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Dysmenorrhoea: A PLAB 2 Guide


📌 Introduction

Dysmenorrhoea refers to painful periods. It is one of the most common gynaecological complaints in adolescents and young women. For PLAB 2, it is a high-yield station because it tests your ability to take a structured history, rule out red flags, show empathy, and explain management in simple, reassuring language.



1. Presentation

  • Typical Symptoms (Primary Dysmenorrhoea):

    • Cramping lower abdominal pain

    • Onset: 1–2 days before menstruation, lasting 1–3 days

    • Radiation: Back or thighs

    • Associated: Nausea, vomiting, diarrhoea, dizziness, headaches, fatigue

    • Usually starts within a few years of menarche

    • Normal flow, no intermenstrual or postcoital bleeding

  • Secondary Dysmenorrhoea (red flags):

    • New onset pain after years of pain-free periods

    • Pain throughout cycle, not limited to menstruation

    • Dyspareunia (pain during sex)

    • Intermenstrual or postcoital bleeding

    • Heavy bleeding or flooding

    • Pelvic masses



2. Risk Factors

  • Primary dysmenorrhoea:

    • Early menarche

    • Heavy menstrual flow

    • Nulliparity (never given birth)

    • Family history of dysmenorrhoea

    • Stress and low physical activity

  • Secondary dysmenorrhoea causes:

    • Endometriosis

    • Adenomyosis

    • Fibroids

    • Pelvic inflammatory disease (PID)

    • Copper IUD

  • Why Does the Pain Occur? (The Role of Prostaglandins)

    • During menstruation, the endometrium (uterine lining) breaks down and releases prostaglandins, especially PGF2α and PGE2.

    • These prostaglandins cause:

      • Strong uterine contractions

      • Reduced blood flow (ischemia) in the womb muscle

      • Activation of pain receptors, leading to crampy abdominal pain

    • Women with dysmenorrhoea often have higher prostaglandin levels than those without pain.

    • NSAIDs work effectively because they block prostaglandin production.



3. Explaining to the Patient (Layman Terms)

"Period pain happens because the womb squeezes to push out its lining. This squeezing can cut down the blood supply to the womb for a short while, which causes cramping pain. It’s very common in teenagers and young women, and it’s not harmful. The good thing is it can usually be managed with medicines and simple measures so you can get back to your normal activities."

✅ Keep it short, empathetic, and reassuring that it is treatable.



4. Management (NHS-Based & PLAB 2)


First-Line

  • NSAIDs (Ibuprofen, Naproxen, or Mefenamic acid)

    • Take at onset or just before periods start

    • With food to avoid stomach upset

  • Paracetamol (alternative, less effective alone)


Non-Medical Measures

  • Warm compress/hot water bottle

  • TENS machine

  • Light exercise, stretching

  • Relaxation and stress management


If Pain Persists

  • Hormonal options:

    • Combined oral contraceptive pill (COCP)

    • Progestogen-only pill or IUS (if COCP unsuitable)


Lifestyle & Emotional Support

  • Balanced diet, hydration

  • Physical activity

  • Support at school/work

  • Consider counselling if psychosocial stress is contributing


Safety Netting

  • Return if pain gets worse, occurs outside periods, or new symptoms (e.g. fever, discharge, heavy bleeding).

  • Seek urgent help for flooding, clots, severe dizziness/fainting.



5. PLAB 2 Tips

  • Interpersonal Skills: Use empathetic language, signpost, check understanding, and offer confidentiality (especially for adolescents).

  • Chaperone: Offer before abdominal examination.

  • Red Flags: Always screen for intermenstrual bleeding, postcoital bleeding, dyspareunia, systemic symptoms.

  • Closing: Reassure it’s common, not harmful, and manageable. Confirm understanding.


✅ Takeaway for PLAB 2:Primary dysmenorrhoea = common, benign, treatable.Your role: Rule out secondary causes, reassure, and offer stepwise management.


📚 References

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