General Gynaecology – Dysmenorrhoea

1. Rachel is a 15-year-old girl who presents with a history of painful periods since menarche. She is now missing at least a day of school a month. Her mother is concerned that she may have endometriosis as she was diagnosed with mild endometriosis in her 20s whilst trying to conceive Anna, although her periods were never painful. During the consultation, Anna becomes tearful and reveals that she is very anxious about her exams. MOST appropriate management for her

2. Laura is a 16 year-old girl who presents with increasingly painful periods over the last 6 months. She admits to having been sexually active for the last 1 year and becomes tearful when she discloses her beliefs that her boyfriend may not always be faithful to her. What do u do next

3. A 25-year-old woman has been trying to conceive for 2 years. She has painful periods and occasional dyspareunia. On examination, the GP felt that the uterus was retroverted with reduced mobility and there were palpable nodules in the rectovaginal septum. The GP has done the following investigations:

• • Full blood count – normal
  • Thyroid function – normal
  • Day 21 progesterone – confirms ovulation
  • FSH and LH level – normal
  • Rubella serology – immune
  • Chlamydia swab – negative
  • Pelvic ultrasound – normal
  • Partner’s semen analysis – normal.

  She is now referred to the gynaecology outpatient clinic What is your most appropriate management?

4. A 40 year-old woman presents to the gynaecology clinic with a two year history of worsening non-cyclical pelvic pain and dysmenorrhoea. An USS pelvis was normal. She has no other medical history of note and smokes 20 cigarettes per day. What is the most appropriate initial treatment?