DYSMENORRHOEA

Lower abdominal pain that starts with the onset of menstruation, and subsides after menses have ended. It may be primary or secondary. Secondary dysmenorrhoea is associated with chronic pelvic infection, fibroids, endometriosis and adenomyosis.

GENERAL MEASURES

For secondary dysmenorrhoea, investigate and treat the underlying condition.

MEDICINE TREATMENT

Symptomatic relief:

• Paracetamol, oral, 1 g 4–6 hourly when required to a maximum of 4 doses per 24 hours

OR

• Ibuprofen, oral, 400–800 mg 8 hourly depending on severity.

For severe pain:

ADD

• A combined oral contraceptive and review after 3 months.

REFERRAL

»    If there is uncertainty about the diagnosis.

»             Young women with pain not responding to conventional treatment. »     Older women with persistent pain.