Dysmennorhoea

Question 1

What is it

Answer 1

Severe or debilitating pain accompanying menstruation

Question 2

What are primary and secondary dysmennorhoea?

Answer 2

Primary dysmenorrhoea is idiopathic and occurs in the absence of pelvic pathology.

Secondary dysmenorrhoea is associated with underlying pathology such as endometriosis, pelvic inflammatory disease, or uterine fibroids.

Question 3

What are common symptoms?

Answer 3

Pelvic pain
Nausea
Vomiting
General malaise
Diarrhoea
Fatigue

Question 4

What are the differentials?

Answer 4

Endometriosis: Characterised by pelvic pain, dyspareunia, and infertility.

Pelvic inflammatory disease: Symptoms include lower abdominal pain, abnormal vaginal discharge, and fever.

Uterine fibroids: Often asymptomatic but may cause pelvic pain and heavy menstrual bleeding.

Question 5

What investigations are done?

Answer 5

Ruling out sexually transmitted infections
Examination for abdominal tenderness/mass, bimanual examination assessing for cervical tenderness
Pelvic ultrasound if investigations suggest underlying pathology (e.g. fibroids, endometriosis)

Question 6

What are management strategies?

Answer 6

NSAIDs
Tranexamic acid
Combined OCP
Prog-only pill
Levonorgestrel-releasing intrauterine system (e.g. Mirena©)
Contraceptive injection (e.g. Depo Provera©)
Contraceptive implant (Nexplanon©)
In rare cases refractory to medical management, surgical interventions such as endometrial ablation or hysterectomy may be considered.