-- Dysmenorrhoea --

( Pain in abdomen during Menses )

Written by Dr. Sarika Doshi

(contd...)

2. Spasmodic Dysmenorrhea

   It is also known as primary, menstrual, intrinsic or idiopathic dysmenorrhoea. The actual causation and mechanism is uncertain; but probably it is due to spasmodic contractions of the uterine muscles.
   The predisposing stimulus to the overactivity of the uterine muscles may be associated with many factors like:

   • Ill development of Uterus: The uterus in cases of severe dysmenorrhoea is generally found to be illdeveloped or infantile uterus.The size is smaller than the normal uterus after puberty.The cervix may be very slender and thin with a pin hole external os.
   
   
   • Mal developed Uterus: The uterus may be bicornuate or separate.
   
   
   • Mal position of uterus: Uterus may be displaced laterallyto one side,or Uterus may be acutely anteflexed or congenital retroversion etc.
   
   
   • Defect in Myometrium.
   
   
   • Abnormalities of menstrual discharge: Deficiency of thrombolysin or the enzyme secreted by the endometrium during menstruation puts to liquidise the menstrual clots in the uterus: when these clots are discharged,the pain is experienced.
   
   

   Clinical features & symptoms:

   • Severe excruciating pain which is intermittant and spasmodic in nature.
   
   
   • Pain is felt in lower abdomen and often down the thighs.
   
   
   • Pain starts usually on the first day of the menses which may last either for the first few hours or may continue throughout the period,the intensity becoming less severe.
   
   
   • Pain is not better by discharge.
   
   
   • Faintness collapse,vomiting or nausea accompanies the pain.
   
   
   • The menstrual cycle is a little irregular and the amount of blood lost during each period is less than the average.
   
   

3. Membranous Dysmenorrhoea

   It is due to the exfoliation of membranes of the uterus. The exfoliation may be deep or superficial giving rise to thick or thin clots. The clots are very rarely complete and come out in half or smaller pieces. The cause of this is yet unknownbut it is thought to be due to some upset in the endocrine control of the uterus. Sometimes thin casts as well as thick casts are often passed without pain; but when retained for sometimes, they become rolled up with blood to form as solid casts and then dysmenorrhoea is severe.

   Clinical features & symptoms:

   • Severe excruciating pain with faintness,collapse with the onset of menses.
   
   
   • With the spasm of pain,the membrane (uterine casts) is shed off.
   
   

General Treatment:

• Open air exercise,no sedentary habits.


• Avoid constipation.


• Treat other general diseases.


• Liquid and nourishing diet.


• Sometimes Dysmenorrhoea is rendered by marriage and child birth. So,those cases are to be dealt with accordingly.


• Improve the general health of the patient.


• Sex abstinence.