Dysmenorrhoea

Dysmenorrhoea is defined as the presence of severe pain during menstruation that interferes with the day to day activities of the patient.

Dysmenorrhoea can be categorized into two, primary dysmenorrhoea (spasmodic dysmenorrhoea) and secondary dysmenorrhoea (also known as congestive dysmenorrhoea).

Primary Dysmenorrhoea (spasmodic dysmenorrhoea)

This is the commonest type of dysmenorrhoea ,which mainly affects teenage adolescents. The pain usually starts a few hours before menstruation and persists for 1-2 days. The pain is spasmodic or colicky in nature (gripping on and off pain).

Primary dysmenorrhoea typically starts 1-2 years after menarche (the first menstrual period in her life), that is once the menstrual cycles become ovulatory.

This condition generally improves after pregnancy.

Although the exact cause is not known, it is thought that increased production of PGF-2 alpha during ovulation may be the cause.

Secondary Dysmenorrhoea (Congestive Dysmenorrhoea)

This is much less common than primary dysmenorrhoea.

In secondary dysmenorrhoea the patients ase generally of an older age group.

The complain usually starts after several years of normal painless menstruation.

Unlike in primary dysmenorrhoea, here the pain precedes the menstrual bleeding by several days, and tends to subside once the bleeding starts.

The cause is mostly due to underlying pelvic pathology.

There will also be symptoms related to the underlying cause (eg dyspareunia- pain during coitus).

Some of the common causes of secondary dysmenorrhoea include adenomyosis, endometriosis, uterine fibroids, pelvic inflammatory disease (PID) and the presence of a foreign body in the uterus (such as IUCD).

Amenorrhoea

Amenorrhoea is defined as absense of menstruation.

Amenorrhoea can be either physiological or pathological amenorrhoea.

A) Physiological amenorrhoea

This occurs in normal individuals, it is a normal physiological process.

causes of physiological amenorrhoea are:

-Pre menarchial period

-Post menopausal period

-Pregnancy

-Lactation

-Following hysterectomy

B)Pathological Amenorrhoea:

Pathological amenorrhoea can be defined as the failure to mensurate for a period of at least 6 months, during the normal reproductive years of life, and not due to any physiological causes (given above).

Pathological Amenorrhoea can be classified into Primary Amenorrhoea and Secondary Amenorrhoea

Primary Amenorrhoea:

primary amenorrhoea is defined as failure to start menstruation at the normal age of menarche.

This is clinically significant at 16 years of age in a patient with normal secondary sexual characteristics and at 14 years in a patient who has not developed secondary sexual characteristics.

What are the causes of primary amenorrhoea?

i) Turner syndrome/Turner mosaics

ii) Gross congenital anomalies (mullerian agenesis/ blind ended vagina)

iii)Androgen insensitivity syndrome (also known as testicular feminization syndrome).

iv) Panhypopituitarism/ hypopitiuatarism

v) Severe malnutrition/ anorexia nervosa

vi) Late onset congenital adrenal hyperplasia

vii) Polycystic ovary disease.

Secondary Amenorrhoea:

Secondary amenorrhoea is defined as absense of menstruation for a period of at least 6 months in a woman who has had normal menstruation prior to that, and who is still pre-menopausal.

What are the causes of secondary amenorrhoea?

i) Cerebral Cortex

-Anorexia nervosa

-Severe physical/Psychological stress

-Starvation/malnutrition

ii) Hypothalamus

-Intracranial tumours/ craniopharyngioma

iii)Pituitary

-Sheehans syndrome (or symonds disease-post partum pituitary necrosis)

-prolactinomas

iv) Ovary

-polycystic ovary disease

-congenital adrenal hyperplasia

-androgen secreting ovarian tumours

-premature ovarian failure (eg due to cytotoxic therapy)

v)Uterus

-Asherman syndrome

-endometrial TB

vi) General

-Chronic renal failure

-Chronic liver disease

-Adrenal failure

-Severe diabetes mellitus

-hyper/hypothyroidism

-iatrogenic (Phenothiazine drugs)

References:

Introduction to Clinical Gynaecology and Obstetrics for Undergraduates. Compiled by Dr WDN De Alwis, Dr  .R Gnansekeram, Dr .N.Gunawansa. Edited by Dr C. Randeniya MBBS, MS, FRCOG. Senior Lecturer, Dept. of Obstetrics and Gynaecology, Faculty of Medicine, Colombo. Honorary Consultant, De Soysa Hospital for Women and the National Hospital of Sri Lanka.

No related posts.

 

You are welcome to discuss this post/related topics with Dr Shihaan and other experts from around the World in our Pregnancy, Gynaecology and Baby health Forums (www.askdrshihaan.org/forums/).