Dysmenorrhoea

 

Refer to General Gynae Clinic with pelvic USS attached

Definition

Lower abdominal or pelvic pain experienced just prior to and/or during menstruation: it may radiate to the groin, upper thighs and/or lower back.

Distinguish between Primary and Secondary dysmenorrhoea

Causes of Secondary Dysmenorrhoea:

• Endometriosis/adenomyosis
• Fibroids
• PID
• Ovarian Ca
• Cervical ca
• IUS insertion

 

Investigations prior to referral:

• Abdominal and pelvic examination (except in young women not sexually active)
• Pelvic USS
• HVS and chlamydia swabs
• Consider pregnancy test (to exclude ectopic pregnancy)

 

Primary Care Management:

• NSAIDs
• COC
• Progesterone only contraceptives may also be considered

 

Refer if:

• Symptoms severe AND have not responded to initial treatment within 3-6 months OR
• Doubt about the diagnosis

 

Information to include when referring

• Indication of parity
• Menstrual history, length of cycle and duration
• Describe symptoms, duration & effect on QOL
• Contraception (consider removing IUD / change to Mirena)
• Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the appointment
• Relevant past medical / surgical history if not on proforma
• Current regular medication if not on proforma
• Primary Care treatments tried

 

 

References: CKS.nice.org.uk/topics/dysmenorrhoea, ROCG guideline The initial management of chronic pelvic pain [RCOG, 2012]

Author: Dr S Burns GP

Contributors: Lisa Verity Consultant Gynaecologist RCHT