Dysmenorrhea is painful menstruation accompanied with:
Edema of ankles,
Signs and symptoms
Mild cramps beginning 12 – 24 hours before the onset of menstruation and become more acute with the flow. The cramp is located in the lower abdomen ( colicky cramping pain in the lower abdomen)
Associated symptoms such as;
Nausea and vomiting
Types of dysmenorrhea
a) Primary dysmenorrhoea
Primary dysmenorrhea is common in young girls. It occurs few years after puberty.
At onset there is lower abdominal pain of colicky in nature, associated with nausea, vomiting and faintness.
The painful cramps are due to excessive production of prostaglandins which causes increased uterine hyper-contractility and arterial vasospasms
As the woman grows older, the pain tends to decrease and the condition disappears after first delivery.
Idiopathic and no abnormalities is found
Obstruction of the cervical canal leading to forceful expulsion of the menstrual products.
Infantile type of uterus
Muscular imbalance during menstruation
Ischemia due to reduced blood supply to the uterus and cervix
b) Secondary dysmenorrhoea
This occurs at any age. The menses at first is normal but the pain rises two days later
There is dragging ache throughout the pelvis, back and inner aspect of the thighs
Once bleeding is well established, the pain disappears gradually followed by menorrhagia at longer interval.
The cycle is also shortened.
Anaemia results from the frequent heavy loss.
Emotions from sexual life where there is more stimulation than satisfaction.
Chronic salpingitis with pelvic adhesion, causing retroversion of the uterus.
PID ( Pelvic inflammatory diseases
IUD (Intra-Uterine Devices)
Common diagnosis and investigation
Bimanual pelvic examination may reveal areas of tenderness, a fibroid tumor, or uterine displacement.
A laparoscopy may visualize endometrial tissue, fibroid tissue or other pelvic abnormality.
Management of dysmenorrhea
Exercise to improve the abdominal and pelvic muscle integrity
Analgesics to relieve pain
If the woman is married, inform her that she will be better after having a baby
Alternatively, use combined oral contraceptives.
Dilatation of the cervix under GA, leaving a glass rod in for 24 hours.
Encourage the woman to ensure adequate rest, nutrition
Constipation should be avoided
Massage can also soothe aching muscles promote relaxation and blood flow
Surgical interventions are used in treating this condition. Also herbs have effective treatment if used appropriately.
Amenorrhea means absence of menstruation.
It is common before ovarian activity begins at puberty, few months following delivery and at menopause following cessation of estrogen activity.
Types of amenorrhea
Amenorrhea occurs in two forms:
a) Primary amenorrhea
This is a situation in which a young woman has not begun to menstruate (i.e. menstruation has never occurred).
Common causes are:
Congenital abnormalities such as imperforate hymen -hematocolposis. If untreated the uterus and tubes may become filled with blood
Systemic diseases such as:
Thyroid and adrenal dysfunction
Juvenile diabetes mellitus
Ovarian diseases – Underactive ovaries
Malformations of the reproductive system
b) Secondary amenorrhea
Menstruation was present then ceased for at least three cycles or 6 months after normal menarche.
Causes of amennorrhoea
Endocrine gland tumor
Wasting chronic diseases (e.g. tuberculosis or starvation)
Emotional reactions affects the menses in various degrees
Exposure to radiations
Nervous tension due to:
Changes in occupation or environment
Fear or desire for pregnancy
Signs and symptoms:
Infrequent menstrual flow
Absence of menstrual flow
Additional symptoms may be associated with underlying disorder such as pregnancy hormonal imbalance or the beginning of menopause.
Management of patient with amenorrhoea
Managements include corrections of underlying cause
Balancing hormone level
Incision of the imperforated hymen
Treat the systemic disease
Relieve psychological stress
In some instance e.g., pregnancy or amenorrhoea due to emotional cause no treatment is necessary.
Encourage the patient to sick medical attention if absence of menstruation is not related to pregnancy, menopause or hormal imbalance if patient is experiencing other symptoms indicate that they could be many reasons for this symptoms and the importance of a thorough investigation to identify the problem.
Infection especially a client with imperforated hymen
This is an excessive duration or amount of menstrual blood loss than the usual at the time of normal menstrual period.
Is excessive bleeding at the time of normal mentstruation.
Chronic pelvic infection (PID)
Endocrine disturbances e.g.
Diabetes mellitus or disorders of the adrenal glands, ovaries or pituitary
Chronic liver condition
Excessive use of anticoagulants or thiazide diuretics
Retroversion of uterine
Signs and symptoms Menorrhagia
Excessive menstrual flow that may or may not be accompanied by cramping or severe pain
Diagnosis is based on description of the symptoms and the number of sanitary pads or tampons used compared to previous menstrual period.
Laboratory and diagnostic test, such as hormone studies, dilatation and curettage
A pelvic examination may reveal a fibroid tumor.
Management of patient with Menorrhagia
Additional treatments depend on the underlying cause, for example, the administration of hormones or surgical removal of fibroid tumor.
Iron supplements or whole blood transfusion in case of anaemia
Hysterectomy can be done to relieve the patient of this distressing symptom.
Once bleeding has stopped progesterone must be given for 14 days to induce secretory change and the endometrial shedding.
Instead of CEE you can give 17 hydroxyprogesterone acetate 125-250 mg intramuscularly, or oral norithisterone 20-30 mg/day in divided doses for 4 days
If a progesterone is used a withdrawal bleed may be expected 3-6 days later. To avoid this give norithisterone (5-10mg daily for 20 days.
If patient is seen between episodes you can give:
Tranexamic acid commencing on the first dose of menstruation.
Nonsteroidal anti-inflammatory drugs-this is commenced 4 days after menstruation.
Levonorgestrel intrauterine device-this normally cures the women in 3 months
Oral contraceptives-especially if bleeding is not severe
Complications of Menorrhagia
Metrorrhagia means bleeding or spotting between menstrual period slightly at mid cycle. It is associated with the decrease in estrogen level prior to ovulation.
Causes of Metrorrhagia
Uterine lesions such as fibroids, polyps, hyperplasia and carcinoma
Cervical erosion and carcinoma
Infection e.g PID
Changes in lifestyle i.e. changes in marital status, recent moves, financial stresses or undue excitement.
Signs and symptoms of patient of with Metrorrhagia
Slight pink or brownish spotting to frank bleeding
Some woman spot for a day or two mid way between menstrual period
Blood occurred when bleeding was not expected
NB- Spotting may also occur in early pregnancy and some time is a warning symptoms that abortion is eminent
Diagnostic measure of patient of with Metrorrhagia
Diagnosis is based on a history and additional test to determine the cause
Cytologic examination of cervical smears and urine.
Blood hormone levels.
Management of patient with Metrorrhagia
Dilatation and curettage
Cauterization of the cervix
Hysterectomy when medical management fails or if the woman no longer wishes to bear children
Complications of Metrorrhagia
Endometritis is an inflammation of the inner layer of the uterus the endometrium
Types of Endometritis
-Chronic Endometritis result from repeated acute attack
Bacteria e.g. Ecolli, streptococcus, gonococcus
Salpingitis(inflammation of fallopian tube sacro emen endometrial growth e.g. polyp carcinoma
Intra uterine contraceptive it affect the uteri acidity
Signs and symptoms of patient with endometritis
Menorrhagia (Excessive bleeding at time of normal menstrual )
Metrorrhagia (vaginal bleeding at time other than menstrual period) irregular bleeding
in chronic endometritis there is scan serosanguineous vagina discharge
Tender and enlarge uterus
Pain on defaecation may occur due enlargement of the uterus
Curettage and histolitiacal study of the recovered materials.
High vaginal swab for culture and sensitivity
Abscess formation (pelvic abscess)
Cervicitis Is an inflammation of the cervix
Causes of the cervix
Pre- disposing factors
Poor body hygiene
Diminished cervix resistance to infection in hypo vitamins
Irritation caused by foreign bodies e.g. pessaries or during sexual intercourse
Types of the cervicitis
A cute cervicits
This is an acute inflammation disorders with may result from continuous infection of the cervix during child birth or operative dilation of cervix or may be secondary vaginal or uterine infection by the gonococcus, Chlamydia and trichomococcus
This infection often follows a cute sepsis caused by bacteria invasion at the delivery or abortion is staphylococcus.
In such case pus is coming from the external pelvic.
Signs and symptoms cervicitis
Deep pelvic pain
Swelling of cervix
Leucorrhoea(sticky whitish) Excessive vaginal discharge
Dysparaumia (painful or difficult during sexual intercourse)
Dysuria (difficult during micturation)
Diagnostic measure of the cervicitis
History from the patient retraining the clinical manifestation
Physical examination – Inspect the cervix
Laboratory findings: –
Pus swab culture and sensitivity of the material obtained from cervix
Urine will contains only white cells, Absent erythrocyte and cuts
Anemia due to bleeding
In fertility due to recurrent infection
Cervical sternosis due to scar formation
Carcinoma of cervix
Strong herbal medicines are applied on curing these problems in reproductive system.