Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with recurrent, crampy lower abdominal/pelvic pain associated with the onset of menses. Pain is described as [sharp/aching/colicky], radiating to the lower back and thighs. Symptoms typically begin [hours before/at onset] of menstrual flow and persist for [1-3] days. Patient denies intermenstrual bleeding, dyspareunia, or abnormal vaginal discharge. No systemic symptoms such as fever or weight loss.
Clinical Examination Findings
Abdominal exam: Soft, non-distended, non-tender to palpation, no rebound tenderness or guarding. Pelvic exam: External genitalia normal. Speculum exam reveals normal vaginal mucosa and cervix; no lesions or abnormal discharge. Bimanual exam: Uterus is [anteverted/retroverted], mobile, and non-tender. Adnexa are non-tender without palpable masses. No cervical motion tenderness.
Treatment Protocol
1. First-line: NSAIDs (e.g., Ibuprofen 400-800mg or Naproxen 500mg) initiated at onset of menses or 1-2 days prior. 2. Hormonal contraception: Combined oral contraceptive pills (COCPs) or progestin-only methods to suppress ovulation and thin the endometrium. 3. Non-pharmacological: Heat therapy to the lower abdomen, regular exercise, and stress reduction techniques. 4. Follow-up: Re-evaluate in 3 months if symptoms persist despite adherence to therapy.