Dysmenorrhea in Emergency Medicine Workup
- Author: Andre Holder, MD; Chief Editor: Pamela L Dyne, MD more...
Laboratory Studies
Laboratory studies may be indicated to elucidate the cause of secondary dysmenorrhea.
- Complete blood count (with differential), for evidence of infection or neoplastic process
- Urinalysis, to exclude urinary tract infection
- Quantitative human chorionic gonadotropin level, to exclude ectopic pregnancy
- Gonococcal/chlamydial cultures, enzyme immunoassay (EIA), and DNA probe testing, to exclude sexually transmitted infections (STIs)/pelvic inflammatory disease (PID)
- Stool guaiac, to rule out GI bleeding
- Erythrocyte sedimentation rate (ESR), for subacute salpingitis
Although these tests can be used as adjuncts in the workup of dysmenorrhea, they may be misleading. For instance, the CBC may show a normal white count in up to 56% of patients with PID. Conversely, the white count can be elevated from physiologic stress. In a patient with associated vaginal bleeding, the hematocrit may be normal in a patient with obvious hypovolemia on examination (eg, positive orthostasis or tachycardia), especially if hemorrhage started within minutes to hours of presentation.[4] Moreover, the EIA and DNA probe tests for gonorrhea and chlamydia have varying sensitivities, anywhere from 86-93%.[4] Therefore, ancillary laboratory testing should not replace a sound clinical basis for diagnosis of dysmenorrhea and its underlying cause.
Imaging Studies
In cases of well-established primary dysmenorrhea, imaging studies are of little value. However, if pelvic pathology is suspected, abdominal and/or transvaginal ultrasonography are inexpensive and effective modalities.
- Ultrasonography is relatively noninvasive, can easily be performed in the ED, and reveals most relevant pelvic pathology. For instance, endometriosis may appear as a complex mass with a speckled appearance.[4]
- Although CT scanning is not routinely ordered in the ED for patients with dysmenorrhea, it does have some utility, particularly in identifying ovarian torsion.[4, 7, 6]
- MRI has some ability to detect adenomyosis and submucous myomas that might otherwise be missed on other imaging modalities.[4] This test is not routinely ordered in the ED.
Procedures
Further investigation outside the ED might include hysterosalpingoscopy or laparoscopy. The latter is usually indicated when initial interventions fail to relieve symptoms.
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