Dysmenorrhoea

Question 1

What is Primary Dysmenorrhoea?

Answer 1

Painful menstruation - caused functionally from excess release of prostaglandins and also leukotriens which increases pain senstivity plus some other misfiring aspects (read)
Usually ask the age of onset and also timing of symptoms at assessment

• Onset - first year after menarche, peaks aged 20s-30s, reduces with increasing age, childbirth.
• Timing - on menstruation, or just before, peak 24 hours after onset, subsides after 2-3 days
• Aggravating/relieving factors - relieved by analgesics, OCP, exercise, childbirth… worse with longer duration of periods
• Accompanying symptoms -PMS symptoms; headache, nausea, constipation, diarrhoea, lower back pain, urinary frequency, malaise, fatigue, vomiting, dizziness, mood changes
  IBS aggravates period pain, as well being aggravated by
• Nature of pain - central, supra-pubic, continual, dull, sense of heaviness, plus episodic cramping pain, intensifies as flow heavier, or when clots are passed.
  Premenstrually the aching can extend to groin, thighs; heavy dull sense of dragging in the vagina, sense of fullness in bowel, sensation that everything will fall out.

Question 2

What are the risk factors for primary?

Answer 2

Biological - early menarche, prolonged or heavy menstruantion, no pregnancy, PMS, genetics, smoking, BMI (low and high)
Social
Psychological - stress, alcohol, depression

Question 3

What is Secondary Dysmenorrhoea?

Answer 3

• Onset - is usually 25 and over as likely points to another secondary condition
• Timing - increasing in severity & duration over period
• Aggravating/relieving factors - Not relieved by Oral Contraceptive Pill, and certain conditions do not respond to analgesics.
• Accompanying symptoms - as secondary conditions
• Nature of pain - as secondary conditions such as pelvic inflammatory disease, fibroids - imporatn to ask if there is dyspeurenia (pain with sex)

Question 4

What might cause Secondary Dysmenorrhoea?

Answer 4

“The following are common and all have different symptoms and pain patterns

• Endometriosis - dyspareunia, infertility, bloating, back pain, pelvic heaviness
• Adenomyosis - dyspareunia
• Pelvic inflammatory disease - dyspareunia, cervical motion tenderness, fever, malaise, pelvic pain, smelly vaginal discharge
• IUD (forgotten?)
• Fibroids - dyspareunia, mechanical effect of pressure e.g. urinary frequency, urinary retention, ureteral obstruction and hydronephrosis
• Pelvic venous congestion
• Ectopic pregnancy