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DYSMENORRHEA & PREMENSTRUAL SYNDROME

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DYSMENORRHEA


Primary

 

  1. menstrual pain not caused by organic disease
  2. may be due to prostaglandin-induced uterine contractions and ischemia
  3. begins 6 months - 2 years after menarche (ovulatory cycles)
  4. colicky pain in abdomen, radiating to the lower back, labia and inner thighs
  5. begins hours before onset of bleeding and persists for hours or days
  6. associated nausea, vomiting, altered bowel habits, headaches

Treatment

  1. PG synthetase inhibitors (e.g. naproxen)
  2. must be started before/at onset of pain
  3. BCP to suppress ovulation and reduce menstrual flow

 

Secondary

 

  1. menstrual pain due to organic disease
  2. begins in women who are in their 20ís
  3. worsens with age
  4. associated dyspareunia, abnormal bleeding, infertility

Etiology

  1. endometriosis
  2. adenomyosis
  3. fibroids
  4. PID
  5. ovarian cysts
  6. IUD

 

PREMENSTRUAL SYNDROME


Definition

 

  1. variable cluster of symptoms that appear to occur on a regular basisprior to each menstrual episode
  2. more correctly called OVARIAN CYCLE SYNDROME since symptoms depend on ovulation  
  3. etiology is unknown

Symptoms

 

  1. occur 7-10 days before menses and relieved by onset of menses
  2. 7 day symptom-free interval must be present in first half of cycle
  3. physical - see Progestin Deficiency and Estrogen Excess Symptoms
  4. psychological
    • irritability
    • anxiety
    • depression
    • sleep disturbance
    • appetite change
    • libido change
    • fatigue
    • suicidal ideation

Treatment

 

  1. no proven beneficial treatment, only suggested treatment
  2. psychological support
  3. diet
    • decreased sodium, fluids, carbohydrates
    • increased protein
    • avoidance of caffeine and alcohol
  4. medications
    • vitamins - B6 (pyridoxine) 
    • BCP
    • progesterone suppositories
    • diuretics for severe fluid retention
    • NSAIDs for discomfort, pain
    • evening of primrose oil (linoleic acid)
    • danazol (Danocrine)
    • SSRI antidepressants in selected cases
  5. regular exercise

 

DYSMENORRHEA & PREMENSTRUAL SYNDROME DYSMENORRHEA & PREMENSTRUAL SYNDROME Reviewed by Radiology Madeeasy on August 23, 2010 Rating: 5
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