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

2. 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

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

4. Ms SDDifferential Diagnosis

5. Primary dysmenorrhoea Gastritis or peptic ulcer PID Endometriosis Psychogenic

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

7. 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

8. Ms SD Additional History Usual cycleMonthly, 7d No IMB

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

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

11. 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

12. 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

13. 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

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

15. 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

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

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

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