Dysmenorrheal can be divided into primary and secondary Dysmenorrheal. Primary Dysmenorrheal is usually defined as cramping pain in the lower abdomen occurring at the onset of menstruation in the absence of any identifiable pelvic disease. Secondary Dysmenorrhoea, which refers to painful menses resulting from a pelvic pathology such as endometriosis, intrauterine polyps and clot colic.

Primary Dysmenorrheal

Assessment

• History clinches the diagnosis - Typically, pain occurs with onset of menstruation and then declines.

• Examination - This is required to exclude surprises from other pathology.

• Investigations - If the history is typical and no surprises are found on examination, then no further investigation is needed.

Treatment

• Non-steroidal anti-inflammatory agents are prostaglandin syntheses inhibitors and will decrease pain and reduce menstrual loss.

• Oral contraceptive pill will inhibit ovulation. Primary Dysmenorrheal is usually associated with ovulation, thus the pill by preventing ovulation, will relieve primary Dysmenorrhoea.

• If treatment fails to improve symptoms then a laparoscopy is needed to exclude pathology.

Secondary Dysmenorrheal

Causes

• Endometriosis
• Adenomyosis/fibroid
• Pelvic inflammatory disease
• Psychological disorders problems.

Assessment

• History is important. It may take time to obtain if psychosexual problems are present.

• Pelvic examination must be performed, and swabs taken if indicated. Restricted mobility or fixed retroversion of the uterus suggests the presence of adhesions secondary to endometriosis, pelvic inflammatory disease, or previous surgery.

• Investigations required will be guided by history, but laparoscopy is indicated in most cases.

Treatment

• This depends on the cause.