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Dysmenorrhea and PMS

Dysmenorrhea and PMS. Patricia Crowley TCD Department of Obstetrics and Gynaecology. Primary Spasmodic Dysmenorrhea. Painful menstruation without underlying pathology Commonest in teens/early twenties Onset 1 or more years after menarche Associated vomiting and faintness.

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Dysmenorrhea and PMS

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  1. Dysmenorrhea and PMS Patricia Crowley TCD Department of Obstetrics and Gynaecology

  2. Primary Spasmodic Dysmenorrhea • Painful menstruation without underlying pathology • Commonest in teens/early twenties • Onset 1 or more years after menarche • Associated vomiting and faintness

  3. Secondary Dysmenorrhea • Painful menses secondary to pathology • Pain may begin before bleeding and may last for entire duration • Commoner 30s and 40s

  4. Secondary Dysmenorrhea • Endometriosis • Fibroids • Adenomyosis • Pelvic Inflammatory Disease • Uterine anomalies

  5. History Taking • Timing • Severity • Disruption in life-style • Previous gynae history • Contraceptive needs • Wish for fertility

  6. Examination • Vaginal exam not essential in young female with ? Primary dysmenorrhea • Vagina -?septum/ tenderness in POD • Uterus- size / mobility/ position/tenderness • Adnexa –tenderness/ enlargement

  7. Investigations • Transabdominal ultrasound with full bladder • Transvaginal ultrasound –increased sensitivity • Laparoscopy –gold standard for endometriosis • Risks versus benefits

  8. Management Primary Spasmodic Dysmenorrhea • Education • Prostaglandin synthetase inhibitors • Combined oral contraceptive pill-choose a progestagen dominant pill • “Bicycle” or “Tricycle” pill • Failure to respond to Pill increases likelihood of underlying pathology

  9. Premenstrual Syndrome • Physiological premenstrual change • All but 5% of females experience one or more symptom

  10. Symptoms • Physical –bloating/breast tenderness/headache • Psychological-agression/agitation/crying bouts/depression/irritability

  11. Measurement and Diagnosis • Cyclical symptoms –character, timing, severity • Degree of underlying psychological dysfunction • Degree of disruption of lifestyle • Usually self documented using diary/calendar

  12. Aetiology • No measurable abnormality in female sex hormones or prolactin • Oophorectomy abolishes symptoms • Cyclical HRT reproduces symptoms • ? Abnormal endorphins • ? Change in serotonin metabolism

  13. Treatment • 15 RCTs SSRIs vs placebo • SSRIs improve physical and psychological symptoms • Both intermittent and continuous therapy beneficial Dimmock et al Lancet 2000

  14. Treatment • Temporary or permanent abolition of hormonal cycle • GnRH analogue • Hysterectomy and Oophorectomy • Progesterone/progestagens shown to be ineffective

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