Dysmenorrhea
Dysmenorrhea: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Dysmenorrhea—painful menstruation—affects more than 50% of menstruating women; in fact, it’s the leading cause of lost time from school and work among women of childbearing age. Dysmenorrhea may involve sharp, intermittent pain or dull, aching pain. It’s usually characterized by mild to severe cramping or colicky pain in the pelvis or lower abdomen that may radiate to the thighs and lower sacrum. This pain may precede menstruation by several days or may accompany it. The pain gradually subsides as bleeding tapers off.
Dysmenorrhea may be idiopathic, as in premenstrual syndrome (PMS) and primary dysmenorrhea. It commonly results from endometriosis and other pelvic disorders. It may also result from structural abnormalities such as an imperforate hymen. Stress and poor health may aggravate dysmenorrhea; rest and mild exercise may relieve it.
History and physical examination
If the patient complains of dysmenorrhea, have her describe it fully. Is it intermittent or continuous? Sharp, cramping, or aching? Ask where the pain is located and whether it’s bilateral. How long has she been experiencing it? When does the pain begin and end, and when is it severe? Does it radiate to the back? Explore associated signs and symptoms, such as nausea and vomiting, altered elimination habits, bloating, water retention, pelvic or rectal pressure, and unusual fatigue, irritability, or depression.
Then obtain a menstrual and sexual history. Ask the patient if her menstrual flow is heavy or scant. Have her describe any vaginal discharge between menses. Does she experience pain during sexual intercourse? Does it occur with menses? Find out what relieves her cramps. Does she take pain medication? Is it effective? Note her method of contraception, and ask about a history of pelvic infection. Does she have any signs and symptoms of urinary system obstruction, such as pyuria, urine retention, or incontinence? Determine how she copes with stress. Determine her risk for sexually transmitted diseases.
Next, perform a focused physical examination. Take vital signs, noting fever and accompanying chills. Inspect the abdomen for distention, and palpate for tenderness and masses. Note costovertebral angle tenderness.
Medical causes
Adenomyosis
In this disorder, endometrial tissue invades the myometrium, resulting in severe dysmenorrhea with pain radiating to the back or rectum, menorrhagia, and a symmetrically enlarged, globular uterus that’s usually softer on palpation than a uterine myoma.
Cervical stenosis
This structural disorder causes dysmenorrhea and scant or absent menstrual flow.
Endometriosis
In this disorder, steady, aching pain typically begins before menses and peaks at the height of menstrual flow, but it may also occur between menstrual periods. The pain may arise at the endometrial deposit site or may radiate to the perineum or rectum. Associated signs and symptoms include premenstrual spotting, dyspareunia, infertility, nausea and vomiting, painful defecation, and rectal bleeding and hematuria during menses. A tender, fixed adnexal mass is usually palpable on bimanual examination.
Pelvic inflammatory disease
Chronic infection produces dysmenorrhea accompanied by fever; malaise; a foul-smelling, purulent vaginal discharge; menorrhagia; dyspareunia; severe abdominal pain; nausea and vomiting; and diarrhea. A pelvic examination may reveal cervical motion tenderness and bilateral adnexal tenderness.
PMS
The cramping pain of PMS usually begins with menstrual flow and persists for several hours or days, diminishing as flow decreases. Abdominal bloating, breast tenderness, palpitations, diaphoresis, flushing, depression, and irritability commonly precede menses by several days to 2 weeks. Other findings include nausea, vomiting, diarrhea, and headache. Because PMS usually follows an ovulatory cycle, it rarely occurs during the first 12 months of menses, which may be anovulatory.
Primary (idiopathic) dysmenorrhea
Increased prostaglandin secretion intensifies uterine contractions, apparently causing mild to severe spasmodic cramping pain in the lower abdomen, which radiates to the sacrum and inner thighs. The cramping abdominal pain peaks a few hours before menses. Patients may also experience nausea and vomiting, fatigue, diarrhea, and headache.
Uterine leiomyomas
If these tumors twist or degenerate after circulatory occlusion or infection or if the uterus contracts in an attempt to expel them, they may cause constant or intermittent lower abdominal pain that worsens with menses. Associated signs and symptoms include backache, constipation, menorrhagia, and urinary frequency or retention. Palpation may reveal the tumor mass and an enlarged uterus. The tumors are almost always nontender.
Other causes
Intrauterine devices
These devices may cause severe cramping and heavy menstrual flow.
Special considerations
In the past, women with dysmenorrhea were considered neurotic. Although current research suggests that prostaglandins contribute to this symptom, old attitudes persist. Encourage the patient to view dysmenorrhea as a medical problem, not as a sign of maladjustment.
Pediatric pointers
Dysmenorrhea is rare during the first year of menstruation, before the menstrual cycle becomes ovulatory. However, the incidence of dysmenorrhea is generally higher among adolescents than older women. Teach the adolescent about dysmenorrhea. Dispel myths about it, and inform her that it’s a common medical problem. Encourage good hygiene, nutrition, and exercise.
Patient counseling
If dysmenorrhea is idiopathic, advise the patient to place a heating pad on her abdomen to relieve the pain. This therapy reduces abdominal muscle tension and increases blood flow.
Effleurage, a light circular massage with the fingertips, may also provide relief. Other comfort measures include drinking warm beverages, taking a warm shower, performing waist-bending and pelvic-rocking exercises, and walking. Inform the patient that increasing aerobic exercise and dietary intake of vitamin B1 and fish oil capsules have also proved effective in relieving dysmenorrhea.
Inform the patient that taking a nonsteroidal anti-inflammatory drug (NSAID) 1 to 2 days before the onset of menses is usually helpful. If she isn’t trying to get pregnant, taking monophasic birth control pills is also beneficial. Warn the patient that both of these treatments may reduce menstrual flow and duration. Be sure to rule out the possibility of pregnancy before starting contraceptive or NSAID therapy. Explain the actions and adverse effects of these drugs. (See Relief for dysmenorrhea.)
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
More About Pelvic Inflammatory Disease
More Medical Textbooks Online about Pelvic Inflammatory Disease
Review other book chapters online related to Pelvic Inflammatory Disease:
Medical Books Excerpts
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Chronic Pelvic Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Vaginal discharge (Professional Guide to Signs & Symptoms (Fifth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
