Health Awareness blog

Subfertility is defined by involuntary failure to conceive after a couple having unprotected intercourse for a year. Infertility can be either primary or secondary. The incidence of primary infertility affected at least 12% of couples.  For diagnosis of infertility, coital history is essential and both partners should be investigated.

Primary infertility refers to a couple that never become pregnant after a year of unprotected sexual intercourse.

Secondary infertility means a couple have been pregnant at least once in their lifetime however have difficulty to become pregnant again.

Causes of infertility:

The total of causes are more than 100% because most of the time there is more than one factor that cause the infertility. Management of infertility is different for each problem. In severe case, assisted reproduction will be necessary.

Other related topic:

• Infertility – female factor
• Infertility – male factor

   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

  PRIMARY DYSMENORRHEA  

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.

  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.