Benefits, Harms, and Costs
- 1.Dysmenorrhea is highly prevalent and commonly undertreated (III).
- 2.Non-steroidal anti-inflammatory drugs are more effective than placebo but have more gastrointestinal side effects. All currently available non-steroidal anti-inflammatory drugs are of comparable efficacy and safety (I).
- 3.Suppression of ovulation is associated with decreased menstrual pain (II-1).
- 4.Amenorrhea induced by any means is beneficial for the treatment of dysmenorrhea (II-2).
- 5.Hysterectomy is effective treatment (II-2).
- 6.There is some evidence to support laparoscopic nerve ablation in selected cases (II-1).
- 7.Endometrial ablation is likely to reduce symptoms of dysmenorrhea when it occurs in the presence of menorrhagia (I).
- 1.Both primary and secondary dysmenorrhea are likely to respond to the same medical therapy. Therefore, initiation of treatment should not depend on establishing a precise diagnosis (II-1A).
- 2.Health care providers should include specific questions regarding menstrual pain when obtaining a woman's medical history (III-B).
- 3.A pelvic examination is not necessary prior to initiating therapy (III-D).
- 4.A pelvic examination is indicated in patients not responding to conventional therapy and when organic pathology is suspected (III-B).
- 5.Non-steroidal anti-inflammatory drugs, administered with regular dosing regimens, should be considered first-line treatment for most women (I-A).
- 6.Hormonal therapies should be offered to women and girls who are not currently planning pregnancy unless contraindications exist (I-A).
- 7.Continuous or extended use combined hormonal contraceptives are recommended (I-A).
- 8.Regular exercise is likely to improve symptoms of dysmenorrhea and should be recommended (II-1A).
- 9.Local heat in the form of heated pads or patches should be recommended as a complementary treatment for dysmenorrhea (I-A).
- 10.High-frequency transcutaneous electrical nerve stimulation should be considered as a complementary treatment or in women unable or unwilling to use conventional therapy (II-1B).
- 11.Acupoint stimulation should be considered for women wishing to use complementary or alternative therapies (II-1B).
- 12.Ginger is recommended for women wishing to use complementary or alternative therapies (I-A).
- 13.Preoperative investigations should include a detailed history and physical examination, ultrasound, and possibly magnetic resonance imaging to discover secondary causes for dysmenorrhea and to direct appropriate therapy (III-A).
- 14.Surgical intervention should only be considered if a concerted trial of medical therapy has not been successful (III-A).
Abbreviations:CANPAGO (Canadian Pediatric and Adolescent Gynecology and Obstetrics Committee), CHC (combined hormonal contraceptive), COC (combined oral contraceptive), hfTENS (high-frequency transcutaneous electrical nerve stimulation), LN-IUS (levonorgestrel intrauterine system), LUNA (laparoscopic uterosacral nerve ablation), NSAID (non-steroidal anti-inflammatory drug), PSN (pre-sacral neurectomy), TENS (transcutaneous electrical nerve stimulation)
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This Clinical Practice Guideline has been prepared and reviewed by the Society of Obstetricians and Gynaecologists of Canada Clinical Practice-Gynaecology and CANPAGO Committees and approved by the Board of the SOGC.
Disclosure statements have been received from all members of the committees.
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- Primary DysmenorrheaJournal of Obstetrics and Gynaecology Canada Vol. 39Issue 7
- PreviewPrimary dysmenorrhea is a frequent and challenging problem in gynaecology that occurs in most, if not all, women. Dysmenorrhea, however, also has the connotation that it may be a first sign of endometriosis, which may progress and cause infertility and chronic or severe pain. Thus dysmenorrhea may require early treatment to prevent progression. Unfortunately, without a laparoscopy, diagnosis is difficult, except in the presence of a large ovarian endometriosis cyst or a large rectovaginal deep endometriosis.