PRIMARY DYSMENORRHOEA Primary dysmenorrhea is common menstrual cramps that are recurrent (come back) and are not due to other diseases. Pain usually begins 1 or 2 days before, or when menstrual bleeding starts, and is felt in the lower abdomen, back, or thighs. Pain can range from mild to severe, can typically last 12 to 72 hours, and can be accompanied by nausea and vomiting, fatigue, and even diarrhea. Common menstrual cramps usually become less painful as a woman ages and may stop entirely if the woman has a baby. SECONDARY DYSMENORRHOEA Primary dysmenorrhea means that your cramps are due to your cycle. Secondary dysmenorrhea is the term your doctor may use if you have a problem in your reproductive organs that causes your cramps. Several conditions can cause it: ENDOMETRIOSIS is a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus. PELVIC INFLAMMATORY DISEASE (PID) is an infection caused by bacteria that starts in the uterus and can spread to other reproductive organs. STENOSIS(narrowing) of the cervix , which is the lower part of the uterus, can be caused by scarring, as well as a lack of estrogen after menopause. UTERINE fibroids. RISK FACTORS You might be at risk of menstrual cramps if: You're younger than age 30 You started puberty early, at age 11 or younger You bleed heavily during periods (menorrhagia) You have irregular menstrual bleeding (metrorrhagia) You have a family history of menstrual cramps (dysmenorrhea) You smoke DIAGNOSIS Your doctor will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your doctor will check for abnormalities in your reproductive organs and look for signs of infection. If your doctor suspects that a disorder is causing your menstrual cramps, he or she may recommend other tests, such as 1)CBC count to see for presence of anemia. 2) Ultrasound: to rule out any pathology in the uterus, tubes and ovaries. 3) CT scan: done occasionally as it gives a more detailed finding. 4)Laproscopy: Although not usually necessary to diagnosis menstrual cramps, laparoscopy can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. To be continued------- dr shete