Health Awareness blog

   Dysmenorrhoea is a recurring abdominal pain associated with menstruation. It can occur prior to onset, during or even after menstruation. It may be accompanied by headache, nausea, vomiting, backache and diarrhea. 50% of British women complaint of moderate pain while 12% complaint of severe disabling pain.

 Classification:

Primary dysmenorrhoea

Secondary dysmenorrhoea

It refers to painful menses without obvious and recognized pathology that occurs only during menstruation. The pain usually associated with ovulatory cycles. The pain is a result of imbalanced prostaglandin F2-alpha levels, which increase endometrial contractility (uterine contractions), which produce ischemic pain.

Most common seen in young adolescents, occurring fist few years after menarche (start of menses).

It usually precedes the onset of menses by several hours.

The pain is most severe during the first 24 hours, occasionally lasting more than 48 hours. However symptom can be expected to improve with age and childbirth.

  SECONDARY DYSMENORRHEA 

Secondary dysmenorrhoea is characterized by more severe pain. The pain may start prior to menses and continue after it has stopped.

It is usually related to an organic pathology in older women, often presented after many years of painless menses.

  Causes:

• Abnormal uterine growth, like adenomyosis, endometrial polyps and fibroids
• Uterine abnormalities
• Endometriosis
• Pelvic inflammatory disease
• Cervical stenosis (following dilatation and curettage)
• Intrauterine device

  Investigations:

• Ultrasound of the pelvis
• Laparascopy
• Hysteroscopy or imaging (i.e. MRI)

  TREATMENT  
Reassurance:

In young girls, reassurance that the pain will eventually ease in the years ahead and does not denote any serious pathology might give a big help.

  Analgesic:

In most cases, analgesic is adequate. NSAIDS is the best treatment option where it works in 80% of women. This class of agents reduces prostaglandin levels that sometimes become imbalance in ovulatory cycles.

In certain cases, NSAIDS can be prescribed together with ranitidine to reduce the gastric effects.

  Oral contraceptives:

This treatment is offered for patients who fail to respond to NSAIDs. This type of oral contraceptives contains 20 to 30mcg estrogen.

This type of treatment should be considered the first line treatment for young, sexually active women who presents with dysmenorrhoea and heavy menses (menorrhagia) because it provides the added benefit of contraception.

  Other hormonal options:

Intrauterine device containing levonorgestrel (mirena) or depot implants like etonogestrel (Implanon) is suitable for those requiring long term contraception.

  Supplementary therapies:

Topical heat treatment and aerobic exercise (increase endorphin levels and reduce analgesic

  Surgery:

This should be considered if nothing else works.

Reference:

1. Overview of gynaecology in primary care, medical tribune 1-15 march 2008, page 20.
2. Oxford handbook of clinical specialties, 5^th edition.

     Inverted nipple is one of the problems that might be facing by mothers. It is a problem when the nipples become retracted when areola is squeezed. Most of them might be very eager to breastfeed their baby but with this kind of problem the baby might refuse to suck the nipple and the mothers will feel discourage hence discontinue to breastfeed their baby.

For this group of mothers, don’t worry, because the babies attach to the areola and not the nipple. If the baby has difficulty attaching because the nipple cannot protrude sufficiently, then you can try some of the following method:

•         Cut a small hole at a brassiere to push the nipple out

•         Wear breast shell between feeds if available.

•         Use breast pump before feed, or someone else sucking(if acceptable)