Question

Discuss the following clinical terms: dysmenorrhea, endometriosis, salphingitis. What are the causes and treatment for each one of these clinical conditions?

Answer 1

Dysmenorrhea

Dysmenorrhea is described as low anterior pelvic pain, abdominal pain and cramping, occurs during menstruation and interferes with daily activity. Symptoms include nausea, headache and diarrhea, etc. Two types of dysmenorrhea exist. Primary dysmenorrhea occurs in young females and refers to menstrual pain without any underlying pathology, while secondary dysmenorrhea occurs in association with painful menstruation with underlying pathology. Treatment includes using Non-steroidal anti-inflammatory drugs (NSAIDs) which inhibit prostaglandins. In addition, hormonal treatments such as combined hormonal contraception, oral progestogen, depo-medroxyprogesterone acetate, levonorgestrel-containing intrauterine system are used.

Endometriosis

Endometriosis is one of the main causes of secondary dysmenorrhea. It is a chronic and recurrent estrogen-dependent inflammatory disease characterized by growth of endometrial stroma and glands. It induces dysmenorrhea, pelvic pain and infertility.

Causes include change in women’s lifestyle which includes late marriage that increases the number of times a woman menstruates and affects the incidence of endometriosis.

Imbalance of prostaglandins such as PGE2 and PGF2 alpha (higher) in the menstrual fluid of dysmenorrheal patients is usually observed. Initial decline of progesterone in the late secretory phase and over-activated prostaglandin levels in the late secretory phase resulting in synthesis of arachidonic acids and the pathway of cyclooxygenase is also seen.

NSAIDs and oral OCs are generally prescribed for endometriosis patients.

Salphingitis

Salphingitis is defined as the infection in the fallopian tubes which causes inflammation. Two types of salphingitis exist, acute and chronic. Symptoms include abdominal pain, pai during ovlation, nausea, fever, bloating etc. Since it is caused by many bacterial species which include, mycoplasma, streptococcus, Chlamydia, etc., antibiotics are routinely used for the treatment.

Answer 2

Dysmenorrhea:Pain in the pelvis or lower abdomen during menstruation is known as dysmenorrhea or menstrual cramps. The pain generally starts at the time of menstruation and lasts for three days.

Generally, the cause of dysmenorrhea is not known this is known as primary dysmenorrhea. If there is known cause such as endometriosis, it is known as secondary dysmenorrhea. The other causes of secondary dysmenorrhea include ovarian cysts and adenomyosis (ectopic glandular tissue).

Treatment: The management of symptoms is done by the birth control pills and non-steroidal anti-inflammatory drugs. The dietary supplements such as thiamine, vitamin E, fish oil, vitamin B6 and Chinese herbal medicine are also found to be effective.

Endometriosis:

Endometriosis is an altered physiological condition, in which the growth of endometrium occurs outside the uterus. The patients generally suffer from severe pain in the pelvic region.

The cause is not known in specific, but family history is found to be one of the cause. The ovaries, tissues surrounding the uterus and the fallopian tubes are generally affected.

Treatment: Pain is managed by non-steroidal anti-inflammatory drugs and hormone therapy. The surgical treatment (conservative of hysterectomy) is performed if necessary.

Salpingitis: The inflammation of fallopian tubes due to inflammation is known as salpingitis. The infection may origin in the vagina and spread to the fallopian tubes. The following are the risk factors of salpingitis.

1). Hysteroscopy

2). Endometrial biopsy

3). Curettage

4). Sexual intercourse

5). Menstruation

6). Ovulation

7). Treatment with antibiotics

8). Uterine contractions

Treatment: The treatment is done with antibiotics based on the causative organism.