Dysmenorrhea and Management

Dysmenorrhea (dysmenorrhea) comes from the ancient Greek word "dys" meaning difficult / painful, "meno" means month, "rrhea" means flow / flow. Then dysmenorrhea is defined as pain that occurs during menstruation. There are two types of dysmenorrhea, namely primary dysmenorrhea (menstrual pain without pelvic abnormalities) and secondary dysmenorrhea (menstrual pain accompanied by pelvic abnormalities).

Risk factors for dysmenorrhea include heavy menstruation, irregular menstrual cycles, age less than 30 years, sexual violence, first menstruation at <12 years of age, malnutrition, obesity, family history, and smoking.

Primary dysmenorrhea can occur due to excessive production of prostaglandin by the endometrium. The production of prostaglandin is affected by progesterone levels, which increase during or immediately after menstruation begins. This prostaglandin causes uterine contractions so that pain is felt during menstruation. Secondary dysmenorrhea can occur due to endometriosis, adenomyosis, polyps, tumors, infections, and attachments.

Dysmenorrhea occurs 6-12 months from the first menstruation, during the menstrual cycle, and lasts for 8 - 72 hours. Complaints related to dysmenorrhea are back and thigh pain, headaches, diarrhea, nausea and vomiting. There are also other complaints such as pain during intercourse, too much menstrual blood, bleeding after intercourse, and bleeding between menstrual schedules that should be.

The doctor will diagnose dysmenorrhea by asking about the characteristics of menstrual pain, history of infection or vaginal discharge, and family history; the doctor will also examine the pelvis and genital organs; if necessary, the doctor will perform transvaginal ultrasonography.

Other useful tests include a pregnancy test for human chorionic gonadotropin in the urine; vaginal and cervical swabs, complete blood count, erythrocyte sedimentation rate in urine, and urinalysis. Cervical cytology can also be done to get rid of malignancy. MRI can be used as a second-line diagnostic choice

The main therapy is non-steroidal anti-inflammatory drugs such as mefenamic acid and ibuprofen. Treatment must be carried out one to two days before the onset of menstruation and continue with a fixed schedule for two to three days. In addition, hormonal contraception can also be used as a treatment for dysmenorrhea. Other therapies other than medicines are exercise and warm compresses.

Reference
1. Obstetrics and gynecology. 3th. Baltimore, MD: Lippincott Williams & Wilkins; 2016
2. aafp.org/ Diagnosis and initial management of dysmenorrhea
3. PNPK. Management of Menstrual Pain in Endometriosis. 2013

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