Dysmenorrhea, Obstetrics and Gynaecology

Dysmenorrhea
Dysmenorrhea is a clinical condition, which is characterized by painful menstruation discharge in any woman with magnitude of pain is such that it incapacitated (unable) woman in performing her daily routine activities.

Pain during M.C discharge is commonly present in every woman but this pain is always mild in nature, but this pain becomes severe then it is considered as dysmenorrhea.

Dysmenorrhea is more common in young girls then older woman.


Etiology
The common etiological factor of dysmenorrhea does classical dysmenorrhea into following two types
1. Primary dysmenorrhea
2. Secondary dysmenorrhea

1. Primary dysmenorrhea
It is a type of dysmenorrhea which is caused by chemical or hormonal imbalance in the woman.
So it means if the hormones such as progesterone oxytocin are imbalanced, then severe pain may occur during M.C discharge which is known as Primary dysmenorrhea.


2. Secondary dysmenorrhea
The secondary dysmenorrhea is caused by any particular anatomical or physiological defect in the reproductive organs of woman such as
• Endometriosis , thickening of wall of uterus
• Imperforate hymen or small opening
• Pelvic Inflammatory disease (PID)
• Uterine fibroids



Clinical features
The only clinical feature of dysmenorrhea is pain. This pain is always very severe with muscle spasm. This muscle cramp is present in the uterine muscle & the pain mostly present in the lower abdomen & lower back area. The pain of dysmenorrhea is so severe that woman can not performed her daily routine activities such as bathing, eating, cooking etc.


Diagnosis
Diagnosis of dysmenorrhea in any woman is performed by following approache.

1. Statement of woman
Confirmation of dysmenorrhea is made according to the statement of woman. If she complaints severe pain in her lower back and abdomen, then it is considered as dysmenorrhea.

2. Hormonal assessment
To identify primary dysmenorrhea in the woman blood hormone level is assessed such as level of estrogen, progesterone, oxytocin.

3. USG
Ultrasonography can also be performed to identify the causes of secondary dysmenorrhea such as uterine fibroids, PID, etc.


Management
Management of dysmenorrhea in any woman is as follows
In case of imperforate hymen or uterine fibroids a surgical management is required.
• NSAIDs analgesics drugs are given to relieve pain such as ibuprofen, diclofenac, indomethacin, paracetamol.
• Woman is advised to have complete bed rest during dysmenorrhea.
• Woman is advised to avoid tea, coffee, smoking, alcohol etc.
• Woman is advised to have good nutrition.
• Hot water bags are applied at lower back & abdomen to relieve pain.
• Psychological support is also provided to woman to relieve mental stress. 

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