This is a common feature of the menstrual cycle with 60-70% of young women experiencing it and some 25% of these being incapictated by the pain. There often a simular history to be found in the siblings and mother of the patient with dysmenorrhoea begining shortly after menarche.
There are two forms:
- Primary dysmenorrhoea where there is no organic cause to be found
- typically starts at the same time as menstruation
- Secondary dysmenorrhoea where there is an underlying pathology identified
- typically begins before menstruation and continues through it relieved by a few days post-menstruation
- Some women are completely incapacitated by this condition so it is important to assess the degree of functional loss and remember if they think that their periods are too painful then they are!
- Ask about "deep" pain in the pelvis and dyspareunia (pain during sexual intercourse) this can indicate serious pathology
- PMH - include questions regarding any previous PID (pelvic inflammatory disease)/STIs and any abdominal, genital tract or pelvic surgery
Examinations and Investigations
Similar to management of menorrhagia- depending on cause of symptoms.
- NSAIDS (mefenamic acid)
- Combined oral contraception
- Mirena coil
- Oral progesterone
- Injected progesterone
- Hysterectomy – if other treatments have failed and the patient does not want periods or more children. Can be done laparoscopically or abdominally.
- Laser ablation of endometriosis