Dysmenorrhoea in Practice: Case 1

Linda Bailey is a young woman aged about 26 years, who asks your advice about painful periods. From your questioning, you find that Linda has lower abdominal pain and sometimes backache, which starts several days before her period begins. Her menstrual cycle used to be very regular, but now tends to vary; sometimes she has only 3 weeks between periods. The pain continues throughout menstruation and is quite severe. She has tried taking aspirin, which did not have much effect.

The pharmacist’s view

This woman sounds as though she is experiencing secondary dysmenorrhoea. The pain begins well before her period starts and continues during menstruation. Her periods, which used to be regular, are no longer so and she has tried aspirin which has not relieved the pain. She should be referred to her doctor.

The doctor’s view

Referral does seem appropriate in this situation. Further information needs to be gathered from history taking (how long overall has she experienced pain and what it is like, effect on her life, any pregnancies, does she use contraception, any history of pelvic infection, her concerns and ideas about her problem, the sort of help is she expecting, etc.), examination and preliminary investigations. It is quite possible that the patient has endometriosis and referral to a gynaecologist may be indicated. The diagnosis of endometriosis can be confirmed by a laparoscopy. The range of treatment options includes other NSAIDs, hormone treatments and surgery. The hormonal treatments that can be used are progestogens, antiprogestogens, combined oral contraceptives and gonadotrophin-releasing hormone analogues (GnRH). GnRH preparations such as goserelin work by suppressing the hormones to create an artificial menopause. They can be used for up to 6 months (not to be repeated) and may have to be used with hormone replacement therapy to offset menopausal-like symptoms.

Dysmenorrhoea in Practice: Case 2

Jenny Simmonds is a young woman aged about 18 years who looks rather embarrassed and asks you what would be the best thing for period pains. Jenny tells you that she started her periods about 5 years ago and has never had any problem with period pains until recently. Her periods are regular – every 4 weeks. They have not become heavier, but she now gets pain, which starts a few hours before her period. The pain has usually gone by the end of the first day of menstruation and Jenny has never had any pain during other parts of the cycle. She says she has not tried any medicine yet, is not taking any medicines from the doctor and can normally take aspirin without any problems.

The pharmacist’s view

From the results of questioning it sounds as though Jenny is suffering from straightforward primary dysmenorrhoea. She could be advised to take a NSAID. She could be recommended to follow this regimen for 2 months and invited back to see if the treatment has worked.

The doctor’s view

Jenny’s pain is most likely due to primary dysmenorrhoea. An explanation of this fact would probably be very reassuring. The treatment recommended by the pharmacist is sensible. If her pain was not helped by a NSAID, she could be advised to discuss further management with her GP. Sometimes the combined oral contraceptive pill can be helpful in reducing painful periods.

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