRESENTATION
Usually presents during adolescence, within three
years of menarche Unusual for symptoms to start
within the first six months after menarche Pain
usually develops within hours of the start of
menstruation and peaks as the flow becomes
heaviest during the first day or two of the
cycle Symptoms of nausea, vomiting, diarrhea,
fatigue, fever, headache or lightheadedness
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SECONDARY DYSMENORRHEA
Dysmenorrhea occurring during the first one or
trwo cycles after menarche Dysmenorrhea beginning
after 25 years of age Late onset
dysmenorrhea Pelvic abnormality Little or no
response to therapy with NSAIDs, OC or both
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TREATMENT
A consistent, good-quality, patient-oriented
evidence B inconsistent or limited quality
patient-oriented evidence C consensus,
disease-oriented evidence, usual practice,
opinion, or case series.
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ROS INDUCES PGF2a
Endometrial stroma
Decidualized endometrial stroma cell
Sugino et al, 2001
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NSAID can reduce PGF2a
Sugino et al, 2001
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SOD regulated by steroid
Sugino et al, 2002
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ROS and SOD

• During normal cellular respiration, oxygen is
  reduced to water and highly reactive superoxide (
  )

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ROS and SOD
These reactive oxygen species (superoxide) react
with nucleic acids, sugars, proteins and lipids -
eventually leading to protein degradation.
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ROS and SOD balance
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Antioxidant
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Antioxidant role of vitamin E
Vitamin E
Free Radical
Quenched Free Radical
Polyunsaturated Fatty Acid
Protein
Cholesterol
Phospholipid
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THANK YOU