eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Dysmenorrhea: Differential Diagnoses & Workup

Author: Karim Anton Calis, PharmD, MPH, FASHP, FCCP, Professor, Medical College of Virginia, Virginia Commonwealth University, Clinical Professor, University of Maryland; Clinical Specialist, Endocrinology and Women's Health, Director, Drug Information Service, Mark O Hatfield Clinical Research Center, National Institutes of Health
Coauthor(s): Vaishali Popat, MD, MPH, Medical Officer, Food and Drug Administration; Devra K Dang, PharmD, BCPS, CDE, Assistant Clinical Professor, University of Connecticut School of Pharmacy, Clinical Faculty, Burgdorf Health Center; Sophia N Kalantaridou, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Ioannina Medical School, Greece
Contributor Information and Disclosures

Updated: Jan 28, 2009

Differential Diagnoses

Abortion
Irritable Bowel Syndrome
Ectopic Pregnancy
Ovarian Cysts
Endometriosis
Pelvic Inflammatory Disease
Inflammatory Bowel Disease
Urinary Tract Infection, Females

Other Problems to Be Considered

The most important differential diagnosis of primary dysmenorrhea is secondary dysmenorrhea.

Workup

Laboratory Studies

  • No tests are specific to the diagnosis of primary dysmenorrhea. Diagnosis is made based on clinical findings.
  • The following can be performed to exclude organic causes of dysmenorrhea:
    • Cervical culture to exclude sexually transmitted diseases
    • WBC count to exclude infection
    • Human chorionic gonadotropin level to exclude ectopic pregnancy
    • Sedimentation rate
    • Cancer antigen 125 (CA-125) assay: This has limited clinical value in evaluating women with dysmenorrhea because of its relatively low negative predictive value.

Imaging Studies

  • Noninvasive studies may include abdominal and transvaginal ultrasound. (Other more-invasive studies, including hysterosalpingography, may be required.)
  • Pelvic ultrasound scans are indicated to evaluate for situations such as ectopic pregnancy, ovarian cysts, fibroids, and intrauterine contraceptive devices. This is a highly sensitive test for detecting pelvic masses.
  • Hysterosalpingograms are used to exclude endometrial polyps, leiomyomas, and congenital abnormalities of the uterus.
  • Intravenous pyelograms are indicated if uterine malformation is confirmed as a cause or contributing factor for the dysmenorrhea.

Procedures

  • Other more-invasive studies, including laparoscopy, hysteroscopy, and dilatation and curettage, may be required.
  • Laparoscopic examination is the single most useful procedure. It involves a complete diagnostic survey of the pelvis and reproductive organs to ascertain the presence of any pathology that may account for the clinical symptoms.
  • Hysteroscopy and dilatation and curettage may be indicated to evaluate intrauterine pathology found on imaging.
  • An endometrial biopsy may be indicated if endometritis is considered likely.

More on Dysmenorrhea

Overview: Dysmenorrhea
Differential Diagnoses & Workup: Dysmenorrhea
Treatment & Medication: Dysmenorrhea
Follow-up: Dysmenorrhea
References
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Further Reading

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Keywords

primary dysmenorrhea, secondary dysmenorrhea, painful menstruation, painful menses, spasmodic dysmenorrhea, congestive dysmenorrhea, endometriosis, pelvic inflammatory disease, PID, ovarian cysts, ovarian tumors, cervical stenosis, cervical occlusion, adenomyosis, fibroids, uterine polyps, intrauterine adhesions, congenital malformations, bicornuate uterus, subseptate uterus, intrauterine contraceptive devices, IUCDs, intrauterine devices, IUDs, transverse vaginal septum, pelvic congestion syndrome, Allen-Masters syndrome

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Contributor Information and Disclosures

Author

Karim Anton Calis, PharmD, MPH, FASHP, FCCP, Professor, Medical College of Virginia, Virginia Commonwealth University, Clinical Professor, University of Maryland; Clinical Specialist, Endocrinology and Women's Health, Director, Drug Information Service, Mark O Hatfield Clinical Research Center, National Institutes of Health
Karim Anton Calis, PharmD, MPH, FASHP, FCCP is a member of the following medical societies: American College of Clinical Pharmacy, American Society of Health-System Pharmacists, and Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Vaishali Popat, MD, MPH, Medical Officer, Food and Drug Administration
Vaishali Popat, MD, MPH is a member of the following medical societies: American Association of Clinical Endocrinologists and Endocrine Society
Disclosure: Nothing to disclose.

Devra K Dang, PharmD, BCPS, CDE, Assistant Clinical Professor, University of Connecticut School of Pharmacy, Clinical Faculty, Burgdorf Health Center
Disclosure: Nothing to disclose.

Sophia N Kalantaridou, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Ioannina Medical School, Greece
Disclosure: Nothing to disclose.

Medical Editor

Anthony Charles Sciscione, DO, Director, Division of Maternal-Fetal Medicine, Professor, Department of Obstetrics and Gynecology, Drexel University College of Medicine
Anthony Charles Sciscione, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital, Mammoth Lakes, California, Pioneer Valley Hospital, Salt Lake City, Utah, Warren General Hospital, Warren, Pennsylvania and Mountain West Hospital, Tooele, Utah
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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