-A pain wich is utherine origin and directly due to menstruation.This is known as true dysmenorrhea.
-A pain which arises in a organ or tissue other than the uterus and which is merely associated with menstruation.
A pain which is equally severe before,throughout and after menstruation is lakely to have its origin in the psyche,no pelvic lesion can cause such.
Menstrual disconfort is typically midle or bilateral in the lower abdomen or back,but can be unilateral.
One sided dysmenorrhea experianced in the lower abdomen has only four possible bases:one horn of a malformed uterus,endometriosis which a unilateral distribution,a small fibroid at the uterotubal junction-the site of origin of uterine contractions,or spasm or distension in the colon.
Not less then 50% of wemen are said to experiance some disconfort in relation to manstruation,and 5-10% of girls in their late teens and early twenties are incapacitated for several hours each month.
Circumstances wich lead to nervous tension may make dysmenorrhea worse even if they do not cause it.This include unhappiness at home or at work,unsatisfied sex life,fear or loss of employment,or anxiety over examinations.
In true dysmenorrhea the pain sensation arise in the uterus and is related to muscle contractions.It is experianced a few hours before and after the onset of menstruation and rarely lasts in a severe form for longer than 12 hours.
During a severe attack the patient looks drawn and pale and may sweat,nausea and vomiting are common,there may be diarrhea and rectal and blodder tenesmus.All this features suggest an upset in the autonomic nervous system.
Prevention:
Unfavourable environmental factors,malnutrition,general ill health and any errors in the patient's mode of life should be corrected.
Regular physical activity of some kind is to be encouraged both between and during mensatruation.
While the pain is at its highest the girl may have to lie down relief from warmth applied to the lower abdomen.
Treatment:
The drugs most commonly employed to relieve pain and induce sleep were aspirin,paracetamol and codeine in various combinations.Proprietary antispasmodics can be effective if given 2 days before the expected date of the period has started Buscopan 20mg four times daily may be tried
Hormone therapy:
Anovulatory cycle are always painless so suppression of ovulation gives certain relief from true dysmenorrhea.This is best achieved by means of one of the progesteron-oestrogen oral contraceptive preparations
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