DYSMENORRHOEA

Abdominal pain that occurs just before or during menstruation. Symptoms begin about 12 hours before onset
of menses and last for 1–3 days.

Primary dysmenorrhoea occurs more commonly among adolescents and young women. Symptoms usually begin
6–12 months after menarche and occur mainly with ovulatory cycles. Generally, severity of symptoms decreases
with age, sexual activity and child birth.

Secondary dysmenorrhoea is usually due to a gynaecological condition such as infection or fibroids, and usually occurs in older women above 30 years.

Causes of primary dysmenorrhea

  • Not known

Causes of secondary dysmenorrhoea

  • Pelvic inflammatory disease
  • Endometriosis
  • Uterine fibroids

Clinical features

  • Lower abdominal cramping
  • Backache, headache
  • Nausea, vomiting, diarrhoea, fainting, fever, fatigue, dizziness

Differential diagnosis

  • Endometriosis
  • Other causes of lower abdominal pain

Management

Non-pharmacological

  • Encourage the patient to rest or sleep
  • Encourage the patient to do some exercises
  • Advise the patient to apply a warm compress to the abdomen
  • Encourage the patient to wear loose fitting clothes
  • Advise the patient to have a diet low in fats and supplements such magnesium, vitamin B1,
    vitamin E and zinc

Pharmacological

  • Give NSAIDs e.g. ibuprofen 200–400 mg every 8 hours as required
  • Other medications include paracetamol 1 g every 6 hours (in case of mild pain); or diclofenac 50 mg
    every 8 hours for severe forms
  • Review the patient after 5 days and if no response or if recurrent, refer for specialist management
  • In secondary dysmenorrhoea, treat cause e.g. PID with antibiotics