MENSTRUAL PAIN OF NEW ONSET AND WORSENING MENSTRUAL PAIN; WHY AND WHAT CAN I DO ABOUT THIS?

-
source: pixabay.com/
Secondary dysmenorrhea refers to menstrual pain of new onset in a woman previously void of menstrual pain or the presence of worsening menstrual pain over a period of time.It is secondary to an underlying pelvic disease.
Causes
These include diverse set of diseases or disorders affecting the uterus (womb), adnexea and the pelvic cavity. They are:
Presentation
The presentation varies and depends on the underlying disease condition. It typically presents as any other pattern of menstrual pain different from that described for primary dysmenorrhea. It has no singular pattern of presentation and may occur at any phase of the menstrual cycle as well as during menstruation and unlike primary dysmenorrhea that typically appears few months after menarche, it may appear at anytime during the reproductive years. It may also present as worsening primary dysmenorrhea or as a new onset of cyclical lower abdominal pain felt in a woman who never experienced primary dysmenorrhea. With multiple possible causes, its severity varies with its cause and resolution of symptoms usually occurs following the treatment of the underlying cause.
It may also present with other symptoms typical of the underlying cause of the dysmenorrhea. For example, secondary dysmenorrhea may be associated with heavy menstrual bleeding in uterine fibroids, adenomyosis and in women with IUCD. Similarly, women with uterine fibroid and adenomyosis may present with a lower abdominal swelling and an abdominal mass on physical examination while those with PID may present with an offensive vaginal discharge associated with fever. Endometriosis another common cause of secondary dysmenorrhea often present with severe symptoms associated with painful intercourse on deep penetration (dyspareunia).
Diagnosis
This involves taking a detailed history, performing a thorough examination and employing the use of necessary investigations. Usually from the clinical history, it is easy to differentiate primary dysmenorrhea from secondary dysmenorrhea, but not always so from the different causes of secondary dysmenorrhea. Specific presentation, investigations and treatment of the various causes of secondary dysmenorrhea will be discussed in detailed in respective articles written about them. In the main time, basic investigations necessary for the diagnosis of secondary dysmenorrhea are discussed below.
Differential diagnosis
This includes primary dysmenorrhea as well as any of the above listed causes of secondary dysmenorrhea.  
Investigations
Investigations commonly done are;
Abdominal ultrasound: This is important in making a diagnosis of uterine fibroids, adenomyosis as well as to diagnose the presence of ovarian masses in suspected cases of endometriosis.
Laparoscopy: This is the gold standard of diagnosis of PID, endometriosis and pelvic adhesions. It can also be used to view first hand, the presence of any other pelvic diseases such as the uterine fibroids and ovarian cysts.  It has the advantage in expert hands to be used for the treatment of many of the causes of secondary dysmenorrhea.
Chlamydia and Gonorrhea screening tests: Patients with vaginal discharge and those with symptoms suggestive of pelvic inflammatory disease (PID) should be screened for Gonorrhea and Chlamydia infection. These include antibody tests for Chlamydia and endo-cervical swab M/C/S for Gonorrhea. If present other STDs should be investigated and all contacts traced to disrupt the chain of transmission.
Treatment
The definitive treatment of secondary dysmenorrhea is by the treating its cause. However, many of the above listed approach for the treatment of primary dysmenorrhea may help to reduce the symptoms till a definitive approach of treatment is available or desirable. For example, patients with uterine fibroids, endometriosis and adenomyosis presenting with secondary dysmenorrhea may benefit from the use of NSAIDs, OCPs or the insertion of Mirena for the relief of their menstrual pains pending their definitive management with surgery. For treatment of specific causes of secondary dysmenorrhea, kindly please see a gynaecologist.

Previous Article:  Primary dysmenorrhea
Reference
Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. British Medical Journal 2006; 332: 1134–8.


 Source: Ewomen Clinic

Comments

Post a Comment

Popular posts from this blog

CHILD SAFETY: OUR HOMES HAVE MORE POISONOUS SUBSTANCES THAN WE REALIZE

-
Image
Source: Max Pixel I had a friend who told me how her last child mistakenly drank Dettol liquid. She immediately went into panic mode (as you would expect of a mother). She had to ensure her child drank some palm oil to neutralize any possible effect(African first aid,lol). But what is the best way to handle such unexpected events. You first have to understand that children knowledgeable enough to distinguish between what is actually healthy and harmful. They copy what adults do yet not knowing the reason we do them or where to draw the line when taking seemingly risky acts. Remember the scene in Home Alone 1, where Macaulay Culkin's character (Kelvin) used his father's shaving cream. He screamed because of the sensation he felt. He (Kelvin) didn't understand that the actual use of the shaving foam. He just wanted to behave like his dad. Without proper supervision, a  child can pick up any liquid and ingest it. What poisons are in our homes that can be harmful t
Read more

THE TICKING TIME BOMB; HOW WELL DO YOU KNOW THE HEALTH RISKS OF ECTOPIC PREGNANCIES?

-
Image
Blood transfusion is usually required to save women with ruptured ectopic pregnancy from shock due to massive internal bleeding. Courtesy wikimedia commons. An ectopic pregnancy is an abnormal pregnancy in which a fertilized egg also known as the  embryo , attaches itself into any other parts of the female genital tract or the abdomen other than the  endometrium  or the inner  lining of the  uterus. While they can be divided into various types, based on location of the ectopic pregnancy in the female genital tract, see  DEFINITION AND TYPES OF ECTOPIC PREGNANCIES ,  they can also be divided based on presentation at the hospital into ruptured, non ruptured and slow leaking ectopic pregnancies.  Most of the complications of ectopic pregnancies are seen following an unsuspected ruptured ectopic pregnancy.  A ruptured ectopic pregnancy refers to  an ectopic pregnancy that has outstretched its confining structures resulting in a significant tear followed by sudden and massive bleedin
Read more

GIRL RESUSCITATES HER BROTHER BY PERFORMING CPR (VIDEO)

-
Image
Source: Linda Ikeji's Blog Finally, I found the video of the girl who was videoed performing CPR (Obviously this was her first time performing CPR) on her brother who had collapsed. With her mom and possibly her mom’s friend guiding her on what to do over the phone on CPR procedure. This must have been one of the most terrifying and stressful assignment for her to perform. However,it was a life and death issue. Words cannot describe how she felt doing it or was able to perform this, but she did and saved the day,an avoidable death was prevented. #AFABulouSSister! She performed the hands only procedure, although she did not exactly get it done as recommended, but the outcome was good. Check CPR procedures on my blog. Be equipped with the skill and the kit! You never know when a loved one or a stranger would collapse in your presence, it could end up been a disaster if you don't know what to do. But undergoing a first aid training and practice with a professional
Read more