Gynae and Obstetrics

Nursing
1

2 N D YEAR
POST RN B.SC.N
MRS. ADELINE YOUNAS
TOPIC: DYSMENORRHEA

BCON

10/16/2016

Objectives
2

By the end of this session learners will be able

to:
Define Dysmenorrhea.
Types of Dysmenorrhea
Define pathophysiology of Dysmenorrhea
Management of Dysmenorrhea

BCON

10/16/2016

Dysmenorrhea
3

Means difficult menstruation

but
the term is used painful menstruation.

Primary Dysmenorrhea
BCON

Secondary dysmenorrhea
10/16/2016

Primary Dysmenorrhea
4

Menstrual

pain that's not a symptom of an

underlying gynecologic disorder but is related to the
normal process of menstruation.
OR
A pain which is of uterine origin and directly linked
to menstruation but with no visible pelvic pathology.

BCON

10/16/2016

Sign/Symptoms
5

sharp, intermittent spasm, usually in suprapubic area.

pain may radiate to the back of the leg or the lower

back
systemic symptoms:
o nausea
o vomiting
o diarrhea
o fatigue
o fever
o Headache or dizziness
BCON

10/16/2016

Causes
6

Excess secretion of prostaglandins

Immaturity of the Hypothalamus- Pituitary

ovarian axis leading to an ovulatory cycle.

Outflow tract obstruction.

BCON

10/16/2016

Investigations
7

--Ultrasound to exclude pelvic lesions

--Hormonal profile

BCON

10/16/2016

To treat primary dysmenorrhea:

8

pain relief : NSAIDs

hormonal contraceptives
life style changes:
daily ex.
limit salty foods
wt. loss
smoking cessation
relaxation techniques

BCON

10/16/2016

To treat primary dysmenorrhea

9

Alternative
Combined oral estrogen-progestogen contraceptive

continued 9-12 months leading to an ovulatory cycles

if symptoms improve.

BCON

10/16/2016

Secondary dysmenorrhea
10

Menstrual pain that is generally related to some kind

of gynecologic disorder. Most of these disorders can be
easily treated with medications or surgery. Secondary
dysmenorrhea is more likely to affect women during
adulthood.

BCON

10/16/2016

Sign/Symptoms
11

sharp, intermittent spasm, usually in subra pubic area.

pain may radiate to the back of the leg or the lower back
systemic symptoms:
o nausea
o vomiting
o diarrhea
o fatigue
o fever
o Headache or dizziness

BCON

10/16/2016

Causes
12

fibroids benign tumors that develop within the

uterine wall or are attached to it.

adenomyosis the tissue that lines the uterus (called
the endometrium) begins to grow within its
muscular walls.
a sexually transmitted infection (STI)
endometriosis fragments of the endometrial lining
that are found on other pelvic organs

BCON

10/16/2016

Causes
13

pelvic inflammatory disease (PID), which is

primarily an infection of the fallopian tubes, but can

also affect the ovaries, uterus, and cervix.
an ovarian cyst or tumor.
the use of an intrauterine device (IUD), a birth
control method.

BCON

10/16/2016

Investigations
14

-- FBC ESR or C-reactive protein

--Vaginal swab,
--Urinalysis
--Ultrasound
-- Laparoscopy
--Hysteroscopy.

BCON

10/16/2016

Management
15

dysmenorrhea will vary with the underlying cause.

o Diagnostic laparoscopy.
o hormonal treatments.
o trial of transcutaneous electrical nerve stimulation

(TENS) are potential next steps.

o Surgery can be done to remove fibroids or to widen
the cervical canal if it is too narrow.
o pain relief : NSAIDs

BCON

10/16/2016

Reference
16

BCON

10/16/2016

BCON

17

10/16/2016