SIGNS & SYMPTOMS, INVESTIGATIONS & DIAGNOSIS, TREATMENT PLAN

SIGNS & SYMPTOMS

Primary:

• Develops 6-12 months after menarche
• Pain in the lower abdomen, radiating to the back and thighs
• Onset shortly before menstruation
• Lasts ~72 hours, and improves as menses progresses
• Associated non-gynaecological symptoms: lower back pain, dizziness, nausea, vomiting, diarrhoea
• Normal pelvic examination

Secondary:

• Develops years after menarche
• Pain inconsistent with the menstrual cycle
• May persist after bleeding or throughout the cycle
• Associated with other gynaecological symptoms: intermenstrual bleeding, postcoital bleeding, dyspareunia, menorrhagia, vaginal discharge Abnormal pelvic examination

INVESTIGATIONS & DIAGNOSIS

• Pelvic examination: Primary (normal), Secondary (abnormal)

TREATMENT PLAN

Primary:

• NSAIDs
• Paracetamol
• Local hot pads
• TENS
• Monophasic combined hormonal contraceptive pills (if no pregnancy concerns)
• Refer if no improvement within 3-6 months

Secondary:

• Urgent referral if:

Abnormal cervix on examination

Abnormal mass

Positive pregnancy test with dysmenorrhea, heavy bleeding, pelvic/abdominal discomfort (consider ectopic)

Persistent intermenstrual/postcoital bleeding without PID features (consider cancer)