Dysmenorrhoea

Question 1

Define primary and secondary dysmenorrhoea

Answer 1

PRIMARY

• Pain has no obvious underlying cause
• Up to 50% of women
• Usually appears couple year after menarche

SECONDARY
-Pain due to underlying condition

Question 2

What history-taking questions are important in exploring dysmenorrhea?

Answer 2

• Timing and severity of pain (degree of functional loss)
• Any pelvic pain or superficial/deep dyspareunia
• PHx of PID or STIs
• Previous abdominal or genital surgery

Question 3

What percentage of women are thought to have primary dysmenorrhoea?

Answer 3

50%

Question 4

When does primary dysmenorrhoea usually appear?

Answer 4

1-2 years after menarche

• Pain typically starts just before or within a few hours of the period starting
• Suprapubic cramping pains which may radiate to the back or down the thigh

Question 5

What conditions may cause secondary dysmenorrhea?

Answer 5

Endometriosis
PID
Copper coil
Fibroids

Question 6

When does secondary dysmenorrhea typically develop?

Answer 6

Many years after menarche

Question 7

How may the pain features of secondary dysmenorrhea differ from primary?

Answer 7

Usually starts 3-4 days before onset of period

Question 8

How is dysmenorrhoea managed?

Answer 8

MEDICAL

• Mefenamic acid & ibuprofen helps in 80%
• COCP/Mirena (2nd line)

REFERAL - for any secondary dysmenorrhoea

SURGICAL

• Laparoscopic - endometriosis, PID, obstruction
• Hysterectomy (rare)