treatment . At 24 she had her first baby and to date has not had severe cramps since her delivery .
Secondary dysmenorrhoea usually presents in women in their thirties , in women who have had children and is not related to any social status . It presents after history of relatively painless periods and usually associated with heavy menstrual flow or irregular bleeding and pelvic abnormalities on examination and generally poor response to combined oral contraceptive and Non-steroidal anti-inflammatory drugs such as brufen or diclofenac . It can also be associated with a vaginal discharge , dyspareunia ( painful sex ) and infertility .
Causes of Secondary dysmenorrhoea include pelvic infection , enodometriosis ( cells of the uterine lining outside the uterus ), adenomyosis ( cells of uterine lining in the muscle of uterus - these cells are normally only found in the lining and is what is shed off during menstruation ), uterine fibroids , endometrial polyps ( small growths arising from overproduction of lining of the uterus ), intrauterine contraceptive devices ( IUCD ) ovarian cysts and tumors .
Other causes are cervical stenosis ( when the cavity of the cervix is narrowed ) or occlusion , intrauterine adhesions ( bands of tissue that cause the walls of the uterus to be stuck together ), transverse vaginal septum ( this is a congenital abnormality in the vagina that consists of a barrier or wall blocking the upper part of the vagina hence no blood able to flow out of the vagina ) pelvic congestion syndrome , congenital malformations of the uterus such as bicornuate uterus .
There are no specific tests to diagnose primary dysmenorrhoea . The diagnosis is made on the basis of clinical findings .
Treatment of primary dysmenorrhea is directed at providing relief from the cramping pelvic pain and associated symptoms ( eg headache , nausea , vomiting , flushing , and diarrhea ) that typically accompany or immediately precede the onset of menstrual flow . The pelvic pain can be distressing and occasionally radiates to the back and thighs , often necessitating prompt intervention .
Non steroidal anti-inflammatory drugs ( NDAID )
NSAIDs are the most common treatment for both primary and secondary dysmenorrhea . They decrease menstrual pain by decreasing intrauterine pressure and lowering prostaglandin levels in menstrual fluid . Examples of common NSAIDS include Diclofenac , Ibuprofen , Ketoprofen , Mefenamic acid and Naproxen .
Other analgesic agents
Patients who do not respond to NSAIDs may require treatment with narcotics ( strong drugs such as morphine ) for pain control . Patients whose symptoms are not relieved by NSAIDs are very likely to have an underlying pelvic condition like endometriosis . Simple analgesics , such as aspirin and acetaminophen , may also be useful , especially when NSAIDs are contraindicated like in patients known to have ulcers .
Contraceptives
Oral contraceptives ( OCs ), which block monthly ovulation may decrease menstrual flow thereby reducing symptoms . The most commonly used are the combined oral contraceptive pills ( COCs ) and they may be an appropriate choice for patients who do not wish to conceive .
The levonorgestrel intrauterine device commonly known as Mirena , and depot medroxyprogesterone acetate
‘‘ Painful periods is very simplistic when we talk about dysmenorrhea ; it is painful menstruation that is severe enough to interfere with the day to day activities of the sufferer .’’
( the three monthly injection for family planning ) provide effective pain relief and are associated with reduced menstrual flow . It may be necessary to add an NSAID to the contraceptive chosen especially during the first few cycles after commencement of therapy .
Dietary and Other Therapies
Other therapies for dysmenorrhea have been proposed , but most are not well studied . A low-fat vegetarian diet , pyridoxine , magnesium , and vitamin E are examples .
In addition , acupuncture , acupressure , various herbal medicines and dietary supplements , transdermal nitroglycerin , calcium-channel blockers , beta-adrenergic agonists , antileukotrienes , transcutaneous electrical nerve stimulation ( TENS ) units , and massage therapy and isometric exercise have been suggested for therapeutic use in this setting . Topical application of continuous low-level heat may be beneficial for some patients . Interruption of nerve pathways has been performed , but data on it is limited .
I have not come across any literature but also a low salt diet and exercise anecdotally appears to improve symptoms and in primary dysmenorrhoea an association with great reduction in symptoms
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