Dysmenorrhoea & Premenstrual syndrome

Dysmenorrhoea:
This term describes painful menstruation. The prevelance is high. It is classified into primary & secondary. In primary dysmenorrhoea there is usually no underlying organic pathology & the pain is thought to be the result of contraction of the myometrium which in turn caused by agents released from the endometrium at time of menstruation e.g, prostaglandins & leukotriene. Uterine blood flow decrease during contraction & minimum flow appear to coincide with maximal pain favouring the concept that ischaemia due to hypercontractility causes primary dysmenorrhoea.
Secondary dysmenorrhoea is often associated with pelvic pathology. These include:
Extrauterine pathology:
• Endometriosis
• Adhesions after pelvic inflammatory disease or previous surgery
Intrauterine pathology:
• Adenomyosis
• IUCD
Symptoms:
The peak incidence of primary dysmenorrhoea is in the late teens & twenties. The early cycles after the menarche are anovular & tend to be painless. The incidence then decreases with age & after child birth (possibly as a consequence of damage to nerve endings in the myometrium & cervix). Secondary dysmenorrhoea is mostly seen in women aged between 30-45 years.

Premenstrual syndrome:
It is the complaint of recurrent psychological or somatic symptoms (or both), ocurring in the luteal phase of the menstrual cycle & which resolve in the follicular phase at least by the end of menstruation. Premenstrual dysphoric disorder is the extreme predominantly psychological end of the PMS spectrum estimated to occur in 3-9% of women.
Depression, irritability, anxiety, tension, aggresion, inability to cope & feeling out of control are typical psychological symptoms. bloatedness, mastalgia, & headache are classical physical symptoms.