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Primary dysmenorrhoea — RACGP Fellowship MCQ

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ModeratePaediatrics and adolescentPrimary dysmenorrhoeaRACGP Fellowship

A 13‑year‑old girl presents with severe menstrual cramps causing her to miss school. Her menstrual cycles are regular, pain begins with bleeding, and there is no history of sexual activity, fever, abnormal discharge, or palpable pelvic mass. What is the most appropriate initial management?

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Correct answer: B — Start NSAIDs at the onset of menses and consider hormonal contraception if pain is inadequately controlled

Option B is correct. In classical primary dysmenorrhoea in an adolescent, first‑line treatment is NSAIDs (ideally initiated around the onset of menses). If symptoms persist after a trial of NSAIDs over several cycles, hormonal contraceptives may be added. Referral for invasive investigation (laparoscopy) is only indicated after failure of medical therapy. Antibiotics are unwarranted in absence of infection. NSAIDs are safe and appropriate in adolescents. Age 18 is not a threshold for withholding evidence‑based management.

Reference: RACGP: Dysmenorrhea: An update on primary healthcare management (AJGP, 2024); RACGP Case‑based Female reproductive system check (May 2018), https://www1.racgp.org.au/ajgp/2024/january-february/dysmenorrhea