Dysmenorrhea

Question 1

What are the 2 types of dysmenorrhea?

Answer 1

1. primary = not due to underlying pelvic pathology
2. secondary = due to underlying pelvic pathology

Question 2

What is the pathophysiology thought to be of dysmenorrhea?

Answer 2

Prostaglandins released stimulate myometrial contraction and spiral artery vasospasm causing ischaemia of the secretory layer of the endometrium.

Question 3

What are the risk factors of dysmenorrhea?

Answer 3

Early menarche
Long menstrual phase
Heavy periods
Smoking
Nuliparity

Question 4

DDx of dysmenorrhea?

Answer 4

Primary dysmenorrhoea is a diagnosis of exclusion. Therefore, other diagnoses to consider are the main causes of secondary dysmenorrhoea:

Endometriosis
Adenomyosis
Pelvic inflammatory disease
Adhesions
Non-gynaecological differentials include inflammatory bowel disease and irritable bowel syndrome.

Question 5

How do you investigate dysmenorrhea?

Answer 5

No investigations are specific to primary dysmenorrhoea and therefore the work up is focused on ruling out underlying pathology.

If the patient is at high risk of a sexually transmitted infection, then a high vaginal swab and endocervical swabs are indicated to screen for underlying infection.

If on examination a pelvic mass is palpated, a transvaginal ultrasound scan (TVS) should be performed to investigate further.

Question 6

How do you manage dysmenorrhea?

Answer 6

depends on the pathology… or else symptom mgmt

Lifestyle Changes
Stop smoking (there is a clear relationship between smoking and dysmenorrhoea).

Pharmacological
NSAID
COCP
Depot progesterones
Mirena coil

Non-Pharmacological
Local application of heat (water bottles or heat patch)
Transcutaneous Electrical Nerve Stimulation (TENS)

Question 7

Causes of secondary dysmenorrhea?

Answer 7

fibroids, endometriosis, adenomyosis, PID