Dysmenorrhoea

Background

• 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)

Assessment

• 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
    • e.g. dyspareunia, vaginal discharge; menorrhagia; intermenstrual bleeding; post-coital bleeding;
  • 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

Management

• 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