Secondary Dysmenorrhoea

Cyclical Pain Abdomen Related With Menstruation – Dysmenorrhoea

The commonest complain in my Out Patient Department I encounter from all age group of patients is cyclical pain associated with menstruation. The medical term for this condition is dysmenorrhoea. The condition is very common and most of the time, not always, it is nothing serious. In this article you will have some idea how and why such cyclical pain occurs and what one should do?

More than 90% of women some time or other, in their life experience pain during her menstruation. In clinical terms we have two types of dysmenorrhoea.

1. Primary dysmenorrhoea
   
2. Secondary dysmenorrhoea
   

Secondary dysmenorrhoea:

This kind of cyclical pain during menstruation is associated with some disease/ pathology in the genital organ i.e., uterus, fallopian tubes and ovaries. Secondary dysmenorrhoea develop years after the onset of menstruation. Here the pain begins 1 – 2 weeks prior to menstrual flow and persists till few days after cessation. The mechanism of secondary dysmenorrhoea is not fully understood and NSAID ( Nonsteroidal Antinflammatory Drugs) do not provide full relief. Treatment to this kind of dysmenorrhoea should be directed to the treatment of the underlying cause.

Here are the few common gynaecological cause of secondary dysmenorrhoea:

1. Adenomyosis
   
2. Endometriosis
   
3. Fibroid uterus
   
4. Pelvic congestion syndrome
   
5. Sub acute pelvic infection
   
6. Adhesions
   

Adenomyosis:

Though this is a disease of women in their forties, but frequently encountered in younger women nowadays. The normal site for endometrium is lining of the uterine cavity. In this disease endometrium is abnormally found in the musculature of the uterus. This make the uterus large and painful during menstruation. The affected woman complains painful heavy periods and pain during intercourse.

Diagnosis of adenomyosis is easily done from the symptoms, clinical findings and ultrasonography.

There is no medical treatment available at present for this condition. The affected organ uterus has to be removed by operation (Hysterectomy) after she completes her family. Till such time symptomatic treatment with analgesics are done.

Endometriosis:

Nowadays an extremely common condition affecting girls and women of almost all age group after 16 years! I will post a separate article on this condition to give a little in depth information. In this condition endometrium is found in different abnormal location inside the abdominal cavity and even the skin. In each cycle endometrium in these abnormal sites bleed along with the normal endometrium, lining the uterine cavity. This bleeding causes severe pain and varied kind of symptoms depending on the site of bleeding. Endometriosis is a major cause of infertility. Painful, sometimes incapacitating heavy menstruation, pain during intercourse are the major complains.

Diagnosis of endometriosis is done by clinical history, examination, ultrasonography and finally by diagnostic laparoscopy.

Definitive treatment of endometriosis is removal of ovaries and uterus. Unfortunately the disease is mostly found in young woman without any child. Different kind of hormonal treatment and conservative surgery are usually advised to them. Once they complete their family and still the symptoms persist removal of uterus and ovaries (hysterectomy) done.

Fibroid Uterus:

These are benign tumors in the uterine musculature. Though mostly remain symptomless, but sometimes obstructs the natural flow of menstruation and causes pain. The other symptoms are swelling of abdomen, excessive bleeding during and sometimes in between menstruation, repeated abortions, failure to conceive depending on the size and site of the tumor.

Diagnosis of fibroid uterus is done from complain of the patients, clinical examination and ultimately by ultrasonography.

Treatment of fibroid uterus: This depend on the symptoms, age and whether the woman has completed her family or not. If family is completed, in a symptomatic patient, the affected organ is removed surgically ( Hysterectomy). Otherwise removal of the tumors (conservative surgery) is done.

Pelvic congestion syndrome:

Common sufferers are the women in their reproductive age. This condition is most likely associated with emotional stress, which in turn increases the blood flow to the genital organs i.e. uterus, fallopian tubes and ovaries. This causes pain during menstruation, heavy bleeding and pain while intercourse ( dysparunea).

Diagnosis of pelvic congestion syndrome is done from history, clinical examination, ultrasonography, MRI, trans uterine pelvic venogram and laparoscopy.

Treatment depends on the age and the number of children the woman has. If her family is not completed conservative treatment with analgesics and different hormones are done. Once she completes her family and still suffers hysterectomy is done.

Subacute pelvic infections:

Inadequately treated infection of the uterus and its appendages, fallopian tubes and ovaries may persist and causes dysmenorrhoea, excessive bleeding and dysparunea. Proper treatment of the infection may solve the issue but in resistant cases hysterectomy is the answer.

Adhesions:

Adhesions may occur with the surrounding organs like urinary bladder, intestines, rectum and within the uterus and its organs i.e. ovaries and fallopian tubes. The cause of such adhesions may be repeated infections, sexually transmitted diseases or any abdominal or vaginal operations like MTP (Medical Termination Of Pregnancy).

The woman presents with dysmenorrhoea, dysparunea, difficulty in passing urine and stool. Diagnosis is done by laparoscopy . The minor adhesions are usually dealt with freeing the uterus and appendages by operation either by laparoscopy or open operation. In bad type of such adhesion removal of uterus is the only answer.