Primary dysmenorrhoea — DRCOG MCQ

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HardGynaecologyPrimary dysmenorrhoeaDRCOG

A 52-year-old woman has cramping pelvic pain starting with bleeding, normal examination and no dyspareunia. What is the most likely diagnosis?

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Correct answer: A — Primary dysmenorrhoea

The symptom pattern is classic for primary dysmenorrhoea: recurrent cramping pelvic/lower abdominal pain that starts with menstrual bleeding, with a normal examination and no features suggesting pelvic pathology. Absence of dyspareunia makes endometriosis or other secondary causes less likely. The other options do not fit: threatened miscarriage requires pregnancy; fibroids typically cause heavy/prolonged bleeding, pressure symptoms or an enlarged/irregular uterus; stress urinary incontinence causes leakage with exertion; and bacterial vaginosis causes malodorous discharge rather than cyclical cramping pain.

Reference: NICE Clinical Knowledge Summaries (CKS). Dysmenorrhoea. Last revised October 2023. https://cks.nice.org.uk/topics/dysmenorrhoea/