Malady Wise

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Period Pain

Overview

  • Recurrent, crampy, lower abdominal pain during menses in the absence of underlying disease

Goal

  • Adequate pain relief to allow patients to perform most if not all of their usual activities

Algorithm

  • Exclude and treat underlying causes

    • Endometriosis

    • Adenomyosis

    • Fibroids

    • Haematometra following surgery

    • STI

    • PID

  • Trial of baseline intervention

    • Exercise

    • Topical heat

    • Assess response in 1 to 2 menses

  • Analgesia

    • NSAID

      • Ideally, start 48 hours before period and continue for 2 to 3 days into period

      • Ibuprofen 200 to 400mg three to four times daily

      • Mefenamic acid (Ponstan) 500mg TDS

      • Naproxen 500mg at the start then 250mg 3 to 4 times daily

    • Trial 3 to 4 menses

  • Tranexamic acid

    • Can be added to analgesic

    • 2 to 3 tablets every 6 to 8 hours for 3 to 5 days of cycle

  • Hormonal Contraception

    • First line

      • Combined contraceptive pill

      • Vaginal ring

    • Second line

      • Progestin IUD

      • DMPA Injection

      • Continuous high-dose progestational therapy

Improvement with hormonal contraception

  • If partial, then consider trialling another form of hormonal contraception

  • If no improvement, then stop and refer Gynae to consider workup and diagnosis Endometriosis