OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• gynaecology
• chronic pelvic pain in women
• premenstrual syndrome

• dysmenorrhoea means painful menstruation and occurs in 3-90% of menstruating women depending on the population studied and criteria used to define it.
• dysmenorrhoea may also refer to a symptom complex (perhaps better referred to as premenstrual syndrome) including:
  • nausea, vomiting, headache, nervousness, fatigue, diarrhoea, syncope, lower abdominal cramping, bloating, breast tenderness, mood changes, backache, and dizziness.
• these symptoms usually appear 1 -2 days prior to or at the onset of menstruation and are maximal during the 1st 48hrs afterward.

• obesity
• early menarche
• heavy bleeding during menses
• family history of dysmenorrhoea
• parous women usually have less dysmenorrhoea than nulliparous women

• no clinically detectable aetiology but thought to be caused by factors intrinsic to uterine physiology
• usually begins with onset of ovulatory cycles from 6-24 months after menarche, and generally becomes more severe over time, peaking at ages 23-27yrs or first pregnancy, then decreasing in severity.
• discomfort may begin 2 days prior to onset of menses and generally the pain becomes more severe on the 1st day of menses and usually lasts no more than 48hrs.

• exclude pregnancy, secondary causes (as below)
• non-steroidal anti-inflammatory drugs (NSAIDs)
• consider inhibition of ovulation eg. combined oral contraceptive pill (OCP)

• acquired due to an identifiable pathology such as:
  • pelvic inflammatory disease (PID)
    • Ix - cervical swab for chlamydia and gonococcus PCR
  • endometriosis
    • esp. nulliparous women
    • may also be associated with rectal pain, tenesmus, backache, etc.
    • Ix - laparoscopy
  • adenomyosis
    • esp. multiparous middle-aged women, often associated with menorrhagia
    • Ix endometrial biopsy to excl. malignancy; hysteroscopy may help Dx.
    • Rx options include combined oral contraceptive pill (OCP), hysterectomy or endometrial ablation
  • uterine fibroids (leiomyomas)
    • only cause dysmenorrhoea if submucosal or protrude into uterine cavity
    • Ix - USS, hysteroscopy
    • Rx - consider myomectomy or hysterectomy
  • IUCD
    • may respond to non-steroidal anti-inflammatory drugs (NSAIDs)
    • progesterone-containing IUCDs generally cause less pain than copper or plastic ones
  • congenital uterine abnormalities
  • ovarian cysts and other cysts in the adnexae
  • true cervical canal stenosis
  • endometrial carcinoma
  • tuberculosis (TB)
  • pelvic adhesions