J.

RASHMA
DYSMENORRHOEA 2015 BATCH
DEFINITION
Cramping pain accompanying menstruation

Pain menstruation that prevents a woman from performing normal

activities
 Types of Dysmenorrhoea

Primary Secondary

No identifiable pelvic Presence of organic pelvic

pathology pathology
CAUSES OF SECONDARY DYSMENORRHOEA
1. Endometriosis (MC)
2. Pelvic inflammatory disease (2nd MC)
CAUSES OF SECONDARY DYSMENORRHOEA

3. Adenomyosis
4. IUCD in utero
5. Uterine Fibroid
6. Endometrial polyps
7. Cervical stenosis
8. Congenital malformations – Bicornuate uterus
Adenomyosis Uterine Fibroid
Bicornuate uterus
 CLINICAL VARIETIES 3

CLINICAL VARIETY ONSET & DURATION FEATURES

Spasmodic 1st and 2nd day of Primary

dysmenorrhoea (MC) menstruation dysmenorrhoea
Congestive Few days before start Secondary
dysmenorrhoea of menstruation dysmenorrhoea
Membranous During passage of cast
dysmenorrhoea (Rare)
PATHOGENESIS
 CLINICAL FEATURES
Pain:
cramping type
Usually seen in the lower abdomen
Radiate to the back or inner thighs.
Associated Symptoms
Nausea and vomiting
Diarrhoea
Prostaglandin F2 Alpha
Fatigue
headache
PRIMARY VS SECONDARY DYSMENORRHOEA
INVESTIGATIONS
Pelvic sonography
CT
MRI
Diagnostic
hysterosalphingogram /
sonosalphingography
Endoscopy – Diagnostic
hysteroscopy / laparoscopy
TREATMENT
MEDICAL MEASURES
Analgesics
paracetamol 500 mg t.i.d.
piroxicam 20 mg b.i.d.

Antispasmodics
hyoscine (Buscopan) compounds t.i.d.
Camylofin (Anafortan) t.i.d.
Drotaverine (Drotin) t.i.d.
Diclofenac t.i.d
MEDICAL MEASURES
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Mefenamic acid 250–500 mg q.i.d.
 Indomethacin 25 mg three to six times daily
 Naproxen 275 mg/t.i.d.
 ketoprofen 50 mg/t.i.d.
Ibuprofen 400 mg 6–8 hourly
Progestogen containing IUCD
Mirena
Progestasert
Oral contraceptive drugs
Vitamin E 200 mg b.i.d. starting 2 days before and 3 days
during menstruation
 Diagnostic hysteroscopy followed by
SURGERY Dilation and curettage (D&C)

 Excision of polyp

 Transcutaneous electrical nerve stimulation (TENS)

PRESACRAL NEURECTOMY
PRESACRAL NEURECTOMY
LUNA (laser-assisted Uterosacral nerve ablation)
LUNA (laser-assisted Uterosacral nerve ablation)
Diagnostic laparoscopy
followed by

lysis of pelvic adhesions

Myomectomy
draining of chocolate cyst
cautery or laser
vaporization of islands of
endometriosis
SURGERY
Laparotomy followed by
Excision of chocolate cysts
Eradication of endometriosis
Myomectomy
Excision of localized adenomyoma
Presacral neurectomy (Cotte’s operation).
Hysterectomy- in elderly woman