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Should Clinicians Focus on Dysmenorrhea or Menorrhagia? |
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Should Clinicians Focus on Dysmenorrhea or Menorrhagia?
By Charles Bankhead
ECCC (November. 18, 2009) Two thirds of women with menorrhagia as their sole presenting complaint had concomitant dysmenorrhea, which proved to be more bothersome than the heavy bleeding, data from a prospective study showed. In fact, almost 90% of patients with menorrhagia and dysmenorrhea said they would prefer relief from dysmenorrhea over treatment that addressed heavy bleeding.
“This puts the focus back on dysmenorrhea,” said Hector O. Chapa, MD, an obstetrician/gynecologist at the Women’s Specialty Center and Methodist Medical Center in Dallas. “Unfortunately, dysmenorrhea is so common that we tend to overlook it. We always try to look for another source of pathology.”
As many as half of young women complain of dysmenorrhea, which can lead to increased absenteeism from work or school in 15% of cases (Am J Obstet Gynecol. 1978;130:833-847, Obstet Gynecol. 2006;108:428-441). A study of 1,546 menstruating women showed that 60% had dysmenorrhea, and 60% of the dysmenorrheic patients reported moderate to severe pain (J Obstet Gynaecol Can. 2005;27:765-770). Half of the patients with dysmenorrhea reported that the condition limited activities, and 17% said the condition caused absenteeism.
The study presented at this year’s AAGL meeting included 100 women who presented with heavy menstrual bleeding as their sole complaint. The patients were asked whether menstruation was associated with painful cramps. Those who reported painful cramping were asked to rate the severity of the cramps by means of a visual analog pain scale that ranged from mild (0-3) to severe (7-10).
The patients were also asked about absenteeism from work or school resulting from menstruation-associated cramping and about the extent to which the pain limited daily activities. Lastly, the patients were asked whether they would prefer to be treated for the heavy bleeding or the associated cramping and pain if they had to choose one or the other.
Dr. Chapa reported that 67 of 100 women reported dysmenorrhea. The condition was severe in 20 of 67 (30%) cases and moderate in 30 of 67 (45%) cases. Approximately half of the patients (35 of 67) reported dysmenorrhea with every menstrual cycle. The average interval between periods was 29.1 days, and duration of menorrhagia averaged 6.1 days.
Of the 67 patients with dysmenorrhea associated with menorrhagia, 21 (31%) reported absenteeism from work or school because of dysmenorrhea, and 27 (40%) reported limitation of usual activities, including social withdrawal, sexual avoidance, and avoidance of physical activities.
Dr. Chapa found that 60 of 67 (89.5%) patients would prefer to treat the pain associated with dysmenorrhea than to treat the heavy bleeding. “Management of abnormal bleeding should stop focusing on abnormal bleeding and focus on quality of life,” he said. “This is really the issue.” (Dr Chapa disclosed that he is a consultant for Ethicon Women’s Health & Urology and for Conceptus.)
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