Dysmenorrhea

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍month history of painful periods

Described as ‍crampingstabbingachingburningthrobbing

Location of pain: ‍lower abdomenpelvic area

Onset of pain: ‍beforeduringafter menstruation

Duration of pain: ‍ ‍hoursdays

Severity of pain is ‍mildmoderatesevere and impact on daily activities is ‍minimal

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍heavy bleeding

‍bloating

‍mood changes

‍nausea

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍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

Coitarche: ‍ years old ‍never

Contraception: ‍yesno ‍oral contraceptives

Condom use: ‍alwayssometimesnever

STI risk factors: ‍



Contributing factors:

‍early puberty

‍smoking

‍heavy periods

‍never having given birth

no history of: ‍endometriosis, ‍uterine fibroids, ‍adenomyosis, ‍pelvic inflammatory disease, ‍cervical stenosis

no use of: ‍oral contraceptives, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic:

- External genitalia: ‍normal, ‍rashlesions, ‍inguinal lymphadenopathy

- Vagina: ‍normal, ‍lesions, discharge ‍normal, ‍foul-smelling

- Cervix: ‍normal, ‍, ‍IUD strings visualized

- Bimanual exam: ‍normal, uterus ‍tendernessmass, adnexa ‍tendernessmass ‍on righton left, ‍cervical motion tenderness

- Tests performed: ‍Pap smearHPV test, ‍vaginal culturechlamydia/gonorrhea screeningHSV sample, pH ‍< 4.5 (normal)> 4.5, KOH sniff test ‍negative

- ‍Pelvic exam performed with chaperone 





ASSESSMENT:

‍Primary dysmenorrhea ‍likelysuspectedpossible

DDx: primary dysmenorrhea, endometriosis, adenomyosis, pelvic inflammatory disease, uterine fibroids, ovarian cyst, ectopic pregnancy, chronic pelvic pain syndrome, cervical stenosis, uterine polyps, intrauterine device related pain, gastrointestinal disorders, urinary disorders, sexually transmitted infections, hormonal imbalance, thyroid dysfunction





PLAN:

Investigations:

- Pelvic ultrasound

- Pelvic MRI

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

Treatments:

- Encourage regular exercise

- Heat therapy

- ‍NSAIDs

- ‍Acetaminophen

- ‍Oral contraceptives

- Intrauterine device

Further care:

- 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

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