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APGO educational topic number 46
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dysmenorrhea meet Aunt Flo she is a
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popular euphemism that refers to a
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woman’s menstrual cycle in this video we
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will discuss what happens when Aunt Flo
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turns painful the objectives of this
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video are to define dysmenorrhea and
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distinguish primary from secondary
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dysmenorrhea describe the
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pathophysiology and identify the
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ideologies of dysmenorrhea discuss the
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steps in the evaluation and management
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of dysmenorrhea dysmenorrhea is defined
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as painful menstruation it can be severe
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enough to prevent a woman from
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performing normal activities and it can
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be accompanied by diarrhea nausea
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vomiting headache and dizziness primary
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dysmenorrhea has no clinically
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identifiable cause so here is Aunt Flo
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with a molotov cocktail of
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prostaglandins secondary dysmenorrhea on
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the other hand does have a clinically
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identifiable cause so here is an
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endometriosis cop handcuffing on Flo
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primary dysmenorrhea is thought to be
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secondary to excess production of
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prostaglandins which leads to painful
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uterine muscle activity
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the greatest incidence is in women in
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their late teens and early 20s let’s
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spend a moment to discuss the
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pathophysiology of primary dysmenorrhea
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prostaglandins are smooth muscle
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stimulants
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prostaglandin f2 alpha is produced in
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the endometrium progesterone increases
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production of prostaglandin f2 alpha and
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don’t forget that progesterone levels
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peak ad or soon before the start of
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menstruation secondary dysmenorrhea has
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a clinically identifiable cause it is
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more common as a woman ages because it
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accompanies the rising prevalence of
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causal factors common causes include
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endometriosis adenomyosis pelvic
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inflammatory disease and leiomyoma too
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let’s now move to evaluation and
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management take a careful history find
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out if it’s lower abdominal or super
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pubic area if there is fatigue low back
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pain or headache which are common and
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ascertain how much the pain is
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interfering with our daily activities
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such as school work or sports on
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physical examination look for any clues
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for clinically identifiable causes of
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secondary dysmenorrhea irregular
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enlargement of the uterus suggest
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fibroids and enlarged boggy uterus
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suggest adenomyosis painful uterus
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sacral nodules or restricted motion of
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the uterus suggest endometriosis also
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remember to screen for gonorrhea and
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chlamydia to evaluate for infection
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let’s now move on to management one of
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the first-line treatments is
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non-steroidal anti-inflammatory drugs
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for these are prostaglandin synthase
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inhibitors other management options
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include heat such as heating pads
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exercise psychotherapy and reassurances
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oral contraception is effective for it
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suppresses ovulation and the stabilizes
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estrogen and progesterone levels with
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the resulting decrease in endometrial
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prostaglandin production the therapy for
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secondary dysmenorrhea is similar to the
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therapy for primary dysmenorrhea with
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primarily symptomatic therapy and if
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possible therapy should be directed at
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the underlying condition this concludes
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the aapko video on dysmenorrhea we have
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defined primary and secondary
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dysmenorrhea discuss pathophysiology and
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discuss steps in the evaluation and
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management of dysmenorrhea
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you