Dysmenorrhoea

Question 1

Dysmenorrhoea

Dysmenorrhoea is characterised by excessive pain during the menstrual period. It is traditionally divided into primary and secondary dysmenorrhoea.

Primary dysmenorrhoea

Answer 1

In primary dysmenorrhoea there is no underlying pelvic pathology. It affects up to 50% of menstruating women and usually appears within 1-2 years of the menarche. Excessive endometrial prostaglandin production is thought to be partially responsible.

Features:

• pain typically starts just before or within a few hours of the period starting
• suprapubic cramping pains which may radiate to the back or down the thigh

Management:

• NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
• combined oral contraceptive pills are used second line

Question 2

Dysmenorrhoea

Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period.

Secondary dysmenorrhoea

Answer 2

Causes include:

• endometriosis
• adenomyosis
• pelvic inflammatory disease
• intrauterine devices*
• fibroids