Dysmenorrhoea

Question 1

What is the difference between primary and secondary dysmenorrhoea?

Answer 1

In primary dysmenorrhoea there is no pelvic pathology.

In secondary dysmenorrhoea is due pathology. It usually develops many years after menarche.

Question 2

What is the difference in presentation between primary and secondary dysmenorrhoea?

Answer 2

• Pain - in primary dysmenorrhoea, the pain typically starts just before or within a few hours of the period starting. In secondary dysmennorhoea, the pain starts 3-4 days before the onset of the period.
• Initiation - primary dysmenorrhoea usually occurs 1 to 2 years after menarche.

Question 3

What are some causes of secondary dysmenorrhoea?

Answer 3

• endometriosis
• adenomyosis
• pelvic inflammatory disease
• intrauterine devices* (copper coil The mirena coil will help dysmenorrhoea)
• fibroids

Question 4

What is the cause of primary dysmenorrhoea?

Answer 4

Excessive endometrial prostaglandin production.

Question 5

How do you manage primary dysmenorrhoa?

Answer 5

1. NSAIDs (ibuprofen or mefenamic acid). Efficacy of 80%. Inhibit prostaglandin production.
2. Second line COCP.

Question 6

How do you manage secondary dysmenorrhoea?

Answer 6

Refer them to secondary care for investigation.