Makindo Medical Notes.com

Secondary dysmenorrhoea refers to painful menstrual cramps that are caused by an underlying medical condition, often appearing later in life than primary dysmenorrhoea. Unlike primary dysmenorrhoea, which is typically caused by prostaglandin-mediated uterine contractions, secondary dysmenorrhoea is often associated with a specific pelvic pathology.

About

• Is secondary to a pathological process
• Is commonest in women over the age of 30 who have been pain-free for years
• Dull ache 3-4 days before menses

Causes

• Endometriosis: endometrium grows outside the uterus, causing pain, inflammation, and often secondary dysmenorrhoea.
• Adenomyosis: endometrial tissue grows into the muscular wall of the uterus, leading to heavy, painful periods.
• Fibroids (Uterine Leiomyomas): Benign tumours of the uterus that can cause pain, pressure, and heavy menstrual bleeding.
• Pelvic Inflammatory Disease (PID): An infection causing chronic pelvic pain and painful menstruation.
• Intrauterine Device (IUD) Complications: menstrual pain if they have an IUD, particularly if it is improperly positioned or causes irritation.
• Cervical Stenosis: cervical opening is narrow, causing increased pressure within the uterus during menstruation and leading to pain.
• Ovarian Cysts: Cysts on the ovaries can cause pain during menstruation, particularly if they rupture or cause torsion.

Investigations

• Laparoscopy, Ultrasound, Possible D&C
• Hysteroscopy and Hysterosalpingography

Treatment

• Medications:
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):first line of treatment to reduce pain and inflammation.
  • Hormonal Therapy: Birth control pills, progestins, or gonadotropin-releasing hormone (GnRH) agonists can help regulate or suppress menstruation, reducing symptoms.
  • Antibiotics: Treat any PID, antibiotics are prescribed.
• Surgical Treatment:
  • Laparoscopic Surgery: remove endometriosis lesions, fibroids, or ovarian cysts.
  • Hysteroscopy: remove polyps, fibroids, or adhesions within the uterine cavity.
  • Hysterectomy: removal of the uterus may be considered, particularly in women who do not wish to preserve fertility.
• Lifestyle Modifications: Regular exercise, stress management, and dietary changes can help alleviate symptoms in some women.