2.
Periodic desquamation of the endometrium
The external hallmark of the menstrual cycle
Just before menses the endometrium is infiltrated
with leucocytes
Prostaglandins are maximal in the endometrium just
before menses
Prostaglandins constriction of the spiral arterioles
ischemia & desquamation
Followed by arteriolar relaxation, bleeding & tissue
breakdown
MENSTRUATION
3.
What is the mean duration of the MC?
Mean 28 days (only 15% of ♀)
Range 21-35
What is the average duration of menses?
3-8 days
What is the normal estimated blood loss?
Approximately 80 ml
When does ovulation occur?
Usually day 14
NORMAL MENSTRUAL CYCLE
5.
Painful menstruation of sufficient magnitude so as to
incapacitate day to day activities
Types:
Primary
Secondary
DYSMENORRHOEA
6.
CAUSES
1. Psychosomatic factor
2. Abnormal anatomical and functional aspect of
uterus
3. Role of vasopressin
4. Role of prostaglandins
5. Others
PRIMARY DYSMENORRHOEA
7.
General measures
Drugs
Prostaglandin Synthetase inhibitor
Oral Contraceptive pills
Surgery
Cervical dilatation
Bilateral block of pelvic plexus
Pre sacral neurectomy
TREATMENT
8.
Pain occurring in the presence of pelvic pathology
Treatment aims at the cause rather than the symptom
SECONDARY DYSMENORRHOEA
9.
PMS is a psychoneuro endocrine disorder of
unknown etiology, often noticed just prior to
menstruation
PREMENSTRUAL SYNDROME
10.
Alteration in the level of estrogen and
progesterone
Neuro endocrine factors
Psychological and psychosocial factors
others
PATHOPHYSIOLOGY
12.
Antidepressants or Tranquillizers
Pyridoxine 100 mg BD
Diuretics Frusemide 20 mg OD *5 days
Alprazolam 0.25 mg BD
SSRI Fluoxetine 20 mg
NON HORMONAL
13. OCP continued for 3 – 6 cycles
Progesteron Dydrogesterone 10 mg OD/BD from
fifth day of cycle *20 days
Levonorgestrel IUS
Bromocriptine 2.5 mg OD
Suppression of ovarian cycle
Danazol 200 mg OD
GnRH analogues - Goserelin
HORMONAL
14.
15.
Research studies
1. Primary dysmenorrhea and physical activity.
Department of Obstetrics and Gynecology, St.
Luke's-Roosevelt Hospital Center, New York, NY,
USA.(2012)
Abstract
It has been widely claimed that exercise is beneficial
to dysmenorrhea, yet solid evidence is lacking. Studies
investigating this relationship have been reviewed for
this paper. Most showed improved symptomatology
with exercise.
16.
2. Efficacy of vitamin B-6 in the treatment of
premenstrual syndrome
American college of Obstetrics and
gynaecology,USA,2012
Result
Suggest that doses of vitamin B-6 up to 100
mg/day are likely to be of benefit in treating
premenstrual symptoms and premenstrual depression.
17.
Write about Post menopausal symptoms and submit
on or before 9th of April.
Assignment
