Out of the three main types of dysmenorrhea, spasmodic dysmenorrhea is the most common type. It is said that almost half of adult female population suffer from varying degree of spasmodic dysmenorrhea at some time of their life. But only 10% of them will seek medical attention for the problem. It is generally taken that if a patient’s main problem is dysmenorrhea than it is spasmodic dysmenorrhea. This is because the main symptoms of other two types of dysmenorrhea are not dysmenorrhea but abdominal pain, menorrhagia etc.
The clinical symptoms of spasmodic dysmenorrhea are characteristic and the pain starts on the first day of menstrual bleeding, when severe excruciating lower abdominal pain is felt that last for a short time of approximately 30 minutes to one hour. This pain is severe and intermittent and spasmodic in nature and can lead to nausea, vomiting, fainting and collapse. Sometimes there may be mild shock if the pain is very severe. This initial severe pain of short duration is followed by less severe type of pain that is felt in the lower abdomen, pelvis and sometimes down in the antero-medial aspect of thigh. This pain usually lasts for less than 12 hours. Read more…
Congestive dysmenorrhea is premenstrual pain in lower abdomen or back and is generally seen among sedentary women. Congestive dysmenorrhea usually occur between three to five days (some times more than five days) before starting of menstruation and is always relieved by menstrual flow (pain goes away once menstruation starts).
Congestive dysmenorrhea should be regarded as a symptom of pelvic disease at first instance and there may be some pelvic abnormality in patient with congestive dysmenorrhea. Disease like pelvic adhesion, salpingo-oophoritis (inflammation of ovary and Fallopian tube), parametritis etc almost always produce congestive dysmenorrhea and this may be due to hyperaemic ovaries and covered by adhesions from inflammatory lesions. These lesions become tense during premenstrual period of menstrual cycle and cause pain. Congestive dysmenorrhea is also common symptom of certain diseases like myomas, adenomyoma, acquired retroversion of the uterus, chocolate cyst of ovaries etc. But all the patient of congestive dysmenorrhea does not have an organic disease and an example of congestive dysmenorrhea without an organic disease is premenstrual tension or premenstrual congestion syndrome.
Some patients with congestive dysmenorrhea get symptoms (pain and discomfort) referred to one of the iliac fossa usually left iliac fossa. Pain and discomfort is usually accompanied by disturbance in bowel habit (generally constipation and rarely diarrhea) and flatulence distension of abdomen (upper colon) which is due to spasm of some part of colon. Colon is palpable as a tender part of intestine in this situation. Diagnosis can be confirmed by barium enema and radiology. Frequently laxatives are taken with the mistaken idea that purgation will relieve the spasm but in reality it aggravates the condition.
Women suffering from Congestive Dysmenorrhea may be able to take certain medications for the pain and cramps associated with the condition. Any women who meet the criteria and qualify for this prescription medication should seriously consider obtaining it. These pharmacies are relatively new and they offer a great deal of convenience to those who are prescribed to a vast assortment of potentially life-saving medications. The fact that the medicine is delivered straight to the patient’s home is a major advantage as it reduces the chances that one would forget to take their daily dose.
The right management of this type of congestive dysmenorrhea is correct diet (avoiding carbohydrates), avoid purgatives and some anti spasmodic medicines that acts on bowel like Buscopan. These patients of congestive dysmenorrhea should be encouraged to do regular exercise as the patients are generally sedentary office worker.
Treatment of spasmodic dysmenorrhea can be following:
- Explanation of physiology of menstruation, education and reassurance to the patient are important aspects of management of spasmodic dysmenorrhea.
- Proper nutrition with balanced nutritious diet, regular physical activity (spasmodic dysmenorrhea is more common among women with sedentary lifestyle), and proper treatment of constipation and adaptation of healthy lifestyle are very much essential in the treatment of spasmodic dysmenorrhea.
- Initially spasmodic dysmenorrhea should be treated with simple analgesics (pain killers) like aspirin, paracetamol and codeine. Antispasmodics with atropine derivatives, Buscopan (hyoscine bromide), Baralgan etc. are also helpful. With any of the above a tranquillizer is beneficial.
- Prostaglandin synthetase (inhibit the actions of prostaglandins) inhibitors are successful in the treatment of spasmodic dysmenorrhea. Prostaglandin synthetase inhibitors reduce the activity of myometrium of uterus and reduce pain. The drugs are mefanamic acid (500 mg daily), flufenamic acid (200 mg daily), indomethacin (50 mg daily), and naproxen sodium (200 mg daily) etc. The side effects of these drugs are headache, GIT manifestations like vomiting, reduced menstruation, blurring of vision, acute renal problem etc. due to prolonged use.
- Endocrine treatment: oral contraceptive (steroids) pills can be of very good use in treatment of dysmenorrhea especially women who want contraception. The cure rate is very good, but the biggest disadvantage is the need of taking contraceptive pills for 21 days for the pain of few days (2 to 3 days) besides side effects and contraindications of oral pills.
- Danazol a drug which suppress hypothalamic-pituitary-ovarian axis is sometimes helpful in treatment of dysmenorrhea.
- Surgical dilatation of cervix is also useful in treatment of dysmenorrhea. But the relief may be temporary and excessive and forcible dilatation may lead to complications like premature labor, habitual abortion due to cervical incompetence in subsequent pregnancies. This is therefore not recommended.
- Presacral sympathectomy is a surgical procedure that is reserved for patients for whom all other measures have failed. But this surgery does not guarantee benefits.
- Hysterectomy is reserved for the cases for patients there is also pathology pelvis like fibroids and those who have completed their family and do not want any more children.