Dysmenorrhoea

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 and use of 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.

LoEIII [1]

OR

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum daily dose: 4 g in 24 hours.

LoEIII

For dysmenorrhoea caused by endometriosis:

ADD

  • Combined oral contraceptive and review after 3 months.

LoEI [2]

OR

  • Medroxyprogesterone acetate (long-acting), IM, 150 mg, 12 weekly.
    • Review after 3 months.

LoEII [3]

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.