Dysmenorrhoea Flashcards
What is dysmenorrhoea?
Painful menstruation
How common is dysmenorrhea?
The most common gynaecological symptom
What sort of pain is dysmenorrhoea typically?
Colicky pain that starts with the onset of bleeding
When is dysmenorrhoea usually at its most painful?
In the first few days of the period
What is primary dysmenorrhoea?
Dysmenorrhoea in the absence of any significant pelvic pathology
What causes primary dysmenorrhoea?
Excessive myometrial contractions producing uterine ischaemia in response to local prostaglandins from the endometrium
When does dysmenorrhoea usually develop?
6 months - 2 years after menarche
Who is dysmenorrhoea usually more frequent or severe in?
Women whose period starts at an early age
Is there a familial component to dysmenorrhoea?
Yes
What are the associated symptoms of dysmenorrhoea?
- Nausea
- Vomiting
- Diarrhoea
- Dizziness
How can dysmenorrhoea affect a woman’s social life?
It can affect it negatively - I’m so done with these cards ngl
What is the pattern of dysmenorrhoea pain?
Ovulatory cycles
Where does the pain of dysmenorrhoea usually occur?
Lower abdominal and pelvic
Where can dysmenorrhoea sometimes radiate to?
The anterior aspects of the thighs
When can dysmenorrhoea often resolve?
After the birth of the first child
What is secondary dysmenorrhoea?
Dysmenorrhoea associated with some form of pelvic pathology
When is the usual onset of secondary dysmenorrhoea?
After menarche
When does the pain of secondary dysmenorrhoea usually occur?
Several days prior to the period
What sort of pain is seen in secondary dysmenorrhoea?
Heavy, dragging nature
Where can secondary dysmenorrhoea radiate to?
- Back
- Loins
- Leg
What are the potential causes of secondary dysmenorrhoea?
- Endometriosis
- Fibroids
- Adenomyosis
- Pelvic infections
- Adhesions
- Developmental anomalies
What features if dysmenorrhoea is it important to find out in a history?
- Timing of onset
- Characteristics
- Associated symptoms
What associated symptoms should be asked about in a patient presenting with dysmenorrhoea?
- Dysuria
- Dyspareunia
What should the decision to perform pelvic examination in dysmenorrhoea be based on?
- Sexual activity
- Need for a Pap smear
- Whether it is likely to be primary dysmenorrhoea
What is normally seen in primary dysmenorrhoea on examination?
Normal findings
What should be assessed for on examination in secondary dysmenorrhoea?
- Uterine and adnexal tenderness
- Masses
- Uterine mobility
- Posterior fornix and cervical movement pain
What investigations should be performed in dysmenorrhoea?
- Swabs
- Pelvic USS
What is pelvic USS good for detecting in dysmenorrhoea?
Fibroids
What will not commonly be detected by pelvic USS in dysmenorrhoea?
- Adenomyosis
- Endometriosis
What investigation is given to women with dysmenorrhoea who have persistent or progressive pain and are unresponsive to treatment?
Diagnostic laparoscopy
What is often a useful step in managing primary dysmenorrhoea?
Explaining that there is not underlying pathology and how the pain is being caused
What are some non-medical interventions used to treat dysmenorrhoea?
- Stopping smoking
- Exercise
- Using heat pack on lower abdomen
- Vitamin B1 supplementation
What is the most commonly used pharmacological treatment for dysmenorrhoea?
NSAIDs
When should patients with dysmenorrhoea be offered COCP?
After 3 menstrual periods with no response to NSAIDs
How does the COCP help with dysmenorrhoea?
It reduces the uterine prostaglandin release
What should the patient get if they do not respond to COCP for dysmenorrhoea?
Evaluation for structural or infective cause
What does the treatment for secondary dysmenorrhoea depend on?
Underlying cause
How may extreme cases of secondary dysmenorrhoea be relieved?
Hysterectomy
