Dysmenorrhoea and premenstrual syndrome

1. Big picture

This topic has two common menstrual-cycle problems:

Dysmenorrhoea = painful menstruation.
Premenstrual syndrome (PMS) = cyclical physical, emotional, and behavioural symptoms before menstruation.

The examiner wants a practical answer:

Menstrual pain or premenstrual symptoms
        ↓
First exclude pregnancy and acute pelvic emergencies if clinically relevant
        ↓
Decide: primary functional disorder or secondary organic disease?
        ↓
Treat symptoms, protect fertility, and do not miss endometriosis, pelvic inflammatory disease, fibroids, adenomyosis, or ectopic pregnancy.

The most important distinction is:

Primary disorder	Secondary disorder
No pelvic pathology found	Caused by identifiable pelvic/systemic pathology
Usually starts soon after ovulatory cycles begin	Often starts later, worsens progressively, or changes pattern
Normal pelvic examination	May have pelvic tenderness, mass, fixed uterus, discharge, heavy bleeding
Responds well to non-steroidal anti-inflammatory drugs and hormonal contraception	Needs treatment of underlying cause

Dysmenorrhoea and premenstrual syndrome

1. Big picture

PART A — DYSMENORRHOEA

Unlock the rest of this topic