Dysmenorrhoea

Question 1

Give 5 causes of secondary dysmenorrhoea

Answer 1

Endometriosis
Fibroids
PID
Ovarian cancer
Cervical cancer
IUD insertion

Question 2

What is dysmenorrhoea?

Answer 2

Excessive pain during menstruation

Question 3

What is primary dysmenorrhoea?

Answer 3

Dysmenorrhoea with no underlying pathology

Question 4

First line treatment of primary (& 3 examples)

What to offer if this is CI

Answer 4

NSAID
Mefenamic acid, ibuprofen, naproxen

If this is CI, offer paracetamol

Question 5

Primary: alternative first-line if woman doesn’t wish to concieve

Answer 5

COCP

Or mirena

Question 6

Features of pain in endometriosis

Assc symptoms

Answer 6

Cyclical or chronic pelvic pain, may occur before menstruation

Heavy menstrual bleeding
Deep dyspareunia
?rectal pain & bleeding

Question 7

Features of pain in fibroids

Assc symptoms

Answer 7

Lower abdo pain
Menorrhagia

?pelvic mass o/e

Question 8

Features of PID

Answer 8

Lower abdo pain & tenderness

Dyspareunia, abnormal discharge & bleeding

Question 9

Dysmenorrhoea in IUD insertion

Answer 9

May be pain for 3-6 months after insertion

Longer, heavier periods
Intermenstrual bleeding & spotting

Question 10

‘Red flags’ of dysmenorrhoea

Answer 10

Ascites
Pelvic mass
Abnormal cervix o/e
Persistent intermenstrual or post-coital bleeding without suggestion of PID

Question 11

Mx of secondary dysmenorrhoea

Answer 11

Management of the underlying cause