Dysmenorrhoea

Dysmenorrhoea refers to painful menstrual periods. It is very common and, in most cases, is not caused by any underlying disease (primary dysmenorrhoea), though in some women it results from an underlying gynaecological condition (secondary dysmenorrhoea).

• Crampy, aching pain in the lower abdomen, typically starting just before or at the onset of menstrual bleeding and lasting one to a few days
• Pain may radiate to the lower back or thighs
• Nausea, fatigue, headache, or diarrhoea can accompany the pain in some women
• Pain that is unusually severe, worsening over time, or not well controlled with simple pain relief may suggest an underlying condition (secondary dysmenorrhoea)

• Primary dysmenorrhoea results from natural uterine muscle contractions during menstruation, triggered by hormone-like substances (prostaglandins), without any underlying disease.
• Secondary dysmenorrhoea results from an underlying gynaecological condition, such as endometriosis or uterine fibroids.
• Primary dysmenorrhoea is most common in younger women and often improves with age or after childbirth.

• Diagnosed through a detailed menstrual and pain history, together with a pelvic examination.
• Features suggesting secondary dysmenorrhoea — such as pain beginning later in life, pain that is progressively worsening, or pain not well controlled with standard treatment — prompt further evaluation, potentially including pelvic ultrasound, to look for an underlying cause.

An NSAID, such as ibuprofen or mefenamic acid, taken regularly starting just before or at the onset of pain, is highly effective for most women with primary dysmenorrhoea.

Hormonal contraception, such as the combined oral contraceptive pill, can also effectively reduce period pain for women who wish to use it, particularly if pain is persistent or contraception is also desired.

Applying heat to the lower abdomen and light exercise can provide additional symptom relief for some women.

Pain that does not respond to standard treatment, or symptoms suggesting an underlying condition, should be assessed further, as this may indicate secondary dysmenorrhoea requiring specific treatment of the underlying cause.

• Take an NSAID early, at the first sign of period pain, for the best effect.
• Apply heat to the lower abdomen for symptom relief.
• Engage in regular physical activity, which can help reduce the severity of period pain over time.
• Seek medical assessment if pain is severe, worsening, or not controlled by standard measures, to check for an underlying cause.