Dysmenorrhea
Dysmenorrhea — painful menstruation — is the most common gynecologic complaint and a leading cause of absenteeism from school (affecting 10% of high school girls each month) and work (causing about 140 million lost work hours annually). Dysmenorrhea can occur as a primary disorder or secondary to an underlying disease. Because primary dysmenorrhea is self-limiting, the prognosis is generally good. The prognosis for secondary dysmenorrhea depends on the underlying disorder.
Causes and incidence
Although primary dysmenorrhea has no known single cause, possible contributing factors include hormonal imbalances and psychogenic factors. The pain of dysmenorrhea probably results from increased prostaglandin secretion, which intensifies normal uterine contractions. (See Causes of pelvic pain, page 938.) Dysmenorrhea may also be secondary to such gynecologic disorders as endometriosis, cervical stenosis, uterine leiomyomas, uterine malposition, pelvic inflammatory disease, pelvic tumors, or adenomyosis.
Because dysmenorrhea almost always follows an ovulatory cycle, both the primary and secondary forms are rare during the anovulatory cycles of menses. After age 20, dysmenorrhea is generally secondary.
Signs and symptoms
Dysmenorrhea produces sharp, intermittent, cramping, lower abdominal pain, which usually radiates to the back, thighs, groin, and vulva. Such pain — sometimes compared to labor pains — typically starts with or immediately before menstrual flow and peaks within 24 hours. Dysmenorrhea may also be associated with the characteristic signs and symptoms of premenstrual syndrome (urinary frequency, nausea, vomiting, diarrhea, headache, chills, abdominal bloating, painful breasts, depression, and irritability).
Diagnosis
Pelvic examination and a detailed patient history may help suggest the cause of dysmenorrhea.
Primary dysmenorrhea is diagnosed when secondary causes are ruled out. Appropriate tests (such as laparoscopy, dilatation and curettage, and pelvic ultrasound) are used to diagnose underlying disorders in secondary dysmenorrhea.
Treatment
Initial treatment aims to relieve pain. Pain-relief measures may include:
❑ analgesics (such as aspirin) for mild to moderate pain (most effective when taken 24 to 48 hours before onset of menses; are especially effective for treating dysmenorrhea because they also inhibit prostaglandin synthesis; stronger anti-inflammatories may be used.
❑ opioids if pain is severe (infrequently used)
❑ prostaglandin inhibitors (such as mefenamic acid and ibuprofen) to relieve pain by decreasing the severity of uterine contractions
❑ cox-2 inhibitors (such as celecoxib, rofecoxib, and valdecoxib) to promote comfort
❑ heat applied locally to the lower abdomen (may relieve discomfort in mature women but isn’t recommended in young adolescents because appendicitis may mimic dysmenorrhea).
For primary dysmenorrhea, administration of sex steroids is an effective alternative to treatment with antiprostaglandins or analgesics. Such therapy usually consists of hormonal contraceptives to relieve pain by suppressing ovulation. However, patients who are attempting pregnancy should rely on antiprostaglandin therapy instead of hormonal contraceptives to relieve symptoms of primary dysmenorrhea.
Because persistently severe dysmenorrhea may have a psychogenic cause, psychological evaluation and appropriate counseling may be helpful.
In secondary dysmenorrhea, treatment is designed to identify and correct the underlying cause. This may include surgical treatment of underlying disorders, such as endometriosis or uterine leiomyomas. However, surgical treatment is recommended only after conservative therapy fails.
Special considerations
Effective management of the patient with dysmenorrhea focuses on relief of symptoms, emotional support, and appropriate patient teaching, especially for the adolescent.
❑ Obtain a complete history, focusing on the patient’s gynecologic complaints, including detailed information on any signs and symptoms of pelvic disease, such as excessive bleeding, changes in bleeding pattern, vaginal discharge, and dyspareunia.
❑ Provide thorough patient teaching. Explain normal female anatomy and physiology to the patient, as well as the nature of dysmenorrhea. This may be a good opportunity, depending on circumstances, to provide the adolescent patient with information on pregnancy and contraception.
❑ Encourage the patient to keep a detailed record of her menstrual symptoms and to seek medical care if her symptoms persist.
❑ Instruct the patient on some home care remedies that may be helpful in relieving discomfort, such as applying a heating pad to the lower abdomen, taking warm showers or baths, drinking warm beverages, and performing circular massage with the fingertips around the lower abdomen.
❑ Encourage the patient to walk or exercise regularly. Recommend pelvic rocking exercises and relaxation techniques, such as meditation or yoga. Let her know that keeping her legs elevated while lying down or lying on her side with her knees bent may also increase comfort.
❑ Instruct the patient to eat light but frequent meals and to follow a diet rich in foods high in complex carbohydrates, such as whole grains, fruits, and vegetables. Tell her to avoid alcohol and foods high in salt, sugar, and caffeine.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 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: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Menorrhagia
» Next page: Dysmenorrhea (Professional Guide to Signs & Symptoms (Fifth Edition))
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