Dysmenorrhea Overview and Symptoms

Dysmenorrhea

• Dysmenorrhea is difficult or painful menstruation
• It's a common gynecological complaint, especially in adolescent and young women
• It can be a cause of chronic pelvic pain in reproductive-aged women

Types of Dysmenorrhea

• Primary Dysmenorrhea: Occurs in the absence of underlying pelvic pathology
• Secondary Dysmenorrhea: Caused by an underlying pelvic pathology

Primary Dysmenorrhea: Clinical Symptoms

• History of pain: Starts 6-12 months after menarche
• Nature of pain: Spasmodic and cramping
• Severity of pain: Severe, intense
• Site of pain: Lower abdomen, may radiate suprapubically, inner thigh, or back
• Onset of pain: Occurs with onset of menstrual blood loss or the day before
• Associated symptoms: Headache, nausea, vomiting, diarrhea, fatigue

Primary Dysmenorrhea: Pathophysiology

• Excessive prostaglandins: PGF2α and PGE2 cause myometrial contraction, leading to vasoconstriction and ischemia (reduced blood flow) in the uterus, which triggers pain.
• Uterine contraction abnormalities: Uterine contractions are often elevated, non-rhythmical, and may have a higher number of contractions per 10 minutes, which causes poor uterine perfusion and oxygenation. This can trigger pain.
• Cervical stenosis: This can contribute to the pain.
• Psychological factors: A mother's attitude may influence a daughter's response to the pain.

Primary Dysmenorrhea: Investigation

• Careful history: Taking a detailed history regarding the pain
• Pelvic examination: Physical assessment of the pelvic region
• Laparoscopy: Reserved for cases not responding to treatment to rule out any underlying conditions like endometriosis.
• Ultrasound: Uses sound waves to visualize internal organs
• MRI: Uses magnets and radio frequencies to create detailed images

Primary Dysmenorrhea: Management

• General and psychological treatment: General relaxation techniques
• Drug therapy: Prostaglandin inhibitors (aspirin, naproxen, ibuprofen), contraceptive pills to suppress ovulation
• Surgical treatment: Mechanical dilation of the cervix, presacral neurectomy (surgical removal of pain fibers)

Primary Dysmenorrhea: Physical Therapy Management

• Exercises: Increases endorphin, enkephalin, and serotonin levels.
• Relaxation techniques: General relaxation, relaxation on face (specific positions for pelvic blood flow)
• Massage: For pain relief
• Hot packs: To help manage pain
• Transcutaneous electrical nerve stimulation (TENS): Helps with pain via gate control theory and endorphin release (80-120 Hz frequency, 150 μs pulse width, minimal intensity)
• V-shaped technique: Electrode placement
• Low-level laser therapy: Gallium Arsenide laser at 904 nm, maximum peak power of 5 milliwatts
• Interferential current (IF): Constant frequency of 100 Hz in first 3 sessions, pulse with rhythmical frequency of 10-100 in the other sessions, using 2 plate electrodes of 100 cm² and 200 cm² size on lower abdomen and lumbosacral areas, recommended 12-25 mA dose, and 15-20 minutes duration daily

Secondary Dysmenorrhea: Clinical Symptoms

• History of pain: Pain starts after many years of menstruation or is painless. • Nature of pain: Dull, aching pain • Severity of pain: Severe, intense • Site of pain: Lower abdomen • Radiation of pain: Radiates to the back • Onset of pain: Starts 3-5 days before menstruation • Duration of pain: Pain relief with onset menstruation • Associated symptoms: Dyspareunia (painful intercourse), infertility, abnormal bleeding

Secondary Dysmenorrhea: Pathophysiology

• Pelvic congestion: The cause of pain is marked pelvic congestion during pre-menstrual periods, which intensifies as menstruation approaches and relieves with the start of menstrual flow.

Secondary Dysmenorrhea: Etiology

• Organic pelvic pathology:
  • Endometriosis
  • Adenomyosis
  • Pelvic infections
  • Fibroids
  • Pelvic inflammatory disease (PID)
  • Pelvic adhesions
  • Ovarian cysts

Secondary Dysmenorrhea: Investigation

• Careful history
• Pelvic examination
• Laparoscopy

Secondary Dysmenorrhea: Management

• Depends on the cause: Treatment depends on the underlying cause
• Drug therapy: Antibiotics, NSAIDs
• Surgical treatment
• Physical therapy (pre and post-operative)

Explore the complexities of dysmenorrhea, including its types, clinical symptoms, and underlying pathophysiology. This quiz provides insights into primary and secondary dysmenorrhea, focusing on the nature and severity of pain experienced by individuals. Test your knowledge about this common gynecological issue.