Dysmenorrhea (Painful Menstruation)

Introduction

Dysmenorrhea refers to cyclical lower abdominal pain associated with menstruation.
The pain is thought to result from uterine contractions.
It may be primary when there is no identifiable cause or secondary when associated with an underlying cause.

Causes of painful menstruation

  1. Often no underlying cause (primary)
  2. Uterine fibroids
  3. Chronic pelvic infections e.g. Chlamydial infections
  4. Endometriosis

Symptoms of painful menstruation

  • Lower abdominal pain that is cramping or colicky in nature but may be dull and constant
  • Pain may radiate to the lower back or legs
  • Nausea, vomiting, headaches and dizziness may sometimes be associated with the pain

Signs of Dysmenorrhea (Painful Menstruation)

  • No typical physical signs

Investigations

  • FBC
  • Sickling
  • Pelvic ultrasound scan to rule out pelvic lesions such as fibroids

Treatment for Dysmenorrhea (Painful Menstruation)

Objectives

  • To relieve pain
  • To treat underlying cause

Non-pharmacological treatment

  • Bed rest
  • Warm pads applied to the lower abdomen

Pharmacological treatment

A. Mild Cases

1st Line Treatment
Evidence Rating: [A]
Paracetamol, oral, 1 g 6-8 hourly

B. Severe cases

A: ibuprofen (PO) 200-600mg 8hourly (maximum 2.4 g/day)

Or

A: acetylsalicylic acid (PO) 300-600mg 4hourly

Or

 A: diclofenac (PO) 50-100mg 8-12hourly

Or

B: mefenamic acid (PO) 500mg 8hourly

AND

A: hyoscine butyl bromide (PO) 20mg 8hourly for 5days
Women with regular complaints can easily detect length of use during their periods (2-3days usually enough). Treat the underlying condition if known.
Note

For primary dysmenorrhea, patients may be advised to start taking ibuprofen one or two days before menses and continue for three to four days during menses to minimize painful menstruation

Referral Criteria

Refer to a gynaecologist if pain interferes with normal activity especially if treatment is ineffective or an underlying cause is identified.