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Resources » Articles/Knowledge Sharing » Health »
Cyclical Pain Abdomen Related With Menstruation – Secondary Dysmenorrhoea
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The commonest complain in my Out Patient Department I encounter from all age group of patients is cyclical pain associated with menstruation. The medical term for this condition is dysmenorrhoea. The condition is very common and most of the time, not always, it is nothing serious. In this article you will have some idea how and why such cyclical pain occurs and what one should do?
More than 90% of women some time or other, in their life experience pain during her menstruation. In clinical terms we have two types of dysmenorrhoea.
a) Primary dysmenorrhoea
b) Secondary dysmenorrhoea
See Primary Dysmenorrhoea for more details.
Secondary dysmenorrhoea:
This kind of cyclical pain during menstruation is associated with some disease/ pathology in the genital organ i.e., uterus, fallopian tubes and ovaries. Secondary dysmenorrhoea develop years after the onset of menstruation. Here the pain begins 1 – 2 weeks prior to menstrual flow and persists till few days after cessation. The mechanism of secondary dysmenorrhoea is not fully understood and NSAID ( Nonsteroidal Antinflammatory Drugs) do not provide full relief. Treatment to this kind of dysmenorrhoea should be directed to the treatment of the underlying cause.
Here are the few common gynaecological cause of secondary dysmenorrhoea:
1. Adenomyosis
2. Endometriosis
3. Fibroid uterus
4. Pelvic congestion syndrome
5. Sub acute pelvic infection
6. Adhesions
Adenomyosis:
Though this is a disease of women in their forties, but frequently encountered in younger women nowadays. The normal site for endometrium is lining of the uterine cavity. In this disease endometrium is abnormally found in the musculature of the uterus. This make the uterus large and painful during menstruation. The affected woman complains painful heavy periods and pain during intercourse.
Diagnosis of adenomyosis is easily done from the symptoms, clinical findings and ultrasonography.
There is no medical treatment available at present for this condition. The affected organ uterus has to be removed by operation (Hysterectomy) after she completes her family. Till such time symptomatic treatment with analgesics are done.
Endometriosis:
Nowadays an extremely common condition affecting girls and women of almost all age group after 16 years! I will post a separate article on this condition to give a little in depth information. In this condition endometrium is found in different abnormal location inside the abdominal cavity and even the skin. In each cycle endometrium in these abnormal sites bleed along with the normal endometrium, lining the uterine cavity. This bleeding causes severe pain and varied kind of symptoms depending on the site of bleeding. Endometriosis is a major cause of infertility. Painful, sometimes incapacitating heavy menstruation, pain during intercourse are the major complains.
Diagnosis of endometriosis is done by clinical history, examination, ultrasonography and finally by diagnostic laparoscopy.
Definitive treatment of endometriosis is removal of ovaries and uterus. Unfortunately the disease is mostly found in young woman without any child. Different kind of hormonal treatment and conservative surgery are usually advised to them. Once they complete their family and still the symptoms persist removal of uterus and ovaries (hysterectomy) done.
Fibroid Uterus:
These are benign tumors in the uterine musculature. Though mostly remain symptomless, but sometimes obstructs the natural flow of menstruation and causes pain. The other symptoms are swelling of abdomen, excessive bleeding during and sometimes in between menstruation, repeated abortions, failure to conceive depending on the size and site of the tumor.
Diagnosis of fibroid uterus is done from complain of the patients, clinical examination and ultimately by ultrasonography.
Treatment of fibroid uterus: This depend on the symptoms, age and whether the woman has completed her family or not. If family is completed, in a symptomatic patient, the affected organ is removed surgically ( Hysterectomy). Otherwise removal of the tumors (conservative surgery) is done.
Pelvic congestion syndrome:
Common sufferers are the women in their reproductive age. This condition is most likely associated with emotional stress, which in turn increases the blood flow to the genital organs i.e. uterus, fallopian tubes and ovaries. This causes pain during menstruation, heavy bleeding and pain while intercourse ( dysparunea).
Diagnosis of pelvic congestion syndrome is done from history, clinical examination, ultrasonography, MRI, trans uterine pelvic venogram and laparoscopy.
Treatment depends on the age and the number of children the woman has. If her family is not completed conservative treatment with analgesics and different hormones are done. Once she completes her family and still suffers hysterectomy is done.
Subacute pelvic infections:
Inadequately treated infection of the uterus and its appendages, fallopian tubes and ovaries may persist and causes dysmenorrhoea, excessive bleeding and dysparunea. Proper treatment of the infection may solve the issue but in resistant cases hysterectomy is the answer.
Adhesions:
Adhesions may occur with the surrounding organs like urinary bladder, intestines, rectum and within the uterus and its organs i.e. ovaries and fallopian tubes. The cause of such adhesions may be repeated infections, sexually transmitted diseases or any abdominal or vaginal operations like MTP (Medical Termination Of Pregnancy).
The woman presents with dysmenorrhoea, dysparunea, difficulty in passing urine and stool. Diagnosis is done by laparoscopy . The minor adhesions are usually dealt with freeing the uterus and appendages by operation either by laparoscopy or open operation. In bad type of such adhesion removal of uterus is the only answer.
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Responses
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| Author: ThiLaStars 16 Mar 2009 | Member Level: Gold Points : 1 | Dear Sparsha,
How do you got the award from india study channel?. am also try to post some messages into the cool post hot prize. but i cant find the path to post my articles.
kindly give some suggestion to anyone.
Regards,
ThiLaStars.
Member.ISC
| | Author: ankit 13 Oct 2009 | Member Level: Gold Points : 2 | Abstract
Pelvic pain often proves to be a clinical challenge. It may be a manifestation of stress and coping mechanisms that many young women use to react to their external environment, or it may be the result of pelvic pathology. It is an often-lodged complaint in female adolescents.
Dysmenorrhea is defined as difficult menstrual flow. Primary dysmenorrhea is painful menstruation in the absence of specific pathologic conditions. Secondary dysmenorrhea equates with painful menstrual periods in the presence of pathologic conditions of the pelvic organs, such as endometriosis, salpingitis, or congenital anomalies of the müllerian system.
The incidence of dysmenorrhea has been reported to be 92% of adolescents. In a study conducted in Sweden,2 a group of researchers used a scoring system as noted in Table 1. The prevalence and severity of dysmenorrhea are noted in Table 2. Fifteen percent of the responders noted that their dysmenorrhea clearly inhibited daily activity. A correlation was found between severity of dysmenorrhea, duration of menstruation, and the quantity of menstrual flow. No significant difference was found with respect to prevalence and severity of dysmenorrhea among nulligravid women versus those in whom pregnancy had been terminated by either spontaneous or induced abortion. The rates of prevalence and severity of dysmenorrhea in parous women were significantly lower. This study also noted that a total of 50.9% of the respondents had missed time from work or school as a result of dysmenorrhea. Among all women, only 31% reported dysmenorrhea to their physicians. The authors believe that this may reflect women's acceptance of its being “normal.”
One other epidemiologic study of dysmenorrhea was completed by Klein and Litt.37 This study was a survey of a representative cross-section of a “national probability sample” based on 22 million noninstitutionalized adolescents aged 12 to 17 years. The data were collected from 1966 to 1970 at the National Center for Health Statistics. Overall, 70,000 adolescents were surveyed, of which 2699 were postmenarcheal. The prevalence of dysmenorrhea was 59.7%. Of those reporting pain, 12% described it as “severe,” 37% as “moderate,” and 49% as “mild.” The prevalence of dysmenorrhea increased with age, from 39% for 12-year-olds to 72% for 17-year-olds. Dysmenorrhea also increased with sexual maturity, from 38% at age 10 years and Tanner stage 3 to 66% at age 10 years and Tanner stage 5 and from 31% 1 year postmenarche to 78% 5 years postmenarche.
Of the total sample, 14% frequently missed school because of dysmenorrhea, and of those with severe menstrual pain, 50% reported missing school. Although black adolescents reported no increased incidence of dysmenorrhea, they were absent from school more frequently (23.6%) than were whites (12.3%) because of dysmenorrhea, even when socioeconomic status was taken into account. Only 14.5% of the adolescents with dysmenorrhea had ever sought help for the problem. Interestingly, 30% of parents were not aware of their daughters' painful menses.
In a Finnish study, Widholm and Kanter76 noted that the frequency of dysmenorrhea among 13- to 20-year-olds ranged from 36% to 56%, with an overall school absence rate of 23.4%. This study noted that a significant number of adolescents suffered from dysmenorrhea, and many did not seek help from health care professionals for the problem.
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