Adnexal tenderness and enlargement may be noted. Evaluate uterosacral ligaments and rectovaginal septum for palpable abnormalities or nodularities. The absence of physical findings does not completely exclude secondary dysmenorrhea. In endometriosis, the ectopic endometrial tissue may be observed only on direct visual examination. Since exact diagnosis is beyond the scope of the ED, refer the patient for gynecologic evaluation and possible diagnostic laparoscopy and laparotomy.
Pelvic ultrasound is the imaging study of choice for initial evaluation of pelvic disease.
ED evaluation of dysmenorrhea excludes serious life-threatening causes of pelvic pain, such as ectopic pregnancy. Since most ovulating females experience cyclic pain, physicians easily can establish a diagnosis of dysmenorrhea. Consider that patients with dysmenorrhea also may have other potential disease processes, such as appendicitis, tuboovarian abscess, ectopic pregnancy, or ovarian cysts. Suppress endometrium if endometriosis is suspected. Prostaglandin inhibitors are a mainstay of therapy.