Painful Periods

HISTORY:

Painful periods for ‍ ‍hoursdays

Type: ‍crampingstabbingachingburningthrobbing

Location: ‍lower abdomenpelvic area

Onset: ‍beforeduringafter menstruation

Duration: ‍ ‍hoursdays

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Impact on daily activities: ‍minimal

Treatments tried: ‍none, ‍effectiveineffective

‍heavy bleeding

‍bloating

‍mood changes

‍nausea

‍headache

‍difficulty getting pregnant

‍pelvic pain outside periods

‍lower back pain

‍fatigue

‍mood swings

‍breast tenderness

‍bloating



Gynecological history:

Last menstrual period: ‍ ‍daysweeksmonths ago

Menstrual cycles: ‍ days, ‍regularirregular

Menarche: ‍ years old

G‍01234 P‍01234 A‍01234

Last Pap smear: ‍ ‍monthsyears ago ‍never

Coitarche: ‍ years old ‍never

Contraception: ‍yesno ‍oral contraceptives

Condom use: ‍alwayssometimesnever





EXAM:

General appearance: ‍well-appearing

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic:

- External genitalia: ‍normal, ‍inguinal lymphadenopathy

- Vagina: ‍normal, discharge ‍normal, ‍malodorous

- Cervix: ‍normal

- Uterus: ‍normal, ‍no cervical motion tenderness

- Adnexa: -R ‍normal, -L ‍normal

- Tests performed: ‍Pap test, ‍HPV DNA, ‍vaginal culture, ‍chlamydia/gonorrhea, vaginal pH ‍< 4.5> 4.5, whiff test with KOH ‍negative

- Performed with chaperone



ASSESSMENT:

‍Primary dysmenorrhea ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Pelvic ultrasound

- Pelvic MRI

- Blood work: ‍CBC, ‍CRP, ‍TSH, ‍prolactin, ‍FSH, ‍LH, ‍estradiol

- Encourage regular exercise

- Heat therapy

- ‍NSAIDs

- ‍Acetaminophen

- ‍Oral contraceptives

- Intrauterine device

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as heavy bleeding or irregular periods, or if symptoms do not improve with treatment

- Go to ER if severe abdominal pain or heavy bleeding occurs