Dysmenorrhoea

Question 1

Presentation of dysmenorrhoea

• Primary
• Secondary

Answer 1

Primary (no pelvic pathology)

• Cramping
• Lower abdomen, pelvis
• Radiates to back and thighs
• Associated with nausea & vomiting
• Duration up to 72 hours, resolves before end of menstruation

Secondary (pelvic pathology)

• Pelvic ‘heaviness’
• Precedes menstruation and may last throughout
• Refractory to analgesia/COCP
• Heavy bleeding
• Associated symptoms:
  
  • Post-coital bleeding
  • Intermenstual bleeding
  • Vaginal discharge
  • Deep dyspareunia

*Rule out conditions that mimic pain similar to dysmenorrhoea - irritable bowel disease, lactose intolerance*

Question 2

Differentials of secondary dysmenorrhoea

Answer 2

• Pelvic inflammatory disease.
  
  • Vaginal discharge
  • Fever
  • Irregular bleeding
  • Hx of STD/PID
• Endometriosis.
  
  • Pelvic pain before and during menses
  • Symptoms progressively worsening over time
  • Dyspareunia
  • Dyschezia (difficulty defecating)
• Uterine adenomyosis
  
  • Parous
  • Onset of symptoms after childbirth
  • Heavy menstrual flow
• Fibroids.
  
  • Heavy/prolonged/irregular bleeding
  • Pelvic pressure
  • Urinary frequency/urgency
  • Constipation
• Endometrial polyps.
  
  • Intermenstrual bleeding
  • Menorrhagia
• Premenstrual syndrome.
  
  • Irritability
  • Low mood
  • Bloating
  • Breast tenderness
• Intrauterine device
• Ectopic / miscarriage
  
  • Typically RLQ pain
  • Vomiting (rupture)
  • Hx of pregnancy/missed period/sexual intercourse