Dysmenorrhoea (Complete) Flashcards
Define dysmenorrhoea
Severe pain that occurs in conjunction with menstruation
What are the two main types of dysmenorrhoea?
Primary
Secondary
Define primary dysmenorrhoea
Dysmenorrhoea that is idiopathic and occurs in absence of any pelvic pathology
What is the suspected aetiology of primary dysmenorrhoea
Suspected to be due to excessive production of endometrial prostaglandin
Define secondary dysmenorrhoea
Dysmenorrhoea which occurs due to underlying pathology
List examples of secondary causes of dysmenorrhoea
Endometreosis
Adenomyosis (endometrial tissue grows into the muscle wall of the uterus)
PID
Uterine fibroids
Intrauterine devices (e.g. copper coils)
What are the main clinical features of dysmenorrhoea?
Pelvic pain
* Primary: Typically starts a few hours before or during start of period
* Secondary: Typically starts 3-4 days before onset of period
Nausea
Vomitting
Malaise/fatigue
Diarrhoea
When do initial presentation of primary dysmenorrhoea tend to occur to relative the start of menarhce (first ever period)
1-2 years from menarche
When do initial presentations of secondary dysmenorrhoea tend to occur relative to the start of menarhce? (first ever period)
Typically develops many years after the menarche
What additional features point towards an underlying pathological cause?
Dyspareunia + Infertility: Suspect endometriosis
Abnormal vaginal discharge + fever: Suspect PID
Heavy menstrual bleeding: Suspect uterine fibroids
What investigations should be considered for patients with dysmenorrhoea?
Bedside:
Bimanual examination: Check for cervical motion tenderness or masses
Vaginal swab: Check for STD
Bloods:
FBC: If patient has heavy bleeds or suspect anaemia
Imaging:
Pelvic ultrasound: check for underlying pathology
What is the management plan for patients with dysmenorrhoea?
Conservative:
Encourage regular exercise
Dietary changes (avoid caffeine and alcohol)
Avoid smoking
Heat and massages to lower abdomen
Medical:
NSAIDs:
* Ibuprofen
* Mefenamic acid
Hormonal contraception
* COCP
* Levonorgestrel-releasing intrauterine system (e.g. Mirena)
Surgical: In severe refractory cases
Endometrial ablation
Hysterectomy
Name 2 examples of NSAIDs given in mangement of dysmenorrhoea
Ibuprofen
Mefenamic acid
What types of hormonal contraception are used in management of dysmenorrhoea?
COCP
Levonorgestrel-releasing intrauterine devices (e.g. Mirena)
