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Dysmenorrhea Posted by A S.
Dear Paul
This is a recent exam question

15 yrs old c/o of pelvic pain not relieved by NSAI or OCPs ,
a) points in the social history you need to know
b) investigation will help the diagnosis
c) diagnosis is primary dysmenorrhea , what is your management?

My answer plan
a) 1. does the pain interfere with social life and schooling(severity)
2. Sexual activity , use of condoms (infections)
3 . ?? sensetive approach sexual abuse
4. ??
I cant think of more relevant points

b) Investigations should include
pain diary( cyclic nature)
urine analysis and mid stream sample for culture
swabs from the vagina for culture and STI screeing
u/s pelvis for anatomy and detection of endometriomas
?? laparoscopy for D.D and possibility of endometriosis

c) if the diagnosis is primary dysmenorrhea
why didn t she improve with OCPs ? poor compliance , incorrect use , psychic element ( she is teenager and exagerating)
what else would I offer ? tricycling the pills , use of danazol (very young and virilizing), GnRH analogues (very young risk of osteoporosis)

If the pain would not respond to OCPs before isn t it logic to think of pelvic pathology(endometriosis , PID) or outflow tract obstruction more than just dysmenorrhea

I cant think of good options for her would you please help

Posted by A S.
Dear Dr Paul
The (c ) part of this question was awarded 8 marks in the exam.
Would be please clarify how to write amodel answer ?