Concept of Dysmenorrhea – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Concept of Dysmenorrhea
Definition of Dysmenorrhea:
Dysmenorrhea can be defined as painful menstruation of sufficient magnitude so as to incapacitate day to day activities.
Or,
Dysmenorrhea, also known as painful periods, or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins
Classification of Dysmenorrhea:
1. True dysmenorrhea (primary/spasmodic/intrinsic/essential): A painful menstruation which is of uterine origin and directly due to menstruation and without any identifiable pelvic pathology.
2. Congestive dysmenorrhea (secondary dysmenorrhea): Dysmenorrhea occurring due to presence of pelvic pathology.
Difference between Primary and Secondary Dysmenorrhea:
| Primary/True Dysmenorrhea | Secondary/Congestive Dysmenorrhea |
| Pain is of uterine origin and directly due to menstruation | Pain arises in an organ or tissue other than the uterus and merely associated with menstruation |
| Pain is experience a few hours before and after the onset of menstruation | Pain is at its height during the 2 or 3 days preceding menstruation and is slowly relived with the onset of menstruation |
| Pain is spasmodic or colicky in type | Pain is dull ache |
| Pain is felt mainly in the hypogastrium and is often referred to the inner and front aspects of the thighs | Pain is felt equally on both sides of the lower abdomen and back, sometimes extending down the thighs |
causes of primary dysmenorrhea
A painful menstruation which is of uterine origin and directly due to menstruation and without any identifiable pelvic pathology.
Causes of Primary Dysmenorrhea:
(a) Psychological and behavioral factors:
- Tension and anxiety during adeloscence
- Lower pain threshold
- Unhappiness at home or at work
- Unsatisfied sex urge
- Fear or loss of employment
- Anxiety over examination
(b) Muscular in coordination and uterine hyperactivity
(c) Hormonal imbalance and excessive prostaglandin
(d) Other factors:
- Higher circulating vasopressin
- Platelet activating factors
Management of Primary Dysmenorrhea:
A. Clinical features of primary dysmenorrhea:
Patient profile: 18-24 years (maximum) and thereafter diminishes.
(a) Symptoms:
- Pain:
✔ Site: Pain is felt in the hypogastrium
✔ Onset: Few hours before or after onset of menstruation
✔ Duration: Usually last few hours rarely 12 hours Character. Spasmodic or colicky in nature
✔ Radiation: Inner and front aspects of the thighs.
- Others: Nausea, vomiting, fatigue, diarrhea, headache.
(b) Signs: Patient looks anxious, Pallor
B. Examination: No general or local abnormality
C. Investigation: Usually not required. USG, hysteroscopy may be done to exclude secondary cause.
D. Management:
(a) General management:
- Reassurance and counseling
- Rest in bed with hot compression
- Physical exercise
(b) Analgesics and antispasmodics:
- Analgesics: Aspirin, paracetamol
- Antispasmodics: Hyoscine butylbromide
- Newer NSAIDs: Any one of the following may be used –
✔ Indomethacin 250 mg 8 hourly
✔ Naproxen 250 mg 8 hourly
✔ Ibuprofen 400 mg 8 hourly
✔ Mefenamic acid 250 mg or 500 mg 6 hourly
(c) Hormone therapy: (to suppress ovulation)
- Oestrogen- progestogen oral pill 1 tablet is taken nightly on each of the 5th to 25* days of the cycle continued for 6 month
- Alternatively oral progestogen 10 mg daily from 5th to 25th days each cycle for 6 months may be used.
d) Surgical treatment: It is considered when the pain is proven to be truly spasmodic incapacitating medical treatments fails.
- Dilatation of the cervix
- Pre sacral neurectomy
- Bilateral block of the pelvic plexus
- Hysterectomy
- Treatment of retroverson if present