Dysmenorrhea diagnosis

Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Primary and secondary dysmenorrhea and premenstrual syndrome Etiology, diagnosis, and management. In Stenchever MA, ed. Comprehensive Gynecolgy. 4th ed. St. Louis Mosby 2001 1065-1078. 

A correct diagnosis of dysmenorrhea, PMS, PMDD, and perimenopause is essential. An evaluation and careful work-up should rule out other possible causes of the symptoms. 

Endometriosis should be suspected in women with subfertility, dysmenorrhea, dyspareunia, or chronic pelvic pain. A definitive diagnosis can be made only by direct surgical visualization of endometrial lesions. Lesions typically are found in the pelvis... 

Pain is a highly subjective part of history taking. Alone, it is not sufficient to make a diagnosis. Symptoms must alter the patient s activities of daily living (ADL) and persist for more than several hours. The symptoms may last as long as several days in acute situations. In the case of secondary dysmenorrhea, weeks to months may pass with major ADL changes before the patient seeks attention. 

Practiced palpatory skills applied to physical diagnosis and a good history combined with appropriately selected diagnostic laboratory and radiologic examinations should separate secondary dysmenorrhea from both primary dysmenorrhea and PMS. 

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