DYSMENORRHEA

Srimalathi.R
II Year M.Sc Nursing
 DEFINITION

• Dysmenorrhea literally means painful

menstruation.
• Types

– Primary
– Secondary
 PRIMARY DYSMENORRHEA

• Spasmodic

• The primary dysmenorrhea is one where there

is no identifiable pelvic pathology.
• Incidence: 15- 20 %
 CAUSES
• Increased prostaglandin production by the
endometrium in ovulatory cycles which cause
contraction of uterus.
 SYMPTOMS
• Pain in the lower abdomen. (common)
• Pain may radiate to the lower back to the
thighs. (common)
• Pain may be sharp pelvic cramps or deep and
dull ache. (common)
 SYMPTOMS
• Primary dysmenorrhea starts from 12 to 24
hours before the onset of menses.
• Abdominal pain often accompanied by:
– Nausea
– Diarrhea
– Fatigue
– Lightheadedness or headache or dizziness.
 MANAGEMENT
 pain relief :
NSAIDs, e.g. Naproxen, Ibuprofen.
 low doses of oral contraceptive pills.
 heat application : Heat is applied to the lower abdomen or
back may reduce Dysmenorrhea.
 life style changes like daily exercises.
 weight loss
 smoking cessation
 relaxation techniques :
sleep and rest for adequate time, avoid unnecessary work load.
 SECONDARY DYSMENORRHEA

• Secondary dysmenorrhea is painful

menstruation due to pelvic or uterine
pathology.
 CAUSES
• Endometriosis
• Adenomyosis
• Pelvic infection
• Uterine fibroids
• Intrauterine device
• Congenital uterine or vaginal anomaly.
 SYMPTOMS
• Secondary Dysmenorrhea usually occurs after
the woman has experienced problem free
periods for sometime.  Pain may be
unilateral, constant and continues, longer than
primary Dysmenorrhea.
•  May be :
– painful Intercourse, painful defecation or irregular
bleeding may occur at times other than menses.
 INVESTIGSTIONS
• CBC R/o evidence of infection.
• Urine analysis to R/o bladder infection.
• Cervical culture to exclude STI.
• ESR (Electrolyte sedimentation rate) to detect an
inflammatory process.
• Non invasive diagnostic procedure.
– Abdominal and transvaginal ultrasound.
• Invasive diagnostic procedure:
– Laparoscopic examination, Hysteroscopy and D & C
( dilation & curettage )
 MANAGEMENT
•  Management of secondary Dysmenorrhea is
directed at diagnosis and treatment of
underlying cause ( e.g. endometriosis or pelvic
inflammatory disease i.e. PID.