(dis″lip″ĭ-dē′mē-ă) [dys- + lipidemia] Any disorder of lipid (fat) metabolism, e.g., hypercholesterolemia or hypertriglyceridemia.
(dis″mă-choor-ĭt-ē) A condition in which newborns weigh less than established normal parameters for the estimated gestational age. SEE: intrauterine growth retardation; postmaturity.
(dĭs″mĕg-ă-lŏp′sē-ă) [″ + megas, big, + opsis, vision] Inability to visualize correctly the size of objects; they appear larger than they really are.
(dis″men″ŏ-rē′ă) [dys- + meno- + -rrhea] Pain associated with menstruation. It is one of the most frequent gynecological disorders and is classified as primary or secondary. An estimated 50% of menstruating women experience this disorder, and about 10% of these are incapacitated for several days during each menstrual period. This disorder is the greatest single cause of absence from school and work among menstrual-age women. In the U.S. this illness causes the loss of an estimated 140 million work hours each year. SEE: premenstrual tension syndrome.
ETIOLOGY: Primary dysmenorrhea has multiple possible causes, including hormonal imbalances, psychogenic factors, and increased prostaglandin secretion in menstrual flow, which intensifies uterine contractions, resulting in increased uterine hypoxia and pain. Above age 20, dysmenorrhea usually has a secondary cause. Secondary dysmenorrhea may be related to gynecologic disorders such as endometriosis, cervical stenosis, uterine leiomyomas (fibroids), uterine malposition, pelvic inflammatory disease, pelvic tumors, or adenomyosis. Dysmenorrhea may be associated with premenstrual syndrome symptoms such as frequent urination, nausea, vomiting, diarrhea, headache, backache, abdominal bloating, painful breasts, chills, irritability, and depression. Prostaglandins and their metabolites also can cause headache, syncope, and GI disturbances.
PATIENT CARE: Young women experiencing discomfort or pain during menstruation are encouraged to seek medical evaluation to attempt to determine the cause. Dysmenorrheal pain usually begins just before or at the start of menstrual flow and peaks within 24 hr. Pain is described as sharp, intermittent, cramping, radiating to the lower back, thighs, groin, or vulva. Relieving the pain should be the initial concern. Patients are taught to evaluate pain severity using a 1 to 10 scale. Pharmacological therapies include analgesics (aspirin, NSAIDs) for mild to moderate pain. These are most effective if taken 24 to 48 hr before the onset of menses, and are effective because they are anti-inflammatory and inhibit prostaglandin synthesis (by inhibiting the enzyme cyclooxygenase), decreasing the strength and severity of uterine contractions. Opioids or acetaminophen/opioid combinations may be prescribed for severe pain, to be used infrequently (when pain is at its worst). In primary dysmenorrhea, hormonal contraceptives relieve symptoms by suppressing ovulation (dysmenorrhea is associated with ovulatory cycles). Patients who would like to become pregnant should use anti-prostaglandins rather than hormonal therapies for their dysmenorrhea.
Support and assistance are offered to help the patient to deal with the problem. Appropriate patient teaching should be ...