THÔNG TIN TÀI LIỆU
Clinical Assessment A detailed menstrual history is important to obtain from the patient complaining of severe menstrual cramps Information about the timing of her first period (menarche), regularity of her cycles, duration of menstrual flow, and the amount of blood flow per period are important to know The practitioner should ask about accompanying signs such as nausea, vomiting, dizziness, or diarrhea Knowing whether the cramps keep the patient home from school gives a clue to the adolescent’s ability to function with the dysmenorrhea Asking about precipitating factors (physical activity, bowel movement, urination) or relieving factors (rest, exercise, heat, medications) is important Symptoms are usually better controlled with NSAIDs than with acetaminophen A physical examination for dysmenorrhea does not routinely include a pelvic examination unless the provider is concerned about an imperforate hymen, adnexal masses, or a sexually transmitted infection Inspection and palpation of the abdominal wall for masses, and hernias should be performed for all patients It is helpful to ask the patient to point to the location of the pain; the provider should gently palpate this area at the end of the abdominal examination to avoid exacerbating pain at the start of the examination Patients should also be asked to flex and contract the abdominal wall muscles Increased pain with these maneuvers suggests a myofascial etiology of the pain (Carnett sign) The back and the sacroiliac joints should be palpated to evaluate for tenderness and radiation For patients with a history of sexual activity presenting with pelvic pain, a bimanual examination should be performed to evaluate for PID Findings of cervical motion tenderness, adnexal tenderness, or uterine tenderness would be consistent with a clinical presentation of PID (see section on PID) Patients with an undiagnosed STI may present with pelvic pain or with irregular or heavy vaginal bleeding Endometriosis may also have findings of adnexal, uterine, or rectovaginal tenderness or nodularity on bimanual or rectal examination, although these symptoms are more likely to develop after several years and are less likely to be found among adolescents than adults It is important to point out that the initial treatment of endometriosis is the same as for primary dysmenorrhea (NSAIDs are first line, followed by hormonal medications); surgical intervention is not indicated unless a patient has failed first-line therapies If pelvic anatomy should be further explored, ultrasonography or MRI is an option to consider Pelvic ultrasound is an appropriate initial imaging study to evaluate uterine and ovarian anatomy Patients and families should be informed that optimal ultrasound imaging of the pelvis often requires use of both an
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