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Dysmenorrhoea

NICE CKS Dysmenorrhoea. Last Revised Oct 2023.

Background Information

Dysmenorrhoea: painful lower abdominal cramping, that occurs shortly before and/or during menstruation.

2 types of dysmenorrhoea:

Primary dysmenorrhoea: absence of any identifiable underlying pelvic pathology + begins 6-12 months after menarche
- Thought to be caused by production of uterine prostaglandins during menstruation

Secondary dysmenorrhoea: caused by an underlying pelvic pathology + begins after few years of painless period

Causes of secondary dysmenorrhoea include:

Endometriosis
Adenomyosis
Fibroids
Pelvic inflammatory disease
Intrauterine device insertion
Ovarian / cervical cancer

Guidelines

Consider:

Local application of heat
TENSTranscutaneous electrical nerve stimulation

1st line options:

NSAID, or
If do not wish to conceive: combined oral contraceptive for 3-6 month trial

If insufficient response to 1st line options → consider combining the above 2 and adding paracetamol.

Refer to gynaecologist if:

Severe symptoms + no response to initial treatment within 3-6 months, or
Doubt about diagnosis

Management depends on underlying cause.

References

NICE CKS Dysmenorrhoea

Author: Adams Lau
Reviewer:
Last Edited: 17/03/25

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