Dysmenorrhoea and premenstrual syndrome

1. Big picture

This topic has two common menstrual-cycle problems:

1. Dysmenorrhoea = painful menstruation.
2. Premenstrual syndrome (PMS) = cyclical physical, emotional, and behavioural symptoms before menstruation.

The examiner wants a practical answer:

Menstrual pain or premenstrual symptoms
        ↓
First exclude pregnancy and acute pelvic emergencies if clinically relevant
        ↓
Decide: primary functional disorder or secondary organic disease?
        ↓
Treat symptoms, protect fertility, and do not miss endometriosis, pelvic inflammatory disease, fibroids, adenomyosis, or ectopic pregnancy.

The most important distinction is:

| Primary disorder