Dysmenorrhea

What is primary dysmenorrhea ?

Primary Dysmenorrhea or Functional Dysmenorrhea is a gynecological disorder characterized by cyclic pain associated with ovulatory cycles without demonstrable lesions affecting the vaginal reproductive structures. Pain arises from uterine contractions and ischemia, probably mediated by prostaglandins produced in secretory endometrium especially in females suffering from a narrow cervical os, malposition of the uterus, anxiety, or due to a lack of exercise, contributing factors may include the passage of tissue through the cervix.

Primary Dysmenorrhea usually occurs during adolescence and tends to decrease in intensity as we get older, or after pregnancy.

How common is dysmenorrhea?

Dysmenorrhea is one of the most commonly reported gynecological conditions worldwide. Almost half the normally menstruating women have some pain for 1–2 days each month.

There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

Symptoms

What are the symptoms of primary dysmenorrhea?

Most females suffer from primary dysmenorrhea at a period of their lives. Symptoms of primary dysmenorrhea include:

1. Acute abdominal pain (lower abdominal or pelvic pain), which is described as deep cramping pain irradiating to the back, and lasting a few days during the typical menstrual cycle
2. Nausea and vomiting
3. Bad appetite
4. Depression and emotional liability
5. Secondary dysmenorrhea related to other health problems, such as endometriosis or cervical stenosis, etc.

Menstrual cramps may begin 1–2 days before your period and can last 2–4 days.

Causes

What are the causes of primary dysmenorrhea (menstrual cramps)?

Hormonal fluctuations in estrogen and progesterone levels are the main causes behind primary dysmenorrhea.

Menstrual cramps are caused by an increase in the amount of prostaglandins (PGs) secreted in the endometrium (the lining of the uterus) during menstruation.

Prostaglandins (PGs) are derived from arachidonic acids.

Decreased progesterone concentration in the late secretory phase stimulates the synthesis of arachidonic acids and increases the synthesis and secretion of prostaglandins (PGs) in the endometrium via activation of the cyclooxygenase pathway. As a result, prostaglandin levels in the endometrium increase more than three times higher than those of the proliferative phase. Moreover, a further increase in prostaglandin levels is observed during the menstrual cycle (menstruation). The concentration of vaginal prostaglandins E2 and F2a is higher in the menstrual blood of women with dysmenorrhea than in healthy women.

Prostaglandin F2 alpha (PGF2 alpha) is considered the main cause of menstrual cramps.

Progestin-only oral contraceptives (mini-pills) decrease prostaglandin synthesis and lessen the amount of bleeding by stopping ovulation and preventing further proliferation of the endometrium. Mini-pills stimulate the secretion of nutritive substances in the lining of the uterus (secretory phase).

Treatment

How to treat primary dysmenorrhea?

Primary dysmenorrhea is usually treated with painkillers, such as Ketanov®, Citramon®, Analgin, Panadol, Ibuprofen, etc.

Tranquilizers are used to control and treat Irritability

Hormonal fluctuations are best controlled with Progesterone via vaginal suppository 200-400mg/day

NSAIDs, such as panadol, or ibuprofen (Advil, Motrin) are used for the acute treatment of headache

Physical PMS and psychological symptoms are treated and cured with Fluoxetine 20mg/day orally or sertraline 50mg/day orally

Hydrochlorothiazide is a thiazide diuretic (water pill) used to treat hypertension, edema and fluid retention, as it prevents your body from absorbing too much salt. Recommended dose: 25-50mg orally daily.

Cut the salt in your diet and reduce your sodium intake. Women with primary dysmenorrhea should eat no more than 5g of salt a day.

Next steps management

1. Supportive therapy
2. Low salt diet, diet number 7 (table salt limited to less than 5gr/day)
3. Vitamin B complex supplements.

 

 

 

References

Verified by: Dr.Diab (November 23, 2017)

Citation: Dr.Diab. (November 23, 2017). Primary Dysmenorrhea. Medcoi Journal of Medicine, 11(2). urn:medcoi:article15705.