12.9.5
Dysmenorrhea
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 12, Sexual and Reproductive Health.
Clinical Description
Lower abdominal pain just before or during menstruation
Signs and Symptoms
- Lower abdominal pain just before or during menstruation
- Pain and cramping in the lower abdomen, lower back pain radiating down the legs.
Investigations
- USS for PID, endometriosis, fibroids, urine dipstick
Non-pharmacological
- hot water bottle
Pharmacological
- Give Mefenamic Acid 500mg 8 hourly during menses for not more than 7 days
Alternatively
- Give Ibuprofen 400 mg 8 hourly (see section on analgesics)
- Diclofenac suppositories 100mg PR PRN
If no response:
- Give cyclical courses of Low Estrogen Combined Oral Contraceptive tablets once daily for 3 - 6 months
If there is still no improvement
- Refer to hospital
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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