Dysmenorrhoea

1. Differential diagnosis of dysmenorrhoea.

1) Cervical stenosis

2) Endometriosis

3) Adenomyosis

4) Uterine fibroid

2. Focus history taking for a case of dysmenorrhoea.

> Age

> Parity

> Pain: site, onset, character, radiation, alleviating factor, aggravating factor, associated
symptom

> Anaemic sign and symptom

> Loss of appetite, Loss of weight, bowel and urinary habit, fever, chest pain,
haemoptysis

> Past gynaecological history: Age of menarche, duration, regularity, how many pads use,
dysmenorrhoea menorrhagia, intermenstrual bleeding, dyspareunia, use of contraception,
pap smear, any gynaecological problem, any gyaecological procedure done before

> Past medical history: Hypertension, Hyperthyroidism, breast cancer, colon cancer

> Family history: History of similar diseases, Inherited disease in family

3. Clinical examination with justificatins and expected findings.

General: Anaemic signs such as palmar pallor, cojunctival pallor, beefy tongue, angular
stomatitis

Abdominal examination: Palpable mass per abdomen suggestive of endometriosis and

uterine fibroid

Per speculum examination: mass protruding cervical os ( Pedunculated submucous

uterine fibroid), mass at cervix (endometriosis mass)
Bimanula examination:

> Tenderness (Adenomyosis)

> Mass moves if pushing the cervix upwards (Uterine fibroid)

> Mass felt at uterosacral ligament or pouch of douglas (Endometriosis)

4. Investigations.

> Full blood count: Hb level

> TAS

> TVS

> Serum CA125

> Endometrial biopsy

> Hysteroscopy

>IVU

> CT Scan

> MRI

5. Management.

> Non hormonal: Mefenemic Acid, Tranexemic acid

> Hormonal: COCP, Progesterone, GnRH agonist, LNG-IUD, Danazol

> Surgical:

Cervical dilatation (Cervical stenosis)

Conservative surgery; myomectomy, Excision, Wedge resection, Uterine artery

embolization

Radical surgery; Hesterectomy, TAHBSO,