Cyclical lower abdominal pain associated with menstruation; primary (no pathology) or secondary.
History taking
- • Age at menarche, cycle length, pain pattern, duration, severity
- • Associated dyspareunia, infertility, abnormal bleeding
- • Effect on work/school; family history of endometriosis
Examination
- • Abdominal & pelvic examination if sexually active
- • Look for adnexal mass, nodularity, restricted uterine mobility
Red flags
- • Progressive pain, late onset (>25 y), abnormal bleeding, infertility — suggest secondary cause
Differential diagnosis
- • Primary dysmenorrhoea
- • Endometriosis, adenomyosis, fibroids, PID, ovarian cyst, IUCD
Recommended investigations
- • USG pelvis (transvaginal preferred) if secondary suspected
- • STI screen, CA-125 in selected
Diagnosis
- • Clinical; investigations to exclude secondary cause
Initial treatment / management
- • NSAIDs first-line, start 1–2 d before menses
- • Combined OCP for sustained relief
- • Heat therapy, exercise, dietary measures
- • Treat underlying cause if secondary
Prescription examples
- • Tab Mefenamic acid 500 mg PO TDS x 3 d at start of menses
- • Tab Naproxen 500 mg PO BD x 3 d
- • Combined OCP cyclically if NSAIDs insufficient
Follow-up advice
- • Review after 2–3 cycles
Patient counselling
- • Reassurance, lifestyle (exercise, balanced diet, stress management)
- • Sexually active: contraception planning
Referral criteria
- • Refractory pain, suspected endometriosis/adenomyosis
Clinical pearls
- • Persistent dysmenorrhoea unresponsive to NSAIDs and OCP — investigate for endometriosis
References
- • ACOG Practice Bulletin: Dysmenorrhea 2018
Educational outpatient guide — verify against local guidelines before clinical use.
