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Dysmenorrhoea (Aetiology (Infection/inflammation
Endometriosis
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Dysmenorrhoea
Aetiology
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Neoplastic
Fibroids
Polyps
Cancer (endometrial, cervical)
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Diagnosis
Examination
Abdo
Pelvic mass (Ca, fibroids)
Pelvic exam
Cervical excitation, adnexal tenderness,
masses, mobility
Investigations
Bedside
Obs (sats, RR, HR, BP, temp)
Bloods
FBC, U+E, LFT, TFT,
BBV screen (HIV, HBV, HCV, syphilis)
Imaging
USS (endometriosis, PID sequelae, fibroids, congenital)
Therapeutic laparoscopy (if USS abnormal)
Swabs
HVS/VVS/ (CT, NG, TV etc.)
Smear
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History
PC/HPC
Pain (SOCRATES), other symptoms
e.g. heavy bleeding, bloating/fullness, bladder/bowel
Gynae history
LMP, cycles, PID/STIs,
smears, surgeries
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DH
Contraception (IUDs), allergies
FH
Painful periods, endometriosis,
Ca, fibroids
SH
Occupation, impact ADLs,
alcohol, smoking
Epidemiology
50% mod pain, 12% severe, disabling pain
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Pathophysiology
Primary
No organ pathology
Uterine vasospasm, ischemia, nervous system sensitisation to PGs, uterine contractions, also GIT (N+V, diarrhoea)
Often starts after menarche, often have a family history
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Management
Secondary
Medical
NSAID
Indication: fertility not needed
E.g. ibuprofen, mefenemic acid
MOA: Inhibits prostaglandins, reducing
contractions and thus reducing pain
Hormonal therapy
Indication: endometriosis
E.g. COCP, progestagens, GnrH analogues
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Surgical
Laparoscopy
Indication: diagnosis/management of endometriosis,
adhesions and complicated PID
Surgery
Indication: obstruction, large fibroids, Ca
MOA: remove causative pathology
Conservative
Identify cause
Information and advice
Psychological (self-help groups)
Pain clinic
TENS (pain)
Primary
Medical
Hormonal contraception
Indication: fetility not needed
E.g. COCP, Mirena, POP
MOA: abolish ovulation
NSAID
Indication: fertility not needed
E.g. ibuprofen, mefenemic acid
MOA: Inhibits prostaglandins, reducing
contractions and thus reducing pain
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Clinical
presentation
Pain
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Associated symptoms
Deep dyspareunia (secondary), menorrhagia,
systemic symptoms (red flags)
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