Primary Dysmenorrhoea

Question 1

What is the most common gynaecological disorder?

Answer 1

Dysmenorrhoea

Question 2

What is Dysmenorrhoea?

Answer 2

Painful periods

Question 3

What are the pathophysiological steps of Dysmenorrhoea? (5 steps)

Answer 3

1. Absence of fertilisation
2. Corpus luteum regresses
3. Decline in oestrogen + progesterone prod
4. Endometrial cells release Prostaglandin
5. Excess prostaglandin release –> primary dysmenorrhoea

Question 4

What are main actions of Prostaglandins on the uterus? (2 things)

Answer 4

1. Spiral artery vasospasm (–> ischaemic necrosis + endometrium shedding)
2. Increased myometrial contractions

Question 5

What are the RF for primary dysmenorrhoea? (5 things)

Answer 5

1. Early menarche
2. Long menstrual phase
3. Heavy periods
4. Smoking
5. Nuliparity

Question 6

Where is the pain of dysmenorrhoea?

Answer 6

Lower abd / pelvic pain

Question 7

Where can the pain of dysmenorrhoea radiate to? (2 things)

Answer 7

1. Lower back
2. Ant thigh

Question 8

What is the quality of the pain of dysmenorrhoea?

Answer 8

Crampy

Question 9

How long does the pain of dysmenorrhoea last for and when does it occur?

Answer 9

48-72 hours during menstrual period

Question 10

When is the pain of dysmenorrhoea worse?

Answer 10

At menses onset

Question 11

What other symptoms can come w dysmenorrhoea? (5 things)

Answer 11

1. Nausea
2. Dizziness
3. Malaise
4. Vomiting
5. Diarrhoea

Question 12

What signs might you find @ examination of a pt w dysmenorrhoea?

Answer 12

Uterine tenderness

Question 13

What is special about diagnosing primary dysmenorrhoea?

Answer 13

It is a diagnosis of exclusion: so you have to exclude causes of SECONDARY dysmenorrhoea

Question 14

What are the causes of secondary dysmenorrhoea to exclude? (4 things)

Answer 14

1. Endometriosis
2. Adenomyosis
3. Pelvic inflamm disease
4. Adhesions

Question 15

What investigations are needed for primary dysmenorrhoea dx?

Answer 15

None

Question 16

What scenarios would make you do some investigations in sus primary dysmenorrhoea? (2 things)

Answer 16

1. Pt = high risk for STI –> do high vaginal swab / endocervical swabs
2. Pelvic mass palpated @ exam –> transvaginal US (TVS) for further investigation

Question 17

What is the aim of management in primary dysmenorrhoea?

Answer 17

Symptomatic improvement (bc ders no pathology to treat)

Question 18

What lifestyle advice would you give a pt w primary dysmenorrhoea?

Answer 18

Stop smoking

Question 19

What is the FIRST line pharmacological tx for primary dysmenorrhoea? (2 things)

Answer 19

1. NSAIDs (ibuprofen / naproxen / mefenamic acid)
2. +/- paracetamol

Question 20

Why do NSAIDs work to treat primary dysmenorrhoea?

Answer 20

They inhibit prostaglandin production (which we said is the cause of primary dysmenorrhoea)

Question 21

What is the SECOND line pharmacological tx for primary dysmenorrhoea?

Answer 21

Trial of hormonal contraception (3-6 month trial)

Question 22

What pill is used first line for hormonal contraception trial tx of primary dysmenorrhoea?

Answer 22

Monophasic combines oral contraceptive pill

Question 23

What else can be used for hormonal contraception trial tx of primary dysmenorrhoea?

Answer 23

Intrauterine system (e.g Mirena coil)

Question 24

What are some non pharmacological tx options for primary dysmenorrhoea? (2 things)

Answer 24

1. Local heat application (water bottles / heat patch)
2. Transcutaneous Electrical Nerve Stimulation (TENS)