-IBIS-1.5.0-
tx
reproductive system
dysmenorrhea
diagnoses

definition and etiology

definition:
Painful menstruation.

etiology:
Dysmenorrhea can be primary (functional) or secondary
(acquired).
• Primary dysmenorrhea occurs in ovulatory cycles without any identified pathology in the genital tract. often, however, the woman's liver may be hypofunctioning; she is constipated (estrogens can be reabsorbed from the bowel if the stools do not evacuate frequently); and she is hormonally imbalanced with too high an estrogen level in relation to her progesterone levels.
• Secondary dysmenorrhea is recognized by painful periods due to an identifiable cause (e.g. endometriosis, uterine fibroids, PID, adhesions). The majority of dysmenorrhea patients also have premenstrual syndrome, and the two syndromes often merge in terms of signs and symptoms.

signs and symptoms

signs and symptoms:
• Low abdominal pain: cramping, pulling, constrictive; may radiate to back, down legs. Starts prior to the period or with the onset of bleeding and usually subsides within 2-3 days of beginning to bleed.
• Clots are present in the menstrual blood. May be large.
• Concurrent symptoms include irritability; weepiness; headache; sugar cravings; bloating; breast tenderness; loose stools.

lab findings:
• Labwork should be done if a secondary cause is suspected; however, a Pap smear should be done as a good screening test.
• Ultrasound

course and prognosis

Dysmenorrhea can be intense enough for the woman to have to be bedridden for 1-2 days. It can be present from menarche or may develop as the woman ages; it can become progressively worse or get significantly better following births.

Conventional treatment consists of ASA; codeine; suppression of ovulation with BCP; surgery (hysterectomy, presacral neurectomy). In secondary dysmenorrhea, the cause should be diagnosed and treated.

differential diagnosis

• determine the cause


footnotes