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Dysmenorrhoea – Information for GPs

Definition

Primary Dysmenorrhoea

Period pains not associated with underlying pathology

  • Usually D1-3 of menses, present from menarche

Secondary Dysmenorrhoea

Painful periods suggestive of underlying pathology

  • g. endometriosis, adenomyosis, PID presents in 20-30 yr olds
  • Pain often persists for 1-7d after menstruation ends

Red flag symptoms

  • Consider PID (acute or chronic) especially in the under 25s with new onset
  • Ovarian cancer can cause bloating and lower abdominal pain (see NICE guidance for suspected cancer)

Management

  • History of problem and affect on quality of life (commonest cause of school absence in girls) and impact on work
  • IMB and PCB present?
  • Examination (will depend on age/whether sexually active)
  • Swabs – HVS and ECS
  • Bimanual – check for cervical excitation/uterine mobility and tenderness/retrovaginal nodules
  • Smear if over 25 and due
  • USS – if secondary cause suspected

Treatment options

Non-hormonal

Mefanamic acid / ibuprofen / hot water bottles / smoking cessation advice (higher pain scores for dysmenorrhoea in smokers)

Hormonal therapy

  • COCP: 3m trial – reduces prostaglandin levels (only use if failed response to NSAIDs in adolescents). Consider tri-cycling of COCP to reduce number of menses/year
  • Depo Provera – some evidence to support its use
  • Mirena: may help some women with dysmenorrhoea, particularly if associated with menorrhagia. Consider changing to IUS if problems associated with IUD

Information to include in referral letter

  • History, including impact on life and expectations of referral (e.g. Diagnostic Laparoscopy or advice on treatment)
  • Contraception
  • Investigations – swabs (if sexually active), USS, smear (if appropriate)
  • Treatment and doses tried so far and response
  • Past medical and surgical history
  • Drug history
  • Smoking status
  • BMI

Patient information

References

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