Primary & Secondary Dysmenorrhea
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Primary dysmenorrhoea typically begins soon after the menarche, starts a few hours to 24 hours before menstruation, lasts 24-48 hours, then subsides after maximal flow of the period.
Secondary dysmenorrhea commences a few hours to 24 hours prior to menstruation, becomes worse with flow, lasts the entire period & may persist after. It is associated with chronic PID, fibroids, endometriosis & adenomyosis.
Diagnosis
- Pain is associated with menstruation
- Take care with the history in the patient who has an irregular cycle
- Remember the uterus in normally tender during menstruation
- Fibroid uterus is common & may or may not be the cause of dysmenorrhea
- Adenomyosis is felt as a tender, boggy, but non-pregnant uterus
- Features of endometriosis are discussed below
Management
Primary dysmenorrhea
Ibuprofen 400 mg orally three times daily, or naproxen 250-500 mg orally twice daily, or mefenamic acid 500 mg orally three times daily (beware a history of a peptic ulcer, bleeding disorders, kidney problems & asthma). These drugs should be taken with food & oral fluids. Combined oral contraceptives may also be effective, as may paracetamol.
Secondary dysmenorrhea
Definitive treatment should be directed to the cause. Simple analgesics & nonsteroidal anti-inflammatories may also be prescribed as for primary dysmenorrhea.