Symptom Finder - Dysmenorrhea
DYSMENORRHEA
Visualizing the parts of the female reproductive system (see figure), on can systematically formulate a differential diagnosis of this common malady. At the cervix, stenosis, cervical polyps, and other neoplasms may obstruct the egress of blood and induce dysmenorrhea. In the uterus, polyps, fibroids, adenomyosis, and deformities such as anteflexion, retroflexion, anteversion, or retroversion may be the cause.
Pelvic congestion syndrome is a possibility. Does the patient have an intrauterine device (IUD)? This may be the cause. The tubes may be involved by endometriosis, abscess, or ectopic pregnancy. The ovaries may be involved by the same processes as the tubes, but they should suggest the most common cause of dysmenorrhea: hormonal. Thus, any condition— thyroid, pituitary, or ovarian—that might disturb the cyclic output of estrogen and progesterone in the proper sequence may induce dysmenorrhea. Psychogenic disturbances are especially significant.
Approach to the Diagnosis
The clinical approach to dysmenorrhea is simply to rule out significant organic disease by a thorough pelvic and rectal examination. If this cannot be done (obesity, etc.), then ultrasonography should be done. A smear and culture for gonococcus and Chlamydia should be done. If there is a negative examination and the pain is consistently relieved by nonsteroidal anti-inflammatory drugs (NSAIDs), nothing else needs to be done. A course of contraceptives or progesterone in adequate doses may then be tried. Diuretics may be indicated if examination suggests pelvic congestion. Removal of an IUD may relieve the pain. When the aforementioned measures fail, a dilatation and curettage (D&C) may be indicated. A gynecologist may decide to do a culdoscopy, a peritoneoscopy, or an exploratory laparotomy.
Other Useful Tests
1. Sonogram (pelvic inflammatory disease [PID], ectopic pregnancy)
2. Pregnancy test
3. Fern test and basal body temperature charting (endometriosis)
4. Gynecology consult
5. Psychiatric consult
6. Transvaginal ultrasonography
DYSMENORRHEA
Visualizing the parts of the female reproductive system (see figure), on can systematically formulate a differential diagnosis of this common malady. At the cervix, stenosis, cervical polyps, and other neoplasms may obstruct the egress of blood and induce dysmenorrhea. In the uterus, polyps, fibroids, adenomyosis, and deformities such as anteflexion, retroflexion, anteversion, or retroversion may be the cause.
Pelvic congestion syndrome is a possibility. Does the patient have an intrauterine device (IUD)? This may be the cause. The tubes may be involved by endometriosis, abscess, or ectopic pregnancy. The ovaries may be involved by the same processes as the tubes, but they should suggest the most common cause of dysmenorrhea: hormonal. Thus, any condition— thyroid, pituitary, or ovarian—that might disturb the cyclic output of estrogen and progesterone in the proper sequence may induce dysmenorrhea. Psychogenic disturbances are especially significant.
Approach to the Diagnosis
The clinical approach to dysmenorrhea is simply to rule out significant organic disease by a thorough pelvic and rectal examination. If this cannot be done (obesity, etc.), then ultrasonography should be done. A smear and culture for gonococcus and Chlamydia should be done. If there is a negative examination and the pain is consistently relieved by nonsteroidal anti-inflammatory drugs (NSAIDs), nothing else needs to be done. A course of contraceptives or progesterone in adequate doses may then be tried. Diuretics may be indicated if examination suggests pelvic congestion. Removal of an IUD may relieve the pain. When the aforementioned measures fail, a dilatation and curettage (D&C) may be indicated. A gynecologist may decide to do a culdoscopy, a peritoneoscopy, or an exploratory laparotomy.
Other Useful Tests
1. Sonogram (pelvic inflammatory disease [PID], ectopic pregnancy)
2. Pregnancy test
3. Fern test and basal body temperature charting (endometriosis)
4. Gynecology consult
5. Psychiatric consult
6. Transvaginal ultrasonography
