DYSMENORRHEA

Ozgul Muneyyirci-Delale

DYSMENORRHEA

Primary

Secondary

CAUSES OF SECONDARY DYSMENORRHEA

Tissue or Organ System PathologyPeritoneum Endometriosis

Allen-Masters’ syndromePelvic congestion syndrome

Ovary Ovarian cysts or tumor

Fallopian Tubes Pelvic inflammatory disease(acute and chronic)

Uterus AdenomyosisUterine myomasUterine polypsIntrauterine adhesions(Asherman’s syndrome

Uterus Congenital malformations

(bicornuate and septate uterus,

blind uterine horn)

IUD

Cervix Stenosis

Vagina Imperforate hymen

Transverse vaginal septum

COMPOUNDS THAT INHIBIT PROSTAGLANDIN FORMATION

(In decreasing order of potency)

Meclofenamic acid>niflumic acid= Indomethacin>mefenamic acid> Flufenamic acid>naproxen> Phenylbutazone>aspirin or ibuprofen

DYSMENORRHEA

A favorable response to placebo was observed in 84% in the first cycle, 21% in the second, 16% in the third, and 10% in the fourth (Fedele L et al, 1989).

OTHER TREATMENT MODALITIES FOR DYSMENORRHEA

Transcutaneous electrical nerve stimulation Terbutaline inhalation Levonorgestrel-releasing intrauterine device Vasopressin antagonist Vasopressin VI receptor antagonist Transdermal nitroglycerine Acupuncture Herbal medicine (shakuyaku-kanzo-to) Cyclooxygenase-2 inhibitor Leukotriene receptor antagonist

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

TENS relieves primary dysmenorrhea through two mechanisms:

1. The pregangionic fibers are bombarded with impulses that saturate the nerve cells of the dorsal horn (the gate control theory).

2. TENS induces the release of endorphins from these nerve cells.