dysmenorrhoea

Question 1

What is it?

Answer 1

painful periods

Question 2

2 types

Answer 2

primary - young females, begins with onset of period and lasts for 24-72hrs, starts 6-12 months after menarche

secondary - REFER, endometriosis, PID, IUD insertion, after years of painless cycles, pain can continue after menstruation stops, chronic not cramping

Question 3

RF

Answer 3

earlier age at menarche
heavy flow
nulliparity
FHx of dysmenorrhoea
stress

Question 4

symptoms

Answer 4

• pain
• cramping
• lower abdomen
• spread to lower back and inner thighs
• cyclical mastalgia (breast pain)
• N&V (if severe)
• before menstruation, for up to 72hrs

Question 5

treatment

Answer 5

naproxen - Feminax

• first day: 2 tabs when pain stats then take another 1 after 6-8hrs if needed
• 2nd/3rd day: 1 tab every 6-8hrs
• max 3 days Tx

+- paracetamol/ibuprofen

Question 6

max duration

Answer 6

max 3 days tx

Question 7

age restrictions

Answer 7

15 - 50 years

Question 8

referral

Answer 8

• severe abdominal pain
• pregnant
• persistent intermenstrual or postcoital bleeding
• Sx of secondary dysmenorrhoea -> irregular bleeding, chronic pain not cramping
• **specific Naproxen red flags

Question 9

Naproxen red flags

Answer 9

<15yrs
>50yrs
Hx peptic ulcer or active GI bleed
asthma (if worsens Sx)

Question 10

counselling

Answer 10

• heat, hot water bottle/heat packs on abdomen
• warm bath
• tea -> regular, camomile, mint
• TENS machine