MODULE 6: REPRODUCTIVE ENDOCRONOLOGY

TOPIC 4: DYSMENORRHEA

DYSMENORRHEA

CLINICAL CASE

A 14-year-old female comes to your office complaining of severe dysmenorrhea (painful periods) for the
past six months. She began menstruating 10 months ago with her first two periods occurring about 2
months apart without pain or any other symptoms. Since then, she menstruates every 28 days and also
notices nausea, diarrhea and headaches during her periods. The pain has gotten so bad for 3 days each
month that she often misses school.

You speak to the patient without her mother and ask if she has ever been sexually active in any way. The
patient denies this activity and you believe her. She is a good student, is involved in sports and after
school programs, and you think it is unlikely that she is pretending to have dysmenorrhea to get out of
school. She denies use of drugs or alcohol, and you believe it is unlikely she is drug seeking. She says that
she gets partial relief by using 3-4 Advil, two or three times a day during her period.

The review of systems, past medical history and social history are noncontributory. The patient’s
mother, but no other relatives, has endometriosis.

Physical exam:
The patient’s vital signs are normal and she is afebrile. Abdominal exam reveals no masses or
organomegaly, and no tenderness or rebound. Because the patient is virginal and you do not want to
induce undue pain, you defer the pelvic exam and do a rectal exam showing a normal size non-tender
uterus, which is mobile and anteflexed. There are no nodules on the back of the uterus, and there are no
adnexal masses or tenderness.

Laboratory:
Urinalysis is negative for blood, nitrites and leukocytes.

DISCUSSION QUESTIONS:

A. Define dysmenorrhea and distinguish primary from secondary dysmenorrheal

B. Describe the pathophysiology and identify the etiologies of dysmenorrheal
C. Discuss the steps in the evaluation and management of dysmenorrhea