Dysmennorrhoea

Question 1

What is primary Vs secondary dysmenorrhoea?

Answer 1

Primary dysmenorrhoea usually starts near menarche, in absence of primary pelvic pathology.
Pain during menstruation, peaks during heaviest day, can affect function, cramps, nausea, vomiting. Pain to upper thighs, back etc. normal examination.

The history will typically include onset of pain within one year of menarche, pain occurring with each period and pain restricted to the first 1-3 days of the period.

Secondary amenorrhoea - starts later in life ie due to endometriosis, fibroids.
Secondary dysmenorrhoea can be caused by many different conditions, and patients therefore generally report various other symptoms such as heavy bleeding, dyspareunia, pain at other times of the cycle, fever, malaise or infertility. Heavy bleeding may be associated with uterine pathology.

Question 2

Outline a few evidence based treatments for primary dysmenorrhoea?

Answer 2

RCT Cochrane 2001 Vitamin B1 100mg/day seems to help
NSAIDs - reduce prostaglandins
Aspirin not as effective
Paracetamol not effective