DYSMENORRHEA

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DYSMENORRHEA

• AHMED ABDULWAHAB
• CONSULTANT
• ASSISTANT PROFESSOR

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• Classification.
• Primary dysmenorrhea .
• Occurs during ovulatory cycles, and usually 6 to
  12 month after menarche.
• Etiology.
• Uterine contractions with ischemia and increase
  contractility, and resting tone due to
  prostaglandin production.
• There is associated symptoms like nausea vomiting
  and headache. Unovulatory cycle contain little
  PGs and hence painless.

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• Clinical features
• Cramping pain usually begin few hours before the
  cycle and may persist for hours or days .
• It is localized in the lower abdomen and may
  radiate to the thigh and lower back
• May be associated with altered bowel habits ,
  nausea ,fatigue , dizziness, and headache .

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• treatment
• NSAIDs are highly effective , ibuprofen and
  mefenamic acid may cause GIT disturbance .
• Other class the cyclo-oxygenase inhibitor that
  have little effect on GIT.
• Oral contraceptive pills by inhibiting ovulation
  .
• Progestins .
• Tocolytic.

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• Secondary dysmenorrhea.
• It is secondary to an underlying cause and PGs
  may play a role .
• Clinical features .
• Generally the pain is not limited to the menses
  and can occur before as well as after the menses
  .
• It develops in older women and usually associated
  with other symptoms like dyspareunia ,
  infertility and abnormal uterine bleeding .

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• Causes .
• 1-Endometriosis .
• Pain in pre and postmenstrual phase ,there is
  deep dyspareunia and tender pelvic examination .
• Pelvic inflammation , like endometriosis
  initially pain may be menstrual and often extend
  into the premenstrual phase with each cycle, may
  have inter menstrual bleeding .

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• 2-Fibroid and adenomyosis.
• There is dull dragging sensation , uterus is
  clinically enlarged and may be tender.
• 3-Ovarian cysts .
• Should be clinically evident.
• 4-Pelvic congestion .
• There is dull ill-defined pelvic ache , usually
  worse pre-menstrually and relived by menses .

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• Treatment .
• Treatment of the underlying disease .
• The treatment used for the primary dysmenorrhea
  are often helpful .