QuizMe 37


A 30-year-old female, G0P0, presented to the clinic due to abnormal vaginal bleeding and painful menstruation for 3 months.  She described the pain to be dull and crampy in nature, occurring 1-2 days before her period lasting throughout the period and several days after. She reported the pain to be 7 out of 10. Her pain is unresponsive to ibuprofen and associated with nausea and fatigue. She also complains of pain during intercourse. Her menarche was at 12 years of age, period length is 28 days, lasting for 7 days with heavy menstruation. Upon vaginal examination she was found to have tenderness. The rectal examination was normal as well as the rest of the examination.

  • Child-bearing age
  • Nulliparous
  • Early menarche and heavy menstruation
  • Dysmenorrhea (1-2 days before and during her menses)
  • Dyspareunia
  • Abnormal vaginal bleeding
  • Endometriosis
  • Ectopic pregnancy
  • Fibroid
  • Ultrasound
  • Hysteroscopy
  • Laparoscopy

Symptomatic treatment for the pain and bleeding with OCP and analgesia

Endometriosis is defined as endometrial glands and stroma that occur outside the uterine cavity. It is an estrogen-dependent, benign, inflammatory disease that affects women during their premenarcheal, reproductive, and postmenopausal hormonal stages.  Approximately 10 percent of reproductive-age women globally have endometriosis. The pathogenesis of endometriosis has not been definitively established. It is a chronic disease that requires long term management. Treatment depends on endometriosis pain severity as recommended by American Society for Reproductive Medicine Practice Committee. Patients with mild to moderate pain are treated with a combination of NSAID´s/OCP while patients with severe symptoms (eg, regularly missing school or work because of pain) are treated with a trial of GnRH analog with add-back hormonal therapy or laparoscopy.



Dr Balqees Attarakih & Dr Aya Al-Shati