Dysmenorrhea
Dysmenorrhea, or painful menstruation, is one of the most common gynecologic complaints. It is divided into two broad categories: Primary dysmenorrhea refers to severe uterine cramping during ovulatory menses and in the absence of demonstrable pelvic disease; secondary dysmenorrhea is painful menstruation in the presence of underlying pelvic disease (e.g., endometriosis).
Differential Diagnosis
- Primary dysmenorrhea
–Symptoms develop before age 25
–Pain occurs with onset of bleeding, then gradually diminishes
- Secondary dysmenorrhea
–Endometriosis (uterosacral ligament nodules, severe dysmenorrhea)
–Adenomyosis (enlarged uterus, menorrhagia, age 40–50, parous)
–Acute PID (acute adnexal and cervical motion tenderness, fever, discharge, and/or new-onset dysmenorrhea)
–Chronic PID (due to scarring)
–Uterine leiomyoma/fibroids (enlarged, mobile uterus, menorrhagia)
–Ovarian cysts (new dysmenorrhea, unilateral fullness)
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Mental health issues
–Somatization
–Substance abuse
–Depression
–Sexual abuse
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Extrapelvic disorders
–Irritable bowel syndrome
–Appendicitis
–Urinary tract infection
–Inflammatory bowel disease
–Diverticulitis
–Cholecystitis
-
Fibromyalgia
-
Malformations of the müllerian ducts
-
Interstitial cystitis
-
Intestinal or uteropelvic junction obstruction
-
Malignancy (e.g., uterine, ovarian)
-
Ectopic pregnancy
Workup and Diagnosis
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History, physical, pelvic, and rectal examination will often identify the diagnosis
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Patients unresponsive to an initial trial of NSAIDs and oral contraceptives may have pelvic pathology (secondary dysmenorrhea)
-
- Initial labs include CBC, urinalysis, β-hCG, wet mount, KOH prep, and gonorrhea and Chlamydia cultures, which may uncover pathology associated with secondary dysmenorrhea
-
Abdominal and/or vaginal (with vaginal probe) ultrasound may be used to detect pelvic masses (e.g., ovarian cysts, uterine leiomyoma)
-
Hysterosonogram if intrauterine pathology is suspected
-
Hysteroscopy should follow abnormal hysterosonogram
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Abdominal and/or pelvic CT scan will evaluate gynecologic and abdominal pathology
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Laparoscopy may be both diagnostic and therapeutic
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Culdocentesis may be indicated if ruptured ectopic pregnancy is suspected; however, rarely used today, because of the advent of ultrasound
Treatment
- Primary dysmenorrhea is initially treated with NSAIDs
–High-dose ibuprofen may be administered beginning the day before the onset of menses
–Oral contraceptives with or without NSAIDs may be effective when NSAIDs alone are inadequate
–Low-fat vegetarian diet, a fish oil supplement, and vitamin E may reduce pain severity
- Patients unresponsive to NSAIDs and oral contraceptives should be evaluated for pelvic pathology (secondary dysmenorrhea)
–Endometriosis: GnRH analogs, danazol; laparoscopy in severe cases; treat infertility if necessary
–Adenomyosis: Hysterectomy is treatment of choice
–Leiomyoma: Removal, embolization, hysterectomy
–Pelvic inflammatory disease: Antibiotics, oral
contraceptives (to prevent ectopic pregnancy), treat infertility if necessary
–Treat depression and/or anxiety as necessary
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
Other Book Chapters Related to Menorrhagia
Read excerpts from these other book chapters related to Menorrhagia:
Medical Books Excerpts
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "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 ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Menorrhagia
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: DYSMENORRHEA (Differential Diagnosis in Primary Care)
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