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Primary Dysmenorrhea

Dysmenorrhea or painful menstrual periods is a common complaint with many women and adolescent girls. It is characterized by cramps and pain in the lower abdomen. Dysmenorrhea can be broadly classified as Primary and Secondary. While primary dysmenorrhea is identified with menstrual cycles, secondary dysmenorrhea can be traced to pelvic diseases such as endometriosis, pelvic inflammatory disease, lesions and other causes such as IUD or uterine fibroids. Primary Dysmenorrhea usually surfaces with early ovulatory cycles and can start in the teens or 20s. Primary dysmenorrhea is not indicative of any abnormal condition. Accompanying symptoms are vomiting, diarrhea, nausea and abdominal bloating. It is noticed that symptoms of primary dysmenorrhea reduce after pregnancy and in latter years. Pain can be a dull ache or spasmodic and cramping. Since the uterus goes into spasms to expel the endometrial tissue during menstruation, it leads to pain and cramps when the cervical passage is narrow. Pain radiates to the lower back and thighs.


A physician will conduct a pelvic examination to check for any possible growth, lesions or abnormalities. Those with a history of dysmenorrhea are usually advised to take medications a couple of days prior to menstruation. Adequate rest, good diet and exercise play a role in relieving the symptoms of dysmenorrhea. Mild analgesics and non-steroidal anti-inflammatory medications can relieve the pain and discomfort. Often oral contraceptives are prescribed to regulate the hormones and alleviate the symptoms of dysmenorrhea.

Mefenamic Acid

A non steroidal anti-inflammatory drug NSAID, Mefenamic acid is predominantly used for treating mild to moderate dysmenorrhea or menstrual pain for a short term, for not more than a week. It may also be used for treating other symptoms at the discretion of the doctor. Mefenamic acid helps to reduce inflammation and thereby pain by blocking the production of some of the body chemicals that cause inflammation, pain, tenderness, stiffness, swelling and increased temperature.


Mefenamic acid blocks the body from producing prostaglandins that are linked to inflammation, thus treating the symptoms of pain and inflammation. In muscles and joints, Mefenamic acid helps to improve movement by reducing inflammation, although it may take a few weeks to relieve pain after the first few doses. This medicine is normally prescribed at the lowest possible dose for the shortest period of time to reduce chances of any side-effects. However, Mefenamic acid should not be taken if the patient exhibits the following:


  • Is allergic to any ingredient in Mefenamic acid.
  • If the patient has allergic reaction such as severe rash, trouble breathing, dizziness and is allergic to aspirin or to any NSAID such as ibuprofen etc.
  • Had bypass heart surgery recently.
  • Had kidney problems, ulcers, or inflammation of the stomach or bowel.
  • Is in the last 3 months of pregnancy.
  • It is not advised to use this acid on the elderly. They may be more sensitive to its effects, especially stomach bleeding and kidney problems.
  • Mefenamic acid should be used with extreme caution in children younger than fourteen years of age.

Before using Mefenamic acid, a woman must check the following:


  • If she is pregnant or planning to become pregnant or is breast-feeding.
  • If she is taking any prescription or non-prescription medicine (including herbal preparation) or dietary supplements.
  • If she exhibits allergies to medicines, foods or other substances.
  • If she has a history of liver disease, diabetes, or stomach or bowel problems such as bleeding, ulcers and perforation.
  • If she has a history of swelling or fluid buildup, breathing problems and asthma, or mouth inflammation.
  • Has high blood pressure, blood disorders, clotting, or is at risk of any other disease.
  • If she is in poor health, suffers dehydration or low fluid volume, low sodium levels, drinks alcohol or has a history of alcohol abuse.

Using Mefenamic acid

There are some medicines which could interact with Mefenamic acid and the healthcare provider has to be informed if any one of the following is taken:


  • Anticoagulants such as aspirin, corticosteroids, heparin; as there could be the risk of increased stomach bleeding.
  • Magnesium hydroxide; which could increase the side effects.
  • Cyclosporine, lithium, methotrexate (such as ciprofloxacin), sulfonylureas; as the risk of side effects are increased.
  • Angiotensin or diuretics because their effectiveness is reduced by Mefenamic acid.

This acid has to be used with great caution as it could cause dizziness or drowsiness. This can get worse if you take it with alcohol or certain medicines. As Mefenamic acid may interfere with certain lab tests, be sure that the doctor or lab technologist knows that Mefenamic acid is being taken - especially in case of blood cell counts, blood pressure, kidney function tests.



Adenomyosis

Adenomyosis is a condition of the uterus wherein endometrial tissue that lines the inner wall of the uterus breaks through and invades the muscle layers of the organ. Most commonly, the disease affects the back wall (posterior side) of the uterus. It is a benign condition that primarily affects women aged between 35 to 50. Adenomyosis is only seen in women in their reproductive years because its growth requires estrogen. Adenomyosis can occur only till a woman produces estrogen. So this condition is unlikely in menopausal women. Adenomyosis results in enlargement of the uterus; sometimes to even two or three times its original size. The condition can lead to difficulties in getting pregnant or sustaining a pregnancy.


Adenomyosis Symptoms

The extra tissue in the uterine muscles leads to painful menstrual cycle and heavy bleeding. In endometriosis, the endometrial glands live outside the uterus while in adenomyosis, the glands remain within the uterus but deeply embedded into its walls. A woman can suffer both conditions. Some of the symptoms of Adenomyosis include:


  • Pelvic pain

  • Abdominal pressure and bloating sensation

  • Prolonged periods, lasting up to 8-12 days

  • Bladder pressure with frequent urination

  • Dysmenorrhea

  • Abnormal discharge of blood clots during menstruation

  • Pain during sexual intercourse.

Causes and risk factors

The causes of Adenomyosis is not known. However medical experts have identified few factors that can cause Adenomyosis.


  • Invasive growth of tissue due to history of uterine surgery or through incisions made near the uterus during C-section may lead Adenomyosis.

  • Postpartum uterine inflammation after childbirth, may cause a break in the boundary of the uterine wall causing endometrial cells to invade the myometrium (muscle tissue of the uterus).

  • Bone marrow stem cells invade the uterine musculature leading to adenomyosis.

Research is still going on to identify the exact causes of Adenomyosis. However certain risk factors have been identified. Women in their reproductive age, Women over 30 years of age and Women with previous history of cesarean section or other uterine surgery carry the risk of developing Adenomyosis.


Diagnosis and Treatment

The diagnosis of Adenomyosis is tricky, as its symptoms mimic the symptoms other uterine conditions like fibroids and endometriosis. Confirmed diagnosis of Adenomyosis is only made through trans-vaginal ultrasound scan and MRI.

Mild cases of Adenomyosis are treated with analgesics to manage symptoms like pain and heavy bleeding. Doctors may also recommend intrauterine devices and hormonal treatment to reduce the symptoms.

If the woman in question does not respond to the above treatments and is still in a child bearing age, surgical resection of the adenomyosis from the muscle of the uterus can be done with preservation of the uterus. However, this is possible only if the disease is localized with well-defined borders. Hysterectomy is the common surgical option performed on women who are unable to respond to medications and hormone treatments.


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Collection of Pages - Last revised Date: November 11, 2019