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