PRIMARYDYSMENORRHEA

Kanadi Sumapraja

Division of Reproductive Immuno-endocrinology Department of Obstetrics and Gynecology Faculty of Medicine University of Indonesia

Painful menses in women with normal pelvic anatomy

DEFINITION

ETIOLOGY

PGF2

PGE2

Smooth muscle contraction

ETIOLOGY

ETIOLOGY

Phospholipid from the death cells

Arachidonic acid

PGG2 PGH2

Prostaglandin Prostacyclin Thromboxane

Phospholipase A2 IsomeraseCOX

RISK FACTORS

Age < 20 years

Attempts to lose weight

Depression / anxiety

Disruption of social networks

Heavy menses

Nulliparity

Smoking

CLINICAL PRESENTATION

Usually presents during adolescence, within three years of menarche

Unusual for symptoms to start within the first six months after menarche

Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle

Symptoms of nausea, vomiting, diarrhea, fatigue, fever, headache or lightheadedness

SECONDARY DYSMENORRHEA

Dysmenorrhea occurring during the first one or trwo cycles after menarche

Dysmenorrhea beginning after 25 years of age

Late onset dysmenorrhea

Pelvic abnormality

Little or no response to therapy with NSAIDs, OC or both

TREATMENT

A = consistent, good-quality, patient-oriented evidence; B = inconsistent or limited quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series.

ROS INDUCES PGF2

Endometrial stroma

Decidualized endometrial stroma cell

Sugino et al, 2001

NSAID can reduce PGF2

Sugino et al, 2001

SOD regulated by steroid

Sugino et al, 2002

ROS and SOD

During normal cellular respiration, oxygen is reduced to water and highly reactive superoxide ( )

O2

O2 + 4H+ + 4 e- 2 H2O ( about 95% of the time)

(about 5% of the time)2 O2

ROS and SOD

These reactive oxygen species (superoxide) react with nucleic acids, sugars, proteins and lipids - eventually leading to protein degradation.

ROS and SOD balance

Antioxidant

Quenched Free Radical

Vitamin E

Protein

Phospholipid

Free Radical

PolyunsaturatedFatty Acid Cholesterol

Antioxidant role of vitamin E