Dysmenorrhea

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Dysmenorrhea By Dr. Ali Abd El Monsif Thabet
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Definition Pain related to menstruation
that may occur just before or during
menses. Types There are different types
including 1- Primary (spasmodic) dysmenorrhea 2-
Secondary (congestive) dysmenorrhea 3- Membranous
dysmenorrhea 4- Ovarian dysmenorrhea Ovulatory
pain Premenstrual tension
syndrome
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1- SPASMODIC DYSMENORRHEA Definition It is
sever colicky pain in the lower abdomen that may
radiated suprapubically or to the inner aspect of
the thigh and may accompanied with backache and
other symptoms such as nausea, vomiting,
headache, diarrhea and fatigue.
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• Incidence

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Etiology A- Abnormal anatomy B- Nervous
disturbance
C- Hormonal imbalance D- Abnormal physiology
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• CLINICAL SYPTOMS
• SIGNS

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MANAGEMENT

• A- General and psychological
• B- Drug therapy
• C- Surgical treatment
• D- Physical therapy

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2- SECONDARY (CONGESTIVE) DYSMENORRHEA

• Definition
• It is continuous dull aching lower abdominal
  pain accompanied by backache occurring in
  multiparas women after many years of relatively
  painless menstruation due to pelvic congestion
  which is more marked in premenstrual period.

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• Incidence
• It is common in multiparas women between
  30-40 years, it starts few days (3-5 days) before
  menstruation, increased in severity as
  menstruation approaches and relieved by the onset
  of menstrual flow (diminution of pelvic
  congestion).

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• Etiology
• It caused by pelvic congestion that caused
  by -
• 1- simple congestion as constipation or
  coitus interrupts
• 2- chronic inflammation as cervicitis and
  salpingitis
• 3- displacement R.V.F. and prolapse
• 4- neoplasm as fibroid
• 5- endometriosis
• 6- I.U.C.D.

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• Treatment
• 1- treatment of the cause
• 2- avoid constipation
• 3- active life
• 4- mild analgesic
• 5- cold showers
• 6- glycerin icthyol pessaries

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• 3- MEMBRANOUS DYSMENORRHEA
• It is rare condition resembles spasmodic
  dysmenorrhea and in addition the endometrium is
  shed in form of big membranous casts due to an
  abnormality in its separation.

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• 4- OVARIAN DYSMENORRHEA
• It is premenstrual dull aching pain
  occurring in one or both iliac fossae in patient
  with pelvic congestion leading to ovarian
  congestion.

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• OVULATORY PAIN
• It is mid-cycle pain in one iliac fossa due
  to increased tension in mature follicle or
  rupture of the follicle at ovulation causing
  irritation of the peritoneum.

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• PREMENSTRUAL TENSION SYNDROME
• It is premenstrual irritability, depression
  and pain in breasts and sensation of fullness in
  the abdomen which occur few days before
  menstruation and relieved by menstruation. It is
  due to salt retention or increase estrogen and
  deficient progesterone.

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Thank you