Information | Clinical significance |
Menstrual history |
Age at menarche | Regular menses (2 to 7 days of bleeding at intervals of 21 to 45 days) suggest ovulatory cycles. |
Duration of menstrual cycles |
Interval between menstrual periods* |
Date of last 2 menstrual periods |
Symptom history |
Initial onset of symptoms and progression over time | - Primary dysmenorrhea is usually associated with ovulatory menstrual cycles. Most girls have anovulatory cycles for a few months to several years after menarche.
- Acute onset of crampy pelvic pain and uterine bleeding suggests secondary cause, such as miscarriage or ectopic pregnancy (refer to UpToDate topic on evaluation of acute pelvic pain).
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Relation of symptoms to periods | Symptoms of primary dysmenorrhea typically begin several hours prior to the onset of menstruation and continue for 1 to 3 days. |
Presence or absence of nausea, vomiting, diarrhea, dizziness, fatigue, or headache during menstruation | These systemic symptoms are consistent with severe dysmenorrhea. |
Impact of symptoms on daily activities such as school attendance, sports participation, and other activities | Clear inhibition of activities suggests severe dysmenorrhea or other pathology. |
Medication use and perceived effects¶ | Lack of relief from analgesics suggests severe dysmenorrhea or other pathology. |
Sexual history |
Current sexual activity and type of contraception | For sexually active females, hormonal contraceptives are a reasonable first-line choice for treatment of dysmenorrhea. |
History of sexually transmitted diseases and history of pelvic inflammatory disease | Known or suspected pelvic inflammatory disease may be associated with secondary dysmenorrhea. |