7 - Dysmenorrhoea

Summary

Dysmenorrhoea is common and many women consider it to be a normal part of menstruation. For a teenager, congenital uterine abnormalities may present with dysmenorrhoea. Endometriosis is the most common identifiable pathology associated with dysmenorrhoea. At the initial consultation an assessment should be made of the severity of pain and the level of disruption caused. Dysmenorrhoea may begin a few hours before the onset of bleeding, but should tail away as the bleeding ends, or before. Contraception may be required in addition to treatment of the dysmenorrhoea. The combined oestrogen-containing pill offers good contraception and substantial reduction in dysmenorrhoea. The pill may be particularly helpful if the menstrual cycle is chaotic due to anovulatory cycles. If symptoms are particularly troublesome and the woman wishes to stop the bleeding all together, she may choose high-dose progestogens or a GnRH analogue.