What are primary and secondary dysmenorrhoea?
Primary dysmenorrhoea is pain starting about the time that the monthly bleeding begins.
Secondary dysmenorrhoea begins a few days before the onset of the period. It tends to be associated with disease processes including:
- pelvic inflammatory disease (Q 20.2),
- fibroids),
- pelvic congestion (30)
- endometriosis.
Typically, primary dysmenorrhoea starts within a few months of the menarche (first period) whereas secondary dysmenorrhoea starts later after the disease process has developed.
What is retrograde menstruation?
Most of the blood shed with the endometrial lining during a period is passed out through the cervix and then the vagina.
During a period, if the internal pelvic organs are inspected by a gynaecologist (e.g. laparoscopy) there is almost invariably a little blood that has tracked up through the Fallopian tubes. This blood may irritate the peritoneum (Q 2.4) resulting in pain (peritonism).
How can painful periods be treated?
Most teenage girls experience some painful periods. It may be distressing for a teenager to discover that womanhood may involve physical pain as well as emotional upheaval. Usually mild analgesics (pain-killers), such as paracetamol, are all that are required. If this proves inadequate, early medical assessment is advisable. Uncomfortable pelvic examination of young teenagers by the doctor can usually be avoided; an ultrasound picture (pelvic ultrasound) to check that the womb and ovaries appear healthy can provide reassurance to all concerned.
Stronger analgesics (Q 24.17D) or mild hormone treatment should be considered. The hormone treatments include progestogens (e.g. Duphaston or Provera –Q24.17B) or perhaps one of the combined oral contraceptive pills (Table 16.1). There is evidence that the combined oral contraceptive pill can be used to effectively and safely treat dysmenorrhea associated with endometriosis.0804
A positive attitude, encouragement that there are a variety of treatment options for painful periods and reassurance that the girl can continue with a full and active life, should be emphasised.
Patient Story - Dysmenorrhoea:
A sixteen-year old girl was referred because of debilitating primary dysmenorrhoea and slightly heavy periods. Through the first two consultations, her mother in the presence of her daughter, emphasised her anxieties about endometriosis. The mother had suffered with endometriosis for many years eventually requiring hysterectomy (hysterectomy) although not even this provided relief from her pain. Investigation, including ultrasound but not laparoscopy, showed no obvious abnormality. Initially, the mother was reluctant to agree to medical treatment without the laparoscopy as We may be missing something?. Eventually, she accepted that the majority of women have some degree of endometriosis and that the combined contraceptive pill may prove effective for minimal endometriosis, retrograde menstruation or unexplained primary dysmenorrhoea. The girl was not in favour of laparoscopy particularly when we explained that the procedure carries a one in a thousand chance of damage necessitating laparotomy. The pill was prescribed and three months later the girl came to the clinic by herself. The pain had vanished with the medication and she was very happy.
The treatment of secondary dysmenorrhoea will depend on the underlying cause (5).
Related Medical Abstracts - Click on the paper title:-
Please click on the required question.
- Pelvic Pain. Is this a common problem?
- �What are the common causes of pelvic pain in women?
�What are the more common gynaecological causes of pelvic pain?
�What are the more common non-gynaecological causes of pelvic pain?
�What are primary and secondary dysmenorrhoea - painful periods?
�What is retrograde menstruation?
�How can dysmenorrhoea - painful periods be treated?
�What are ovarian cysts?
�How do ovarian cysts cause pain?
�How are ovarian cysts diagnosed?
�How are ovarian cysts treated?
�I think I may be pregnant and I have some pelvic pain. What should I do?
�What is pelvic inflammatory disease and how can it be treated? - 3 What are the more common gynaecological causes of pelvic pain?
- 4 What are the more common non-gynaecological causes of pelvic pain?
- 5 What are primary and secondary dysmenorrhoea - painful periods?
- 6 What is retrograde menstruation?
- 7 How can dysmenorrhoea - painful periods be treated?
- 8 What are ovarian cysts?
- 9 How do ovarian cysts cause pain?
- 10 How are ovarian cysts diagnosed?
- 11 How are ovarian cysts treated?
- 12 I think I may be pregnant and I have some pelvic pain. What should I do?
- 13 What is pelvic inflammatory disease and how can it be treated?
FIBROIDS
- �What are Fibroids?
�I have Fibroids. What difficulties might they cause for me?
�How are Fibroids diagnosed?
�How could my Fibroids be treated?
�I have Fibroids. What difficulties might they cause for me?
�How are Fibroids diagnosed?
�How could my Fibroids be treated?
- 16 How are fibroids diagnosed?
- 17 How could my
fibroids be treated?
ENDOMETRIOSIS
- 18 What is endometriosis?
- 19 How prevalent is endometriosis?
- 20 What causes endometriosis?
- 21 How can my endometriosis be treated?
- 22 How can my doctor determine the cause of my pelvic pain?
- 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
- 24 What is laparoscopy?
- 25 What are pelvic adhesions?
- 26 I have chronic pelvic pain. Could this be related to adhesions?
- 27 What is uterine retroversion (retroverted uterus)
- 28 Does a retroverted uterus cause symptoms?
- 29 How is a retroverted uterus treated?
- 30 What is pelvic congestion?
- 31 What causes pain associated with sexual intercourse (dyspareunia)
- 32 How can painful sexual intercourse (dyspareunia) be treated?
- 33 What is a pelvic mass?
IRRITABLE BOWEL SYNDROME - IBS
- 34 What is irritable bowel syndrome?
- 35 How can we find out if I have irritable bowel syndrome?
- 36 Is irritable bowel syndrome (IBS) a common condition?
- 37 What causes IBS?
- 38 What is the pain associated with IBS like?
- 39 Can IBS be mistaken for gynaecological problems?
- 40 How can my IBS be managed?
- 41 What other treatments are available for IBS?
- 42 What can be done to reduce the amount of bowel gas(flatus)
- 43 What is constipation?
- 44 What causes constipation?
- 45 How can constipation be treated?
- 46 How could we summarise the treatments that are available for my pelvic pain?
- 47 Where can I obtain more information?
- 48 Pelvic Pain Support Groups.
- 49 Endometriosis Support Groups.
- 50 IBS Support Groups.
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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
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