DYSMENORRHEA
DYSMENORRHEA: Excerpt from Differential Diagnosis in Primary Care
Visualizing the parts of the female reproductive system (see figure),
one 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. 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. A smear and
culture for gonococcus and Chlamydia should be done. A course of contraceptives or
progesterone in adequate doses may then be tried. Diuretics may be indicated
if examination suggests pelvic congestion. 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
-
Sonogram (pelvic inflammatory disease [PID], ectopic pregnancy)
- Pregnancy test
- Fern test and basal body temperature charting (endometriosis)
- Gynecology consult
- Psychiatric consult
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Menorrhagia
More Medical Textbooks Online about Menorrhagia
Review other book chapters online related to Menorrhagia:
Medical Books Excerpts
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Consider von Willebrand Disease (vWD) in teenage patients with menorrhagia during menarche (Avoiding Common Pediatric Errors)
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