Dysmenorrhoea

Dysmenorrhoea is painful menstruation and may be

• primary in the absence of detectable pelvic pathology
  
• secondary to organic pelvic disease.

Primary Dysmenorrhoea

Dysmenorrhea is thought to be caused by the release of prostaglandins in the menstrual fluid, which causes uterine contractions and pain. Vasopressin also may play a role by increasing uterine contractility and causing ischemic pain as a result of vasoconstriction.

Risk Factors:
* Age < 20 years
* Attempts to lose weight
* Depression/anxiety
* Disruption of social networks
* Heavy menses
* Nulliparity
* Smoking

Clinical Features:
* Age - 6 - 12 months after the onset of menarche
* Onset - 24 hrs before menstruation and rarely persists for more than 48 - 72 hours.
* Pain - in the lower abdomen which may radiate to the inner surface of the thigh and lower back.
* Nausea and vomiting may be prominent, due to a prostaglandin effect or as a result of severe pain.

Treatment:

Nonsteroidal anti-inf lammatory drugs (NSAIDs): are the best-established initial therapy for dysmenorrhea. They have a direct analgesic effect through inhibition of prostaglandin synthesis, and they decrease the volume of menstrual f low.

Hormonal therapies:
# Oral Contraceptive Pills - it acts by reducing prostaglandin release during menstruation.
# Other - Depo-medroxyprogesterone acetate injection and levonorgestrel intrauterine device (Mirena).

Complementary and Alternative Medicines:
# Thiamine at a dosage of 100 mg daily was found to be effective in treating dysmenorrhea in a double-blind RCT of more than 500 East Indian women aged 12 to 21 years with moderate to severe symptoms.
# The Japanese herbal remedy toki-shakuyakusan (TSS) has been shown in an RCT to be better than placebo in the treatment of women with dysmenorrhea.

Life Style Modification:
# Low-fat vegetarian diet decreases duration and intensity of dysmenorrhea.
# Some studies have reported a benefit with exercise.

Secondary Dysmenorrhoea

It is uncommon before the age of 25 years.

The precise clinical picture is determined by the underlying cause.

A history that is inconsistent and/or physical findings of a pelvic mass, abnormal vaginal discharge, or pelvic tenderness that is not limited to the time of the menstrual period suggest a diagnosis of secondary dysmenorrhea.