Menstruation and Menstrual Disorders - Dysmenorrhoea

Question 1

What is Dysmenorrhoea?

Answer 1

Excessive pain during the menstrual period.

Question 2

Differential Diagnoses of Dysmenorrhoea (6).

Answer 2

1. Primary Dysmenorrhoea.
2. Endometriosis/Adenomyosis.
3. Fibroids.
4. Pelvic Inflammatory Disease.
5. IUD Coil.
6. Cervical or Ovarian Cancer.

Question 3

What should first be excluded in dysmenorrhoea?

Answer 3

STIs.

Question 4

What is Primary Dysmenorrhoea?

Answer 4

Dysmenorrhoea with no underlying pelvic pathology.

Question 5

Epidemiology of Primary Dysmenorrhoea.

Answer 5

1. 50% of menstruating women.

2. Usually appears within 1-2 years of Menarche.

Question 6

Aetiology of Primary Dysmenorrhoea.

Answer 6

1. No underlying pelvic pathology.

2. Theory : Excessive Prostaglandin production.

Question 7

Clinical Features of Primary Dysmenorrhoea (3).

Answer 7

1. Pain typically starts just before or within a few hours of the period starting.
2. Suprapubic cramping pain that may radiate to the back or down the thigh.

Question 8

Management of Primary Dysmenorrhoea.

Answer 8

1. 1st Line : NSAIDs e.g. Mefenamic Acid, Ibuprofen.

2. 2nd Line : COCP.

Question 9

What is Secondary Amenorrhoea?

Answer 9

Typically develops after many years from menarche, as a result of underlying pathology.

Question 10

Differences between Primary Dysmenorrhoea and Secondary Dysmenorrhoea (2).

Answer 10

1. Underlying Pathology (Secondary).

2. Pain has 3-4 Days Before Period Onset (Secondary).

Question 11

Management of Secondary Amenorrhoea.

Answer 11

NICE CKS recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation.