Dysmenorrhea
Dysmenorrhea definition
Dysmenorrhea is a common female problem characterized by cyclic pain related to menstruation , there are different types and degrees of dysmenorrhea and its severity varies according to each female pain threshold.
Dysmenorrhea causes
There are two main different categories of dysmenorrhea , primary dysmenorrhea and secondary dysmenorrhea and each of them has it’s own causes and also own treatment .
Primary dysmenorrhea
That type of dysmenorrhea occurs mainly in virgin and nulliparas , its appear from 2-3 years after puberty , as it occur only in ovulatory cycles and most common female begin their ovulatory cycles from 2-3 years after onset of puberty .
Primary dysmenorrhea pain characterized by pain started on the first day of menstruation and then decrease gradually , the pain is cliky mainly in the lower abdomen , it may be radiating to the inner aspects of the thighs down to the knees , it also may be associated with nausea and vomiting .
Causes of primary dysmenorrhea:
It is mainly caused due to elevation of PGE2 and PGF2alpha , that excessive release of these prostaglandins lead to inrease uterine muscle contractility and lead to abdominal pain also prostaglandins are responsible for nausea and vomiting through increase gut muscle contractions .
There are other causes lead to primary dysmenorrhea like cervical stenosis , also uterine hypoplasia , and other uterine anomlies like bicornuate uterus and cochleate uterus .
psychological disturbance and lower pain threshold , may lead to increase pain sensation , as in these situations there are decrease in normal body endorphins and encephalins , which secreted in body to decrease pain sensation , so abdominal pain improve by psychological exercises.
Primary dysmenorrhea treatment
There are general measures must put in mind if you are one who experiene primary dysmenorrhea , these measures are reassure yourself , that pain is not due to disease , but it is normal occurring and it solve dramatically after intercourse and correct your hemoglobin if you are anemic and try to do relaxing exercises to decrease the stressful life like yoga and doing massage
Medication for primary dysmenorrhea
1. Antiprostaglandins
There are two types of anti-prostaglandins , type one that reduce synthesis of prostaglandins and it has moderate effect like Aspirin , the other type reduce synthesis plus it antagonize prostaglandin effects on different tissue like ibuprofen .
2. Antispasmodics
as hyscine ( buscopan )
3. other analgesics and also anti histaminic .
In some cases , oral contraceptive pills are used to decrease primary dysmenorrhea , as it inhibit ovulation ! .
Secondary dysmenorrhea or congestive dysmenorrhea
It is defined as pain occurs mainly in women after relatively painless cycle (that refer to it’s name secondary dysmenorrhea) , It’s pain characterized by being occurring before menses from 3-5 days , the pain increase gradually in severity reach it’s peak in first day and decrease with the blood flow ( refer to being congestive , due t blood congestion ) . Its pain is dull aching, mainly in lower abdomen with backache.
secondary dysmenorrhea causes :
Its mainly due to plevic congestion , such in simple cases of congestion , such as constipation , also in cases of chronic plevic congestion in cases of cervicitis and salpingitis , it may seen also in cases of prolapse and uterine retro version and in fibroid neoplasm.
Its treatment mainly treatment of its cause.
Other types of dysmenorrhea :
1. Dysmenorrhea of endometriosis
That type of dysmenorrhea it’s pain characterized by starting from 3-5 days before menses , and with the onset of menstruation that pain increase in severity , and then the pain decrease due to absorption of the blood , that patient also complain of other types of pain like dysparunia , back pain and pain during defecation and finally that patient also complain of infertility due to multiple causes.
2. Ovarian dysmenorrhea
That is a rare cause of dysmenorrhea , and its occur mainly due to ovarian congestion as apart of pelvic congestion and that occur mainly in patient with thick tunica albuginea.
3. Membranous dysmenorhea
Some schools considered it as a variety of primary dysmenorrhea , as its pain is similar , and it is mainly due to separation of abig membranous endometerial cast !
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