Makindo Medical Notes

😣 Secondary dysmenorrhoea = painful periods due to an underlying pathology. Unlike primary dysmenorrhoea (prostaglandin-mediated, starts in adolescence), it often develops later (>30 years) in women who were previously pain-free.

📖 About

• Secondary to a pelvic pathological process 🧡
• Most common in women >30 years, new onset after years of painless cycles ⚠️
• Dull pelvic ache starting 3–4 days before menstruation, persisting through period

⚠️ Causes

• Endometriosis 🩸: Endometrial tissue outside uterus → pain, infertility.
• Adenomyosis 🧡: Endometrium infiltrates myometrium → heavy, painful menses.
• Fibroids (Leiomyomas) 🎈: Benign uterine tumours → pressure, menorrhagia, cramps.
• PID 🦠: Chronic infection & scarring → pelvic pain + dysmenorrhoea.
• IUD complications 🌀: Malposition or irritation of device → worsened cramps.
• Cervical Stenosis 🔒: Narrow cervix → obstructed outflow & increased intrauterine pressure.
• Ovarian Cysts 💧: Pain if rupture, torsion, or mass effect.

🔎 Investigations

• 🩺 Clinical history + pelvic exam
• 🖥️ Ultrasound pelvis (fibroids, ovarian cysts, adenomyosis)
• 📹 Laparoscopy = gold standard for endometriosis
• 🔦 Hysteroscopy for intrauterine pathology (polyps, adhesions, fibroids)
• 🧪 Consider FBC, inflammatory markers if infection suspected

🛠️ Treatment

• Medications 💊:
  • NSAIDs = first-line, reduce prostaglandins.
  • Hormonal therapy (COCP, progestins, GnRH agonists) → regulate/suppress cycles.
  • Antibiotics for PID if confirmed/suspected.
• Surgical options 🔪:
  • Laparoscopic excision/ablation of endometriosis.
  • Myomectomy for fibroids.
  • Ovarian cystectomy.
  • Hysterectomy (definitive, if fertility not desired).
• Lifestyle 🌿: Exercise, stress reduction, heat packs, diet modification (reduce caffeine, increase omega-3s).

📚 Case Example

👩 A 35-year-old woman with previously normal cycles now has worsening pelvic pain starting 3 days before menstruation and persisting throughout. Exam: Enlarged, tender, boggy uterus. USS: Features suggestive of adenomyosis. ✅ Diagnosis: Secondary dysmenorrhoea due to adenomyosis. 🛠️ Management: NSAIDs, hormonal therapy, and discussion of surgical options if persistent.