Dysmenorrhoea (analgesia) — MRCGP AKT MCQ

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EasyGynaecologyDysmenorrhoea (analgesia)MRCGP AKT UKMLA PARA

A 26-year-old woman has dysmenorrhoea that affects her daily activities and cyclical deep dyspareunia. Endometriosis is suspected. She has no contraindication to non-steroidal anti-inflammatory drugs. While further assessment is arranged, which is the most appropriate initial analgesic strategy?

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Correct answer: C — Start a short trial of an NSAID

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

A is correct. NICE recommends considering a short trial of paracetamol or a non-steroidal anti-inflammatory drug, alone or in combination, for first-line management of endometriosis-related pain. An NSAID is therefore the appropriate option here because she has no contraindication. Regular opioid treatment is unsuitable as an initial strategy for a potentially chronic pain condition because of adverse effects and dependence risk. Amitriptyline is a neuromodulator used for selected neuropathic pain presentations rather than routine first-line dysmenorrhoea. Analgesia need not be delayed until endometriosis is confirmed, and systemic corticosteroids have no recommended role in treating endometriosis-related pain. Hormonal treatment may also be offered after discussion of preferences and fertility priorities.

Reference: National Institute for Health and Care Excellence. Endometriosis: diagnosis and management (NG73), section 1.4, Analgesics. Updated 2024. https://www.nice.org.uk/guidance/ng73/chapter/Recommendations