Approach to dysmenorrhoea

History

• Pain
• It is important to determine if the pain is actually related to the menstrual cycle or has another underlying cause
• where is the site of the pain ?
• How would you describe the pain ? e.g. continuous or colicky
• How long has it been present 
• Is the pain associated with gastrointestinal function; do you have nausea, vomiting or diarrhoea/loose bowels
• does opening your bowels ease or make the pain worse?
• Do you have pain on urination?
• Menstrual history
• How old were you when you first had your period?
• How often do you have periods and how long does each one last?
• is the period heavy ? if so, on which day of the period?
• What size tampon or pad do you use? do you ever use both?
• how often do you change them?
• do you ever flood through tampon/pad or at night in bed?
• Have your periods caused you to miss school/work/social actives before this period?
• What associated symptoms, including pain and discomfort, do you have?
• What pain relief have taken and does it help?
• Medical and family history 
• do you have any family members with 
• diagnosed endometriosis?
• pelvic pain or pain during menstruation?
• problems getting pregnant or involuntary childlessness?
• Sexual history 
• when the first intercourse occurred
• male or female partners
• route of intercourse
• use of contraception 
• discussion of STIs
• vaccination history including hPV 
• pain or bleeding during sex 
• Examination 
• abdominal examination 
• vaginal examination is often not required esp. in adolescent girls who have never had sexual intercourse before
• Investigation 
• Blood test + STD screen 
• Vaginal or transabdominal ultrasound 
• DDx
• can be broadly classified in primary or secondary dysmenorrhoea 
• for further details about primary dysmenorrhoea, please go to the following link 
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• Management
• Analgesia: NSAID
• Suppression of ovarian function: COCP, GnRH agonist, IUD, etonorgestrel implant and oral dienogest
• surgical ablation 
• management of infertility 30-35% of women with endometriosis have infertility
• Prognosis
• Chronic condition 
• recurrence rate of 10-50% one year after surgery