STUDY - Technical - New Dacian's Medicine
Dysmenorrhea
(Classical / Allopathic Medicine)
Dysmenorrhea -
painful menstruation - affects more than 50% of menstruating
women; in fact, it's the leading cause of lost time from
school and work among women of childbearing age. Dysmenorrhea
may involve sharp, intermittent pain or dull, aching pain.
It's usually characterized by mild to severe cramping or
colicky pain in the pelvis or lower abdomen that may radiate
to the thighs and lower sacrum. This pain may precede
menstruation for several days or may accompany it. The pain
gradually subsides as the bleeding tapers off.
Dysmenorrhea may
be idiopathic, as in premenstrual syndrome and primary
dysmenorrhea. It commonly results from endometriosis and other
pelvic disorders. It may also result from structural
abnormalities such as an imperforate hymen. Stress and poor
health may aggravate dysmenorrhea; rest and mild exercise may
relieve it. Other conditions that mimic dysmenorrhea include
ovulation and normal uterine contractions that occur during
pregnancy.
HISTORY:
Ask the patient how long she's been experiencing the pain.
Ask the patient to describe her dysmenorrhea. Is it intermittent or continuous? Sharp, cramping, or aching? Ask her what relieves her cramps.
Ask the patient where the pain is located and whether it's bilateral. Does it radiate to her back?
Ask the patient when the pain begins and ends and when it's severe.
Ask the patient about associated signs and symptoms, such as nausea and vomiting, altered bowel or urinary habits, bloating, pelvic or rectal pressure, and unusual fatigue, irritability, and depression.
Obtain a menstrual and sexual history. Ask the patient if her menstrual flow is heavy or scant. Have her describe any vaginal discharge between menses. Find out if she experiences pain during sexual intercourse, and does it occur with menses. Note her method of contraception, and ask about a history of pelvic infection.
Find out if the patient has any signs and symptoms of urinary system obstruction, such as pyuria, urine retention, and incontinence.
Determine how the patient copes with stress.
Ask the patient how long she's been experiencing the pain.
Ask the patient to describe her dysmenorrhea. Is it intermittent or continuous? Sharp, cramping, or aching? Ask her what relieves her cramps.
Ask the patient where the pain is located and whether it's bilateral. Does it radiate to her back?
Ask the patient when the pain begins and ends and when it's severe.
Ask the patient about associated signs and symptoms, such as nausea and vomiting, altered bowel or urinary habits, bloating, pelvic or rectal pressure, and unusual fatigue, irritability, and depression.
Obtain a menstrual and sexual history. Ask the patient if her menstrual flow is heavy or scant. Have her describe any vaginal discharge between menses. Find out if she experiences pain during sexual intercourse, and does it occur with menses. Note her method of contraception, and ask about a history of pelvic infection.
Find out if the patient has any signs and symptoms of urinary system obstruction, such as pyuria, urine retention, and incontinence.
Determine how the patient copes with stress.
Relief for
dysmenorrhea
To relieve cramping and other symptoms caused by primary dysmenorrhea or an intrauterine device, the patient may receive a prostaglandin inhibitor, such as aspirin, ibuprofen, indomethacin, or naproxen. These nonsteroidal anti-inflammatories block prostaglandin synthesis early in the inflammatory reaction, thereby inhibiting prostaglandin action at receptor sites. These drugs also have analgesic and antipyretic effects.
Make sure you and your patient are informed about the adverse effects and cautions associated with these drugs.
To relieve cramping and other symptoms caused by primary dysmenorrhea or an intrauterine device, the patient may receive a prostaglandin inhibitor, such as aspirin, ibuprofen, indomethacin, or naproxen. These nonsteroidal anti-inflammatories block prostaglandin synthesis early in the inflammatory reaction, thereby inhibiting prostaglandin action at receptor sites. These drugs also have analgesic and antipyretic effects.
Make sure you and your patient are informed about the adverse effects and cautions associated with these drugs.
Adverse effects
Alert the patient to possible adverse effects of prostaglandin inhibitors. Central nervous system effects include dizziness, headache, and vision disturbances. GI effects include nausea, vomiting, heartburn, and diarrhea. Advise the patient to take the drug with milk or after meals to reduce gastric irritation.
Alert the patient to possible adverse effects of prostaglandin inhibitors. Central nervous system effects include dizziness, headache, and vision disturbances. GI effects include nausea, vomiting, heartburn, and diarrhea. Advise the patient to take the drug with milk or after meals to reduce gastric irritation.
Contraindications
Because prostaglandin inhibitors are potentially teratogenic, be sure to rule out the possibility of pregnancy before starting therapy. Advise a patient who suspects she's pregnant to delay therapy until menstruation begins.
Because prostaglandin inhibitors are potentially teratogenic, be sure to rule out the possibility of pregnancy before starting therapy. Advise a patient who suspects she's pregnant to delay therapy until menstruation begins.
Other cautions
Use caution when administering a prostaglandin inhibitor to a patient with cardiac decompensation, hypertension, renal dysfunction, or a coagulation defect or to a patient receiving ongoing anticoagulant therapy. Because patients who are hypersensitive to aspirin may also be hypersensitive to other prostaglandin inhibitors, watch for signs of gastric ulceration and bleeding.
Use caution when administering a prostaglandin inhibitor to a patient with cardiac decompensation, hypertension, renal dysfunction, or a coagulation defect or to a patient receiving ongoing anticoagulant therapy. Because patients who are hypersensitive to aspirin may also be hypersensitive to other prostaglandin inhibitors, watch for signs of gastric ulceration and bleeding.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, noting fever and accompanying chills.
Inspect the abdomen for distention, and palpate for tenderness and masses. Note costovertebral angle tenderness.
Take the patient's vital signs, noting fever and accompanying chills.
Inspect the abdomen for distention, and palpate for tenderness and masses. Note costovertebral angle tenderness.
SPECIAL
CONSIDERATIONS:
In the past, women with dysmenorrhea were considered neurotic. Although current research suggests that prostaglandins contribute to this symptom, old attitudes persist. Encourage the patient to view dysmenorrhea as a medical problem, not as a sign of maladjustment.
In the past, women with dysmenorrhea were considered neurotic. Although current research suggests that prostaglandins contribute to this symptom, old attitudes persist. Encourage the patient to view dysmenorrhea as a medical problem, not as a sign of maladjustment.
PEDIATRIC
POINTERS:
Dysmenorrhea is rare during the first year of menstruation before the menstrual cycle becomes ovulatory. However, the incidence of dysmenorrhea is generally higher among adolescents than older women.
Dysmenorrhea is rare during the first year of menstruation before the menstrual cycle becomes ovulatory. However, the incidence of dysmenorrhea is generally higher among adolescents than older women.
PATIENT
COUNSELING:
If dysmenorrhea is idiopathic, advise the patient to place a heating pad on her abdomen to relieve pain. This therapy reduces abdominal muscle tension and increases blood flow. Giving a nonsteroidal anti-inflammatory 1 to 2 days before the onset of menses is usually helpful. (See Relief for dysmenorrhea.)
If dysmenorrhea is idiopathic, advise the patient to place a heating pad on her abdomen to relieve pain. This therapy reduces abdominal muscle tension and increases blood flow. Giving a nonsteroidal anti-inflammatory 1 to 2 days before the onset of menses is usually helpful. (See Relief for dysmenorrhea.)
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)