Management of dysmenorrhoea Neil Johnson a,b,c, * a University of Auckland, Department of Obstetrics & Gynaecology, National Women’s Health at Auckland Hospital, Auckland, New Zealand b Fertility Plus, Greenlane Clinical Center, Auckland, New Zealand c Auckland Gynaecology Group, Parnell, Auckland, New Zealand Received 28 June 2005; accepted 13 September 2005 Available online 6 January 2006 Abstract Accurate diagnosis is important to ensure optimal management of dysmenorrhoea—for women whose dysmenorrhoea does not respond to first line treatments, diagnostic laparoscopy is often useful. Randomised trials have confirmed the effectiveness of a wide and varied array of treatments: conservative approaches including aerobic exercise, topical heat, relaxation therapy, high frequency transcutaneous electrical nerve stimulation (TENS) and timely diagnostic ultrasound; drug treatments including paracetamol and non-steroidal anti-inflammatory drugs, hormonal drug treatments for endometriosis, progestogen drug treatment for unexplained chronic pelvic pain; alternative and newer drug treatments including Vitamin B1, Vitamin E, magnesium, fish oil, toki-shakuyaku-san; surgical treatments including laparoscopic excision and laparoscopic ablation for endometriosis, laparoscopic ovarian cystectomy for endometriomas, the levonorgestrel intrauterine system as a post-operative adjunct for endometriosis, and laparoscopic uterine nerve ablation for primary dysmenorrhoea. The future research agenda has been defined by gaps in randomised trial evidence where data are insufficient or conflicting. # 2005 Elsevier B.V. All rights reserved. Keywords: Chronic pelvic pain; Dysmenorrhoea; Endometriosis; Primary; Randomised controlled trial; Secondary 1. Introduction and epidemiology Dysmenorrhoea is a term encompassing painful men- strual cramps of uterine origin. It is very common, estimates varying between 45% and 90% of all women, and it appears to be the commonest gynaecological condition among women of many different ages and ethnicities [1]. Dysmenorrhoea is usually categorised as primary or secondary. Primary dysmenorrhoea is menstrual cramps in the absence of organic pathology. It typically establishes 6–12 months after menarche, the onset of menses, once the cycles become ovulatory (as anovulatory cycles tend to be associated with non-painful menses). A sub-categorisation of primary dysmenorrhoea is that into spasmodic dysmenor- rhoea (spasms of acute intermittent pain in the lower abdomen, low back or inner thighs beginning on the first day of menstruation) and congestive dysmenorrhoea (pre- menstrual dull aching in the lower abdomen, sometimes associated with breast or ankle discomfort and other pre- menstrual symptoms including lethargy, depression and irritability) [2]. It is termed secondary dysmenorrhoea when identifiable pathology such as endometriosis, adenomyosis, pelvic congestion or pelvic adhesions reflecting previous inflammation are present; iatrogenic secondary dysmenor- rhoea may result from intrauterine contraceptive devices; rare causes of secondary dysmenorrhoea include mullerian abnormalities, cervical stenosis and gynaecologic malig- nancy. Secondary dysmenorrhoea usually commences years after menarche in women more advanced into their reproductive years, although it is increasingly recognised that women with endometriosis may experience dysmenor- rhoea from early in their menstrual lifetime, even at menarche. Pain from secondary dysmenorrhoea also typically occurs 24 h or more prior to, and lasts for the entire duration of, menstruation. www.elsevier.com/locate/rigapp Reviews in Gynaecological and Perinatal Practice 6 (2006) 57–62 * Tel.: +64 9 6389919. E-mail address: n.johnson@auckland.ac.nz. 1871-2320/$ – see front matter # 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.rigp.2005.09.008