Dysmenorrhoea (primary)

Question 1

Management

Answer 1

Provide full explanation and appropriate reassurance

Promote a healthy lifestyle:

• regular exercise
• avoid smoking and excessive alcohol

Recommend relaxation techniques such as yoga

Avoid exposure to extreme cold

Place a hot water bottle over the painful area and curl the knees onto the chest

Question 2

Medication

Answer 2

Options include (trying in order):

Simple analgesics (e.g. aspirin or paracetamol)

Prostaglandin inhibitors (e.g. mefenamic acid, 500 mg tds at first suggestion of pain, if simple analgesics ineffective)

NSAIDs (e.g. naproxen, 500 mg statim then 250 mg tds or ibuprofen) in the first 3 d of the period

Combined oral contraceptive pill

progestogen medicated IUD (Mirena)