Dysmenorrhoea is painful menstruation. There are two types of dysmenorrhoea – primary or secondary. Pain can be percieved very differently by different people and is hard to qualify; a careful history needs to be taken of the pain, including a full SOCRATES screen to establish the likely cause and severity.

 

Site of pain where dysmenorrhoea occurs?

Onset - where does the pain usually occur?

Character - what type of pain is it?

Radiation - Does the pain stay in one place or radiate to elsewhere?

Associations - Are there any other symptoms that occur?

Timing - when does the pain occur? Before menstruation? After menstruation?

Exacerbating / alleviating factors - Does anything make the pain better or worse?

Severity - out of 1-10 how would you rate the pain. 1 being least pain and 10 being the worst pain you have experienced. 

 

Primary dysmenorrhoea

 

Primary dysmenorrhoea can either mean:

Painful periods where no organic disease or psychological cause can be found

OR

Cyclical pain occurring regularly from menarche

 

This is due to excess prostaglandin level in the endometrium causing painful uterine contraction, thus leading to uterine ischaemia. The pain is likely to be cramping in nature and worse during first two days of menstruation. Dysmenorrhoea usually starts within the first year of menarche and there is often a strong family history. 

 

Investigations:

Pelvic examination – if normal no further investigation is required, and the pain can be treated.

 

Treatment:

Non-steroidal anti-inflammatory drugs (NSAIDS)e.g. mefenamic acid. These inhibit prostaglandin release during menstruation therefore reducing uterine contraction and pain. 

Combined oral contraceptive pill (COCP). These suppress ovulation and are ideal for use in cyclical pain.  

Reassurance is an important part of treatment, particularly in adolescents.  

 

Secondary dysmenorrhoea

 

Can either mean:

Painful period where a cause can be found

Or

New onset mean painful periods in women who previously had painless periods

 

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Pain usually precedes (and is relieved by) menstruation and is usually associated with deep dyspareunia.

 

Investigations:

  • Microbiological swabs - identifying infection.
  • Pelvic Ultrasound – identifying fibroids and intra- uterine pathology
  • Laparoscopy – identifying pelvic pathology
  • Hysteroscopy – identifying intrauterine pathology especially adhesion.

 

Treatment:  

Treat the underlying cause. If this does not resolve the problem then a Mirena coil may be appropriate.

 

References

M. Parisaei- Crash Course: Obstetrics and Gynaecology

K. Saeed Khan - Core Clinical Cases in Obstetrics and Gynaecology: A Problem-solving Approach

J. Collier - Oxford Handbook of Clinical Specialties

 

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