Dysmenorrhoea

Question 1

Types of dysmenorrhoea

Answer 1

1. Primary - young, 1-2yrs menarche, no pathology
   *Max pain at beginning of period (12hrs before)
   Reassure, PCM, NSAIDs, CHC (severe)
2. Secondary
   *3-4days before period, more severe during period

Question 2

Secondary dysmenorrhoea causes, dxt, mx

Answer 2

1. Endometiosis, adenomyosis
2. PID
3. Submucous myoma, polyp
4. Adhesions

Inv: USG, laparoscopy
Mx- treat the cause

Question 3

Endometriosis, c/f

Answer 3

Endometrium like tissue on (mc)ovary/peritonium/tubes
Sheds from these areas during period…
adhesions, fibrosis…pain
Avg 6.5yrs to diagnose

C/f:
25-35yrs , fam h/o
Dysmeno
HMB
Painful urination, defecation, sex
Subfertility

Signs:
Fixed uterus
Tender, nodular pouch of Douglas
Tender, large uterus
*Uterosacral ligament nodularity - mc finding

*Dysmeno+Dyspareunia+HMB

Question 4

Mc finding of endometriosis

Answer 4

Uterosacral ligament nodularity

Question 5

Adenomyosis

Answer 5

Endometrial tissue in uterine myometrium

Question 6

Dxt endometriosis

Answer 6

Clinical mainly

If insisted-
●Initial: USG
●Gold std/m. appropriate - Laparoscopy with direct visual inspection

Question 7

Mx endometriosis

Answer 7

First line: PCM +/- NSAIDs

Nxt: CHC continuous (no bleed), POP, (best)Mirena, DMPA

Infertility in older reproductive age … Sx: Ovarian drill

Before sx: GnRH analogue x 6 months
Goserelin
Nafarelin

Hysterectomy