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PRIMARY DYSMENORRHEA

PRIMARY DYSMENORRHEA. Kanadi Sumapraja. Division of Reproductive Immuno-endocrinology Department of Obstetrics and Gynecology Faculty of Medicine University of Indonesia. DEFINITION. Painful menses in women with normal pelvic anatomy. ETIOLOGY. Smooth muscle contraction. PGF2 a PGE 2.

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PRIMARY DYSMENORRHEA

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  1. PRIMARYDYSMENORRHEA Kanadi Sumapraja Division of Reproductive Immuno-endocrinology Department of Obstetrics and Gynecology Faculty of Medicine University of Indonesia

  2. DEFINITION Painful menses in women with normal pelvic anatomy

  3. ETIOLOGY Smooth muscle contraction PGF2a PGE2

  4. ETIOLOGY

  5. ETIOLOGY Phospholipid from the death cells Prostaglandin Prostacyclin Thromboxane Arachidonic acid PGG2 PGH2 Phospholipase A2 COX Isomerase

  6. RISK FACTORS Age < 20 years Attempts to lose weight Depression / anxiety Disruption of social networks Heavy menses Nulliparity Smoking

  7. CLINICAL PRESENTATION Usually presents during adolescence, within three years of menarche Unusual for symptoms to start within the first six months after menarche Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle Symptoms of nausea, vomiting, diarrhea, fatigue, fever, headache or lightheadedness

  8. SECONDARY DYSMENORRHEA Dysmenorrhea occurring during the first one or trwo cycles after menarche Dysmenorrhea beginning after 25 years of age Late onset dysmenorrhea Pelvic abnormality Little or no response to therapy with NSAIDs, OC or both

  9. TREATMENT A = consistent, good-quality, patient-oriented evidence; B = inconsistent or limited quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series.

  10. ROS INDUCES PGF2a Endometrial stroma Decidualized endometrial stroma cell Sugino et al, 2001

  11. NSAID can reduce PGF2a Sugino et al, 2001

  12. SOD regulated by steroid Sugino et al, 2002

  13. ROS and SOD During normal cellular respiration, oxygen is reduced to water and highly reactive superoxide ( )

  14. ROS and SOD These reactive oxygen species (superoxide) react with nucleic acids, sugars, proteins and lipids - eventually leading to protein degradation.

  15. ROS and SOD balance

  16. Antioxidant

  17. Antioxidant role of vitamin E Vitamin E Free Radical Quenched Free Radical Polyunsaturated Fatty Acid Protein Cholesterol Phospholipid

  18. THANK YOU

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