Dysmenorrhoea

Question 1

What is dysmenorrhoea?

Answer 1

Painful menstrual bleeding

Question 2

What is the pathophysiology of dysmenorrhoea?

Answer 2

High prostaglandin levels in endometrium, due to contraction and uterine ischaemia.

Question 3

What is this a presentation of?

Crampy ache in back/groin, worse during first two days of menses, starts after menarche usually.

Answer 3

Primary dysmenorrhoea

Question 4

What is the management for primary dysmenorrhoea?

Answer 4

1. TV USS and swabs
2. Mefenamic acid during menses, paracetamol as alternative
3. Ovulation suppression with COCP ca help
4. Smooth muscle anti-spasmodic Hyoscine Butylbromide (Buscopan)

Question 5

What is the cause of primary dysmenorrhoea and which age group is affected?

Answer 5

1. No organic cause

2. <25 years old

Question 6

What is the cause of secondary dysmenorrhoea and which age group is affected?

Answer 6

1. Pain due to pelvic pathology (adenomyosis, endometriosis, PID, ovarian cysts, IUD, fibroids)
2. > 25 years old

Question 7

What is this a presentation of?

Pain preceded and relieved by the onset of menstruation. Deep dyspareunia and menorrhagia are common.

Answer 7

Secondary dysmenorrhoea

Question 8

What is the management of secondary dysmenorrhoea?

Answer 8

1. Treat the underlying cause

2. TV USS and swabs