Management of dysmenorrhea

This article discusses dysmenorrhea which includes any pelvic pain felt by a woman during her menstrual period and which impacts her professional or academic life. The physiological mechanisms of essential dysmenorrhea are still poorly understood. Among the hypotheses put forth are: hyperactivity in the myometrium arrhythmic contractions a decrease in blood flow a drop in progesterone levels and hypersecretion of arginine vasopressin. Furthermore in organic dysmenorrhea the clinical investigation and interview cause an organic foundation to the pain to be suspected. The primary etiologies in question are external endometriosis adenomyosis sequelae from genital infections an intrauterine device and other etiologies such as uterine-vaginal malformations and cervical stenoses after surgery of the cervix. The first major step in the diagnostic approach is the interview which includes a characterization of the pain accompanying signs analysis of menstrual flow and the psychoaffective context. The gynecological examination is also a key step in the procedure. Additional investigations are prescribed in the case of dysmenorrhea which appears to be organic or resists symptomatic treatment. Though of no use in an adolescent or in a woman whose pain has all the characteristics of essential dysmenorrhea these additional investigations are specifically: ultrasound whenever there is doubt about the condition of the reproductive organs hysterosalpingography which is performed when adenomyosis is suspected but also to assess a uterine-vaginal malformation and finally celioscopy which is indicated to cap the assessment of an invalidating dysmenorrhea or one which responds poorly to medical treatments. It seeks any intrapelvic lesions. Therapeutic management is a function of physiopathological mechanisms. The goals of treatment are to control uterine hypercontractility suppress ovulation through oral contraception inhibit prostaglandin synthesis and reduce the concentration of intracellular calcium. Therefore treatment of essential dysmenorrhea is purely symptomatic and conditioned by the intensity of dysmenorrhea and the desire of the patient in terms of oral contraception. Treatment of secondary dysmenorrhea which is determined etiologically is however most often combined with symptomatic treatment required by the intensity of the pain.