Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Dysmenorrhoea - Management
How should I assess a woman with painful periods?

  • Ask about:
    • Onset — was the initial onset of symptoms related to the menarche, or was it after several years of painless periods?
    • The timing of pain in relation to the menstrual cycle.
    • Non-gynaecological symptoms that may be associated with primary dysmenorrhoea (for example, nausea, vomiting, migraine, bloating, and emotional symptoms).
    • Other gynaecological symptoms (for example, dyspareunia, vaginal discharge, menorrhagia, intermenstrual bleeding, and postcoital bleeding) that may suggest underlying pathology.
    • Other non-gynaecological symptoms (for example, rectal pain and bleeding) that may suggest underlying pathology.
  • Establish the impact of dysmenorrhoea on the woman's life (for example, time off work, interference with daily activities).
  • Determine which treatments have already been tried, and their effectiveness.
  • Perform an abdominal examination in all women.
  • Perform a pelvic examination, unless the woman is an adolescent with a typical history of mild-to-moderate dysmenorrhoea who has never been sexually active.
    • Consider taking swabs if the woman is at risk of a sexually transmitted infection. See the CKS topic on Vaginal discharge.
  • Determine whether dysmenorrhoea is likely to be of primary or secondary origin:
    • Primary dysmenorrhoea:
      • Usually starts 6–12 months after the menarche, once cycles are regular.
      • Pain often starts shortly before the onset of menstruation, and lasts for up to 72 hours, improving as the menses progresses.
      • Other gynaecological symptoms are not usually present.
      • Non-gynaecological symptoms may be present.
      • Pelvic examination is normal.
    • Secondary dysmenorrhoea:
      • Menstrual pain appears after several years of painless periods.
      • Pain may persist after menstruation finishes; or may be present throughout the menstrual cycle, but exacerbated by menstruation.
      • Other gynaecological symptoms are often present.
      • Rectal pain or bleeding may indicate recto-vaginal endometriosis.
      • Pelvic examination may be abnormal; however, the absence of abnormal findings does not exclude secondary dysmenorrhoea.
  • Refer urgently for further assessment if red flags are present including:
    • Abnormal cervix on examination.
    • Persistent intermenstrual bleeding.
    • A palpable abdominal or pelvic mass on examination that is not obviously uterine fibroids nor of gastrointestinal or urological origin.

© NHS Institute for Innovation and Improvement