Dysmenorrhoea

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Dysmenorrhoea is a Uterine pain during menses, severe after 24hr of onset of menses and subsides after 2-3 days, 50% women suffer from this. 5% women experience very severe pain because of this 140 million work hours are lost.

Types:

  • Primary – most common
  • Secondary – due to pelvic abnormalities

Diagnosis:

Based on onset of symptoms

  • Primary – soon after menarche or during adolescence
  • Secondary – seen suddenly after many years of menarche

Check for symptoms:

Headache, nausea, constipation or diarrhoea, lower back pain, frequent urination and vomiting (rare)

Ask patients incase of severe symptoms for

  • Early age at menarche (the first occurrence of menstruation)
  • Long / heavy menstrual period
  • Smoking
  • Family history of dysmenorrhoea
  • Stress
  • Depression

Dose and dosage:     

NSAIDs

  • Ibuprofen – 200mg -800mg thrice/day SOS
  • Naproxen – 500- 550 mg twice/day SOS
  • Mefenamic acid  –  250 mg / every 6hrs , 500 mg initial dose followed by 250 mg four times/day SOS
  • Diclofenac sodium – 50 mg, thrice/day SOS
  • Aspirin – 325-650 mg twice/day SOS
  • Paracetamol – 500- 1000 mg every 6hrs SOS

Low dose estrogen / progestin oral contraceptives

  • Medroxyprogesterone acetate tablets – 5-10 mg once/day for 5 days
  • Depo-medroxyprogesterone acetate – 150 mg/ml injection, IM, every three months

Contraindications:

  • Low dose estrogen / progestin oral contraceptives – pregnancy, cardiovascular disorders
  • Aspirin – in aspirin allergy

Counselling on side effects

  • NSAIDs – Indigestion, ulcers – take medicine after taking food
  • Medroxyprogesterone acetate – menstrual irregularities, abdominal pain,weight changes.

Controlling triggering factors in

  • Weakness due to poor dietary habits
  • Smoking
  • Stress
  • Depression
  • Social conditioning of being a woman

Counselling on diet, exercise, lifestyle management

  • Regular aerobic exercises in fresh air to improve general health
  • Relaxation techniques, as well as meditation for raising pain threshold
  • Adequate rest, low fat vegetarian diet, nutritional supplements such as ω3 fatty acids, flax seeds, magnesium, vitamin E, zinc, thiamine supplementation
  • Avoid constipation by taking more water
  • Hot packs on the lower abdomen for 10-15 minutes
  • Take medicine before the onset of menstrual pain and flow
  • Avoid stress

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