1. PRIMARY DYSMENORRHEA Kanadi Sumapraja
Division of Reproductive Immuno-endocrinology Department of Obstetrics and Gynecology Faculty of Medicine University of Indonesia

2. DEFINITION
Painful menses in women with normal pelvic anatomy

3. ETIOLOGY
Smooth muscle contraction
PGF2a
PGE2

4. ETIOLOGY

5. ETIOLOGY Phospholipid from the death cells
Prostaglandin Prostacyclin Thromboxane
Arachidonic acid
PGG2 PGH2
Phospholipase A2
COX
Isomerase

6. Attempts to lose weight Disruption of social networks
RISK FACTORS
Age < 20 years
Attempts to lose weight
Depression / anxiety
Disruption of social networks
Heavy menses
Nulliparity
Smoking

7. 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

8. 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

9. 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.

10. ROS INDUCES PGF2a Endometrial stroma
Decidualized endometrial stroma cell
Sugino et al, 2001

11. NSAID can reduce PGF2a
Sugino et al, 2001

12. SOD regulated by steroid
Sugino et al, 2002

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

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

15. ROS and SOD balance

16. Antioxidant

17. Antioxidant role of vitamin E
Free Radical
Quenched Free Radical
Polyunsaturated
Fatty Acid
Protein
Cholesterol
Phospholipid

18. THANK YOU