“Please do something for my period pain” Max Brinsmead MB BS PhD May 2015.

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Presentation transcript:

“Please do something for my period pain” Max Brinsmead MB BS PhD May 2015

Ms. SD Age 16 Complains of daily nausea, epigastric pain and increasingly painful periods Accompanied by mother who reports complete personality change in 24 months

Ms SD Age 16 Complains of daily nausea, epigastric pain and increasingly painful periods WHAT ARE THE POSSIBLE CAUSES?

Ms SDDifferential Diagnosis

Primary dysmenorrhoea Gastritis or peptic ulcer PID Endometriosis Psychogenic

Ms SD Age 16 Complains of nausea, epigastric pain and painful periods WHAT ADDITIONAL INFORMATION DO YOU REQUIRE?

Ms SD Additional History Required Usual menstrual pattern Sexual history When does the pain occur Description of the pain Other GIT tract symptoms Drugs & medications incl smoking Any pre menstrual staining or pain with defecation during menstruation? Family history of gynaecological problems

Ms SD Additional History Usual cycleMonthly, 7d No IMB

Ms SD Additional History Usual cycle Sexual history Monthly, 7d No IMB Coitus never

Ms SD Additional History Usual cycle Sexual history Pain occurs Monthly, 7d No IMB Never Throughout period and 1-2 days after

Ms SD Additional History Usual cycle Sexual history Pain occurs Description of the pain Monthly, 7d No IMB Never Throughout period and 1-2 days after Central, constant, disabling

Ms SD Additional History Usual cycle Sexual history Pain occurs Description of the pain Other GIT tract symptoms Monthly, 7d No IMB Never Throughout period and 1-2 days after Central, constant, disabling Intermittent diarrhoea

Ms SD Additional History Usual cycle Sexual history Pain occurs Description of the pain Other GIT tract symptoms Drugs Monthly, 7d No IMB Never Throughout period and 1-2 days after Central, constant, disabling Intermittent diarrhoea NSAIDs makes nausea worse. Non smoker

Ms SD Additional History PMS and Pain c defaecation during menstruation YES

Ms SD Additional History PMS and Pain c defaecation during menstruation Family history YES Older sister with endometriosis and infertility. Mother had hysterectomy at age 34

Ms SD Age 16 Complains of nausea and increasingly painful periods Do you examine this patient? What tests would you perform?

Ms SD Tests FBC ESR or C-Reactive Protein UEC & LFTs Upper GIT evaluation USS pelvis Menstrual phase CA125 and CA19.9 Laparoscopy

Ms SD Treatment Options while waiting Ix NSAID c anti emetic Other analgesic Rectal NSAID Continuous COC c extra progestin IM Depo Provera