primary dysmenorrhoea
menstrual pain associated with ovulatory cycle in abesence of pathologic finding.The pain usually begin within 1 to 2 years after menarche and become more sevre with time.The frequency of cases increases upto age 20.
clinical findings
It is low,midline,wave like,cramping pelvic pain often radiating to back or inner thigh.Cramps may last for 1 or more days and may be associated with nausea,diarrhoea,headache and flushing
treatment
NSAIDS such as ibuprofen,ketoprofen,mefenemic acid and naproxen and cox-2 inhibitor such as celecoxib are helpful.Medication should be started 1-2 days before expected menses.Ovulatiuon can be suppresed and dysmenorrhoea prevented by oral contraceptives or depot medroxy progesterone acetate. women who do not wish use hormonal contraceptive other therapies that shos some benefit:thiamine 100 mg/d orally,vit e 200 units/d orally from 2 days prior to and for first 3 days of menses.
secondary dysmenorrhea
organic cause exist for menstrual pain
clinical findings
history and physical examination suggest endometriosis or pid,submucous myoma and adenomyosis.
diagnosis
laproscopy,mri,hysteroscopy,usg
treatment
nsaids and oral contraceptives pills...gnrh agonist,lng ius in adenomyosis
hysterectomy is treatment of choice who have completed child bearing......