• Painful cramping, usually in the lower abdomen, occurring shortly before and/or during menstruation
  • Most common gynaecological symptom (50-90% of menstruating women)
  • Can be
    • Primary (absence of any underlying pathology- thought to be due to excess prostaglandin synthesis)
    • Secondary (e.g. to endometriosis, fibroids or endometrial polyps)


  • It is vital to exclude a secondary cause before diagnosing primary dysmenorrhoea
    • Ask about onset
      • Primary dysmenorrhoea tends to occur within 0-2 years of menarche (later than this suggests secondary cause)
    • Associated symptoms
    • Ask about IUD/IUS contraception (these can cause dysmenorrhoea)
    • Perform an abdominal examination and pelvic examination (unless never been sexually active)
  • A history suggestive of primary dysmenorrhoea includes
    • Pain beginning shortly before menstruation and progressively improving with menstruation progression
      • There may be associated features e.g. nausea/vomiting; migraine; bloating; emotional symptoms BUT other gynaecological features are rare (usually suggestive of secondary cause) and pelvic examination is normal


  • Treat underlying secondary cause
  • For primary dysmenorrhoea
    • offer NSAID e.g. ibuprofen, mefenamic acid (unless contraindicated)
      • Paracetamol if CI
    • If the woman does not wish to conceive, the COCP can be a good second line treatment, as can other hormonal contraceptives (can be used in conjunction with NSAID

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