| |
Dysmenorrhea
French L.
Department of Family Practice,
Michigan State University, College of Human Medicine, East Lansing, Michigan
48824, USA. Linda.French@hi.msu.edu
Dysmenorrhea is the leading cause of
recurrent short-term school absence in adolescent girls and a common problem in
women of reproductive age. Risk factors for dysmenorrhea include nulliparity,
heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated
based on a typical history of painful menses and a negative physical
examination. Nonsteroidal anti-inflammatory drugs are the initial therapy of
choice in patients with presumptive primary dysmenorrhea. Oral contraceptives
and depo-medroxyprogesterone acetate also may be considered. If pain relief is
insufficient, prolonged-cycle oral contraceptives or intravaginal use of oral
contraceptive pills can be considered. In women who do not desire hormonal
contraception, there is some evidence of benefit with the use of topical heat;
the Japanese herbal remedy toki-shakuyaku-san; thiamine, vitamin E, and fish oil
supplements; a low-fat vegetarian diet; and acupressure.
|
|
|
|
If dysmenorrhea remains
uncontrolled with any of these approaches, pelvic ultrasonography should be
performed and referral for laparoscopy should be considered to rule out
secondary causes of dysmenorrhea. In patients with severe refractory primary dysmenorrhea, additional
safe alternatives for women who want to conceive include transcutaneous electric
nerve stimulation, acupuncture, nifedipine, and terbutaline. Otherwise, the use of danazol or
leuprolide may be considered and, rarely, hysterectomy. The effectiveness of
surgical interruption of the pelvic nerve pathways has not been
established.
Publication Types:
|
|
|
