Dysmenorrhea in Emergency Medicine Follow-up

  • Author: Andre Holder, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 15, 2011
 

Further Outpatient Care

  • Patients with both primary and secondary dysmenorrhea should be provided with appropriate gynecologic follow-up. If they do not have regular medical care, an appointment with a primary medical doctor is also indicated.
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Inpatient & Outpatient Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Opioid analgesics
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Deterrence/Prevention

Various measures have been used to manage dysmenorrhea in the outpatient setting. Lifestyle modification seems to be helpful.

Smoking cessation should be encouraged, since this may be a risk factor for dysmenorrhea.[1, 15]

Exercise has been shown to alleviate symptoms of dysmenorrhea, though the mechanism is not well understood.[15]

A CochraneDatabase of Systematic Reviews article of 5 randomized controlled trials showed that certain behavioral interventions may be effective at treating primary and secondary dysmenorrhea.[2] Other potentially effective interventions include a low-fat vegetarian diet and acupuncture.[5, 16]

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Complications

  • If a diagnosis of secondary dysmenorrhea is missed, the underlying pathology may lead to increased morbidity, including difficulty conceiving.[10]
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Prognosis

  • The prognosis for primary dysmenorrhea is excellent with the use of NSAIDs.
  • The prognosis for secondary dysmenorrhea varies depending on the underlying disease process.
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Patient Education

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Contributor Information and Disclosures
Author

Andre Holder, MD  Staff Physician, Departments of Emergency Medicine and Internal Medicine, Jacobi Medical Center

Andre Holder, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Laurel D Edmundson, MD  Clinical Assistant Instructor of Emergency Medicine, Resident, Department of Emergency Medicine, Kings County Hospital Center, Brooklyn

Laurel D Edmundson, MD is a member of the following medical societies: American Medical Association and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Mert Erogul, MD  Assistant Professor of Emergency Medicine, University Hospital of Brooklyn: Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Mert Erogul, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven A Conrad, MD, PhD  Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Durain D. Primary dysmenorrhea: assessment and management update. J Midwifery Womens Health. Nov-Dec 2004;49(6):520-8. [Medline].

  2. Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM. Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. Jul 18 2007;CD002248. [Medline].

  3. French L. Dysmenorrhea. Am Fam Physician. Jan 15 2005;71(2):285-91. [Medline].

  4. Baines PA, Allen GM. Pelvic pain and menstrual related illnesses. Emerg Med Clin North Am. Aug 2001;19(3):763-80. [Medline].

  5. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. May 13 2006;332(7550):1134-8. [Medline].

  6. Kalish GM, Patel MD, Gunn ML, Dubinsky TJ. Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. Ultrasound Q. Sep 2007;23(3):167-75. [Medline].

  7. Kamaya A, Shin L, Chen B, Desser TS. Emergency gynecologic imaging. Semin Ultrasound CT MR. Oct 2008;29(5):353-68. [Medline].

  8. Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S111-22. [Medline].

  9. Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med. Aug 2001;38(2):156-9. [Medline].

  10. Levy BS, Apgar BS, Surrey ES, Wysocki S. Diagnosis and management: chronic pelvic pain and endometriosis. OBG Management. 2007/03;supp:S3-S13.

  11. Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P. Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Fertil Steril. Sep 2006;86(3):711-5. [Medline].

  12. Fujiwara H, Konno R, Netsu S, et al. Efficacy of montelukast, a leukotriene receptor antagonist, for the treatment of dysmenorrhea: a prospective, double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. Feb 2010;148(2):195-8. [Medline].

  13. Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev. Apr 15 2009;CD002120. [Medline].

  14. Ziaei S, Zakeri M, Kazemnejad A. A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. BJOG. Apr 2005;112(4):466-9. [Medline].

  15. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. Apr 1 2006;332(7544):749-55. [Medline].

  16. [Best Evidence] Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. Feb 2008;198(2):166.e1-8. [Medline].

  17. Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol. Nov 15 1982;144(6):655-60. [Medline].

  18. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. Apr 1996;174(4):1335-8. [Medline].

 
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