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OBGYN Residency Knowledge Bank (Jurnal 4)
OBGYN Residency Knowledge Bank (Jurnal 4)
OBGYNResidencyKnowledgeBank
GeneralConsiderations|Primary&PreventiveAmbulatoryHealthCare|Obstetrics|Gynecology|REI|Oncology
TestYear:<20012004>
ReproductiveEndocrinology>MenstrualandEndocrineDisorders>Dysmenorrhea
Clickonthetopictodisplaysummary
BasicScience/Mechanismsof
Disease
Genetics
Pharmacology
PathologyandNeoplasia
PediatricandAdolescent
Gynecology
DevelopmentalAnomalies
oftheUrogenitalTract
PediatricGynecology(birth
tomenarche)
AdolescentGynecology
PrecociousPuberty
DelayedPuberty
MenstrualandEndocrine
Disorders
Dysmenorrhea
DysfunctionalUterine
Bleeding
Amenorrhea
Hirsutism
PolycysticOvarian
Syndrome
Infertility
Evaluation
ReproductiveTechnologies
ManagementoftheClimacteric
Period
Evaluation
Management
Classificationofdysmenorrhea
Causesofprimarydysmenorrhea
Roleofprostaglandinsynthaseinhibitors
Classificationofdysmenorrhea
Contributor:BethMalizia,M.D.
Reviewer:SejalDharia,M.D.
Dysmenorrheaorpainfulmenstruationisoneofthemostcommongynecologic
symptoms.Approximately75%ofwomenexperiencedysmenorrhealand
approximately5%ofwomenofreproductiveageareincapacitatedfor13days
eachmonthbecauseofdysmenorrhea.
Forclinicalpurposesdysmenorrheaisoftenclassifiedintotwobroadcategories:
primaryandsecondary.Primarydysmenorrheaisthepresenceofpainful
menstruationintheabsenceofdemonstratablediseasewhilesecondary
dysmenorrheaisduetoanorganicetiology.Itisoftendifficulttodifferentiate
betweenprimaryandsecondarydiseasebasedonphysicalexamandhistory
alone.Trialsofempiricdrugtherapyanddiagnosticlaparoscopyareoftenneeded
todiscoverthecause.Inprimarydysmenorrheathepaincharacteristicallybegins
withtheonsetofmenstruationandlastsfor12to72hours.Primarydysmenorrhea
isusuallyintheabsenceofovulatorycycles.Itusuallybeginswithin6monthsto1
yearfromtheonsetofmenarche.Thepainisconfinedtothelowerabdomenandis
mostintenseinthemidline.Itisoftendescribedascrampyandisintermittent.
Somewomenmayhaveassociatedbackandthighpain.Theabdominalpainmay
beassociatedwithnausea,diarrhea,fatigue,headacheandageneralsenseof
malaise.Thepainisusuallymostsevereonthefirstdayofmenstruationand
graduallydiminishes.
Prostaglandinsplayanimportantroleindysmenorrhea.PGF2alphaandPGE2are
releasedfromtheendometriumandcausedysmenorrheabyinducingsmooth
musclecontraction.Prostaglandininduceduterinecontractions.Commoncauses
includeendometriosis,uterineleiomyomatasandintrauterinecontraceptive
devices.Mostwomenhavedysmenorrheathatismildandsubsideswithinseveral
daysoftheonsetofmenses.However,somewomenexperiencesymptomsthat
aresevereenoughtointerferewithdailyactivityandrequiremedicalevaluation
andtherapy.
Causesofsecondarydysmenorrhea:
Peritoneum:EndometriosisAllenMastersSyndromePelviccongestion
syndrome
Ovary:Ovariancystsortumors
Tubes:PID(acuteandchronic)
Uterus:AdenomyosisUterinemyomasUterinepolypsIntrauterineadhesions
(Asherman'ssyndrome)Congenitalmalformations(bicornuateandseptate
uterus)IUD
Cervix:Stenosisorocclusion
Vagina:ImperforatehymenTransversevaginalseptum
Estimatesofprevalencevarywidely.Dysmenorrheaseemstooccurin75%of
women.Pathologyofdysmenorrheacentersaroundprostaglandinproductionand
releasebytheendometrium.Treatmentincludeshormonaltherapy,surgical
treatment,prostaglandininhibitors,calciumblockersandneuralstimulation.
Laparoscopyisessentialforwomenwithprogressivemenstrualsymptomsthatare
uncontrolledwithOCPsandprostaglandininhibitors.
1. BarbieriRL,RyanKJ.Themenstralcycle.In:RyanKJ,BerkowitzRS,
BarbieriRL,DunaifA,eds.Kistner'sgynecologyandwomen'shealth.7thed.
St.Louis,Missouri:Mosby,1999:53
2. MaxsonWS,RosenwaksZ.Dysmenorrhea,premenstrualsyndrome,and
othermenstrualdisorders.In:CopelandLJ,ed.Textbookofgynecology.
2nded.Philadelphia,Pennsylvania:WBSaunders,2000:515
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OBGYNResidencyKnowledgeBank
SystemDesign:FrancisNuthalapaty,M.D.|Programming:ElizebethNuthalapaty
2005FrancisS.Nuthalapaty.Allrightsreserved.
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