Dysmenorrhea Presentation PDF

DYSMENORR HEA  DYSMENORRHEA Definition Types Pathophysiology Clinical picture Investigation Management  Definition It is difficult or painful menstruation. It is the most common gynecological complaint among adolescent fem...

DYSMENORR HEA  DYSMENORRHEA Definition Types Pathophysiology Clinical picture Investigation Management  Definition It is difficult or painful menstruation. It is the most common gynecological complaint among adolescent females and young women. It is one of the common causes of chronic pelvic pain in women of reproductive age.  Types Primary Secondary (Spasmodic) (Congestive) (Idiopathic) In the absence of Caused by pelvic pelvic pathology pathology Primary Dysmenorrhea Clinical Symptoms Pain History of pain: Starts 6 to 12 months after menarche Nature of pain: spasmodic and cramping pain Severity of pain: Severe, intense Site of pain: in the lower abdomen Radiation of pain: may radiate suprapubically or to the inner aspect of the thigh or to the back. Onset of pain: Occurs with onset of menstrual blood loss or on the day preceding it. Primary Dysmenorrhea Associated Symptoms -Headache. - Nausea. -Vomiting. - Diarrhea. - Fatigue. Primary Dysmenorrhea Pathophysiology: 1. Excessive levels of prostaglandins Primary Dysmenorrhea Pathophysiology: 2. Uterine contraction abnormalities Dysmenorrhea Normal Elevated (> 10 mmHg). Minimal (< 10 mmHg). Basal uterine tone Number of > 4-5 contractions. 3-4 contractions. contractions per 10 minutes Often > 150-180 Active pressure at the Up to 120 mmHg. peak of a contraction mmHg. Rhythmical & Rhythm of Non-rhythmical. contractions synchronous. Primary Dysmenorrhea Primary Dysmenorrhea Pathophysiolog y 3. Cervical Stenosis 4. Psychological factor The attitude of the mother may influence the response of the daughter Primary Dysmenorrhea investigation Careful history Pelvic examination Reveals no abnormality Laparoscopy Performed for cases reported resistant to therapy.  Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs. Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body. Laparoscopy. This minor procedure uses a laparoscope. This is a thin tube with a lens and a light. It is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the doctor can often detect abnormal growths. Primary Dysmenorrhea Management General and psychological treatment Drug therapy Drugs inhibit prostaglandins action as aspirin, naproxen or ibuprofen. Contraceptive pills to suppress ovulation Surgical treatment Mechanical dilatation of the cervix Presacral neurectomy Surgical removal of the pain fibers to the uterus Primary Dysmenorrhea Physical Therapy Management 1. Regular Aerobic Exercises: It increases levels of endorphin, enkephalin & serotonin Primary Dysmenorrhea 2. Relaxation Techniques A) General relaxation B) Relaxation on face It is a relaxed position, It helps discharge of menstrual blood flow. Primary Dysmenorrhea 3. Massage 4. Hot Packs Primary Dysmenorrhea 5. TENS -Frequency :80-120 Hz. - Pulse width : 150 µs. - Duration : 1 hour several times daily. - Intensity : Minimal intensity. - Techniques: Electrode placement. - Mechanism: 1- Gate control theory. 2- Release endorphins Primary Dysmenorrhea V shaped technique ve- ve- ve- v+ e Primary Dysmenorrhea If pain is radiated to the back Primary Dysmenorrhea Physical Therapy Management 6. Low Level Laser Therapy.Type: Gallium Arsenide laser Wave Length : 904 nm. Intensity : maximum peak power 5 milliwatts. :Mechanism.Increase serotonin metabolism -1 Increase Beta endorphin secretion which -2 associated with inhibiting synthesis of.prostaglandin Decrease nerve conduction velocity and -3.increase its distal latency.Stimulate the gate control theory -4 Primary Dysmenorrhea Low Level Laser Therapy Technique : Primary Dysmenorrhea 7. Interferential Current (IF): Electrodes: 2 plate electrode (200cm2) over the lumbosacral region & other 2 electrodes (100 cm2) over the lower abdomen. Frequency: constant frequency of100 Hz in 1st 3 sessions and rhythmical frequency of 10-100 Hz in the other sessions. Dose: 12-25 mA Duration: 15-20 minutes daily or every other day for 15 sessions. Mechanism of action: Has analgesic and Primary Dysmenorrhea 7. Interferential Current (IF) electrodes 100 cm2 plate 200 cm2 plate Secondary Dysmenorrhea Clinical Symptoms pain History of pain: Starts after many years of painless menstruation Nature of pain: Dull aching pain Severity of pain: Severe, intense Site of pain: In the lower abdomen Radiation of pain: Radiate to the back. Onset of pain: Starts 3 to 5 days before menstruation. Secondary Dysmenorrhea Associated Symptoms -Dyspareunia. - Infertility -Abnormal bleeding. Secondary Dysmenorrhea Pathophysiolog y Pelvic Congestion The mechanism of pain in secondary dysmenorrhoea is due to pelvic congestion which is more marked in the premenstrual period. Pain increases in its severity as menstruation approaches and is relieved by the onset of menstrual flow, due to the diminution of pelvic congestion. Secondary Dysmenorrhea Etiology Secondary dysmenorrhoea is caused by organic pelvic pathology as: Endometriosis Adenomyosis Pelvic infections Fibroids Pelvic inflammatory disease. Pelvic Adhesions. Ovarian cysts. Endometriosis With endometriosis, bits of the uterine lining (endometrium) — or similar endometrial-like tissue — grow outside of the uterus on other pelvic organs. Outside the uterus, the tissue thickens and bleeds, just as typical endometrial tissue does during menstrual cycles. It often affects the ovaries, fallopian Endometriosis tissue acts as the lining inside the uterus would — it thickens, breaks down and bleeds with each menstrual cycle. But it grows in places where it doesn't belong, and it doesn't leave the body. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated and form scar tissue. Bands of fibrous tissue called adhesions also may form. These can cause pelvic tissues and organs to stick to each other. Endometriosis can cause pain, especially during menstrual periods. Fertility problems also may Ovarian cysts Ovarian cysts are sacs, usually filled with fluid, in an ovary or on its surface. Ovarian cysts are common. Most of the time, you have little or no discomfort, and the cysts are harmless. Most cysts go away without treatment within a few months. But sometimes ovarian cysts can become twisted or burst open (rupture). This can cause serious symptoms. Most ovarian cysts cause no symptoms and go away on their own. But a large ovarian cyst can cause: Pelvic pain that may come and go. a dull ache or a sharp pain in the area below your bellybutton toward one side. Adenomyosis occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle. An enlarged uterus and painful, heavy periods can result. The disease usually resolves after menopause. For women who have severe discomfort from adenomyosis, hormonal treatments can help. Removal of the uterus (hysterectomy) cures adenomyosis Secondary Dysmenorrhea investigation Careful history Pelvic examination Laparoscopy Secondary Dysmenorrhea Management Depends on the cause Drug therapy.Antibiotics NSAIDs. Surgical treatment Physica therapy (pre and post operative) With my best