Dysmenorrhoea

Question 1

What is dysmenorrhoea?

Answer 1

Painful periods

Question 2

What are the types of dysmenorrhoea?

Answer 2

Primary

Secondary

Question 3

What is primary dysmenorrhoea?

Answer 3

Menstrual pain occurring with no underlying pelvic pathology

Question 4

What is secondary dysmenorrhoea?

Answer 4

Menstrual pain that occurs with associated pelvic pathology

Question 5

What can cause secondary dysmenorrhoea?

Answer 5

Endometriosis
Adenomyosis
PID
Fibroids

Question 6

What is the pathophysiology of primary dysmenorrhoea?

Answer 6

Absence of egg fertilisation -> reduced oestrogen and progesterone

Endometrial cells respond to progesterone decline by releasing prostaglandins

Prostaglandin actions

• spiral artery vasospasm -> shedding of endometrium
• increased myometrial contractions

Question 7

What are risk factors for primary dysmenorrhoea?

Answer 7

Early menarche
Long menses
Heavy periods
Smoking
Nulliparity

Question 8

What are the features of dysmenorrhoea?

Answer 8

Lower abdo/pelvic pain
Crampy pain
Lasts 48-72 hours at the beginning of menses

Associated symptoms

• malaise
• nausea
• vomiting
• diarrhoea
• dizziness

Question 9

How is primary dysmenorrhoea managed?

Answer 9

Stop smoking
Heat - hot water bottle/ heat patch

Analgesia - NSAID +/- paracetamol

Hormonal

• COCP
• mirena coil