Dysmenorrhoea
Definition
Dysmenorrhoea is pain associated with the menses. The pain may begin before or at the start of the menses, usually peaks after 24 hours, and decreases after 48 hours. It is most common during adolescence and tends to decrease over time and after pregnancy. Pain results from myometrial uterine contractions stimulated by increased prostaglandin production in secretory endometrium. Treatment involves suppressing prostaglandin secretion and/or ovulation and addressing underlying disorders. Primary dysmenorrhoea is cyclical pain associated with menses during ovulatory cycles without demonstrable lesions affecting the reproductive structures. Secondary dysmenorrhoea is pain with menses that is caused by demonstrable pathology. Dysmenorrhoea causes more absenteeism from school and work than any other single factor. Up to 40% of female adults have some degree of menstrual pain.
Aetiology / Risk Factors
Major causative factors and risk factors that can contribute to the incidence of dysmenorrhoea include:
- Inflammation – contractions due to increased prostaglandin secretion
Uterine ischemia
Anxiety and stress
Endometriosis
Narrow cervical os, cervical stenosis or other anatomic abnormalities
Extrauterine pregnancy
Endometrial polyp
Fibroids
Uterine/pelvic infections
Chronic/acute pelvic inflammatory disease (PID)
Intrauterine device (IUD)
Abdominal surgery
Sexually transmitted diseases
Symptoms & Signs
Common signs and symptoms of dysmenorrhoea include:
- Lower abdominal cramping
- Dull ache radiating to lower back, groin, legs
- Heavy menstrual flow with increased incidence of clots in menstrual flow
- Headache and/or migraine
- Nausea and/or vomiting
- Gastrointestinal upset with constipation and/or diarrhoea
Frequent urination