Assessment of dysmenorrhoea

• full gynaecological history - with special attention to:
  • onset of dysmenorrhoea and relation to menses
  • intra-uterine contraceptive device - present ?
  • dyspareunia, menorrhagia, or infertility ?
    
    
• general examination - including:
  • bimanual pelvic examination / speculum examination
  • look for polyps protruding through the cervical os and for enlargement, tenderness or fixity of the uterus or adnexa
    
    
• specialised investigations:
  • laparoscopy
  • dilatation and curettage
  • hysteroscopy - to reveal endometrial polyps or submucous leiomyomas which may be missed on curettage; diagnostic hysteroscopy is often performed as an outpatient procedure

Reference

1. Kho KA, Shields JK. Diagnosis and Management of Primary Dysmenorrhea. JAMA. 2020 Jan 21;323(3):268-269.