Dysmenorrhoea
Description General measures Medicine treatment Referral ICD-10 code: N94.4-6 DESCRIPTION Lower abdominal pain that starts with the onset of menstruation and subsides after menses have ended. This may be associated with headaches, nausea, and vomiting. It may be primary or secondary. Primary dysmenorrhoea is menstrual pain without organic disease. Secondary dysmenorrhoea is associated with identi
ICD-10 code: N94.4-6
DESCRIPTION
Lower abdominal pain that starts with the onset of menstruation and subsides after menses have ended. This may be associated with headaches, nausea, and vomiting. It may be primary or secondary. Primary dysmenorrhoea is menstrual pain without organic disease. Secondary dysmenorrhoea is associated with identifiable disease, e.g. chronic pelvic infection, fibroids, endometriosis, adenomyosis; or the use of an intrauterine contraceptive device.
GENERAL MEASURES
For secondary dysmenorrhoea, investigate and treat the underlying condition.
MEDICINE TREATMENT
Symptomatic relief:
- NSAID, e.g.:
- Ibuprofen, oral, 400 mg 8 hourly with or after a meal.
OR
- Paracetamol, oral, 500 mg - 1 g, 4–6 hourly as required (to a maximum of 4 g in 24 hours).
- Maximum dose: 15 mg/kg/dose.
For dysmenorrhoea caused by endometriosis:
ADD
- Combined oral contraceptive and review after 3 months.
OR
- Medroxyprogesterone acetate (long-acting), IM, 150 mg, 12 weekly.
- Review after 3 months.
REFERRAL
- If there is uncertainty about the diagnosis.
- Young women with pain not responding to conventional treatment.
- Older (> 40 years of age) women with persistent pain.
Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 5: Gynaecology; Version 1.0, 2020-4_June 2024