Dysmenorrhea Disease

BASICS

DESCRIPTION

Pelvic pain occurring at or around the time of menses. Is a leading cause of absenteeism for women under age 30

Primary dysmenorrhea - without pathological physical findings
Secondary dysmenorrhea - pain occurring prior to or during menses, often more severe than primary, having a secondary pathologic (structural) cause
System(s) affected: Reproductive
Genetics: Not well studied
Incidence/Prevalence in USA:
- 40% of adult females have menstrual pain
- 10% are incapacitated for 1-3 days each month
Predominant age:
- Primary - teens to early 20's
- Secondary - 20's to 30's
Predominant sex: Female only

SIGNS AND SYMPTOMS

Mild - pelvic discomfort or cramping or heaviness on first day of bleeding with no associated symptoms
Moderate - discomfort occurring on first 2-3 days of menses and accompanied by mild malaise, diarrhea and headache
Severe - intense, cramp-like pain lasting 2-7 days; often with gastrointestinal upset, back pain, thigh pain, and headache

CAUSES

Primary:
- Elevated production (2-7 times normal) of prostaglandins and other mediators in the uterus which produce uterine ischemia through:
  - Platelet aggregation
  - Vasoconstriction
  - Dysrhythmic contractions with pressures higher than the systemic blood pressure
Secondary:
- Congenital abnormalities of uterine or vaginal anatomy
- Cervical stenosis
- Pelvic infection
- Adenomyosis
- Endometriosis
- Pelvic tumors - especially leiomyomata

RISK FACTORS

Primary:
- Nulliparity
- Obesity
- Cigarette smoking
- Positive family history
Secondary:
- Pelvic infection
- Sexually transmitted diseases
- Endometriosis

DIAGNOSIS

LABORATORY

Noncontributory except in case of acute infection, in which case white blood cell count may be elevated and blood or cervical cultures positive

Drugs that may alter lab results: Antibiotics
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Primary:
- None
Secondary:
- Uterine enlargement
- Leiomyomata
- Ligamentous thickening
- Fixation of pelvic structures
- Endometritis
- Salpingitis

SPECIAL TESTS

Primary - consider ultrasound to rule out secondary abnormalities
Secondary - ultrasound or laparoscopy to define anatomy

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Primary:
- History is characteristic
- Physical examination should be normal
Secondary:
- History of onset at least 18-24 months after menarche
- Physical examination may reveal anatomic abnormalities or tenderness
- Laparoscopy (rarely needed)

TREATMENT

APPROPRIATE HEALTH CARE

Primary - outpatient
Secondary - usually outpatient

GENERAL MEASURES

General physical conditioning, exercise to raise endorphins
Transcutaneous electrical nerve stimulator (TENS)
Secondary dysmenorrhea - treatment of infections. Suppression of endometrium if endometriosis is suspected.

SURGICAL MEASURES

If due to severe endometriosis, presacral neurectomy; adenomyosis, hysterectomy

ACTIVITY

Normal

DIET

Dietary supplementation with vitamin B1 (thiamine) 100 mg po daily has been found effective when used for at least 90 days
Dietary supplementation with fish oil capsule daily found effective when used for 2 months

PATIENT EDUCATION

Reassure patient that primary dysmenorrhea is treatable with use of nonsteroidal anti-inflammatory agents prior to menses and/or oral contraceptives, and will usually abate with age and parity
Refer to web site: www.5mcc for resources for patient education material

FOLLOW UP

PREVENTION/AVOIDANCE

Primary - choose a diet low in animal fats, dairy products and eggs. Increase vegetables, raw seeds and nuts to increase production of beneficial prostaglandins.
Secondary - reduce risk of sexually-transmitted diseases

POSSIBLE COMPLICATIONS

Primary - anxiety and/or depression
Secondary - infertility from underlying pathology

EXPECTED COURSE AND PROGNOSIS

Primary - improves with age and parity
Secondary - likely to require therapy based on underlying cause

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

N/A

Pediatric: Onset with first menses raises probability of genital tract anatomic abnormality such as transverse vaginal septum, uterine anomalies
Geriatric: N/A
Others: N/A

PREGNANCY

Consider ectopic pregnancy in differential diagnosis of pelvic pain with vaginal bleeding

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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