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CONTINUING PROFESSIONAL DEVELOPMENT
upon urination or any unfamiliar
Finally, you suggest that Kylie try a
few other things that might help her
pain, such as a heat pack or hot water
bottle, and gentle exercise. However
she should check with you or her doctor
before using any other medicines for
pain relief. You provide her with the
Period problems Self Care Fact Card,
and invite her to contact you if she has
any further questions.
NSAIDs are effective for many women
with primary dysmenorrhoea; for the
treatment of dysmenorrhoea, NSAIDs
are usually more effective than
NSAIDs should be started two days
before expected menstruation, and
continued until pain resolves (usually
by day three of the cycle). Trial one
NSAID for at least three cycles before
considering alternative treatment.
The risk of side effects is limited when
NSAIDs are used sort‐term for the
treatment of dysmenorrhoea.
There is some evidence that non‐
pharmacological treatments such as
heat, dietary changes and exercise
help relieve dysmenorrhoea.
Refer women who don’t respond to
NSAIDs, or have signs of secondary
1. Harel, Z. Dysmenorrhea in adolescents and young
adults: an update on pharmacological treatments and
management strategies. Expert Opin Pharmacother
2. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2013. At: www.amh.net.
3. Pharmaceutical Society of Australia. Non-prescription
medicines in the pharmacy – a guide to advice and
treatment. Canberra: Pharmaceutical Society of Australia;
4. Marjoribanks J, Proctor M, Farquhar C, et al. Non-steroidal
anti-inflammatory drugs for dysmenorrhoea. Cochrane
database of systematic reviews 2010, Issue 1. Art.
5. Dysmenorrhoea [revised Feb 2009]. In: eTG41 complete.
Melbourne: Therapeutic Guidelines;2013. At: http://online.
6. French L. Dysmenorrhea. Am Fam Physician. 2005 Jan
7. Web MD: Dysmenorrhea (Painful menstrual cramps). 2011.
8. Bjarnason I. Gastrointestinal safety of NSAIDs and over the
counter analgesics. Int J Clin Prac 2013;67(sup 178):37–42.
9. Therapeutic Goods Administration. Beware the triple
whammy. 2006. At: www.tga.gov.au/hp/aadrb-0610.htm#.
10. Proctor M, Murphy PA. Herbal and dietary therapies
for primary and secondary dysmenorrhoea. Cochrane
Database of Systematic Reviews 2001, Issue 2. Art. No.:
CD002124. DOI: 10.1002/14651858.CD002124
11. Better Health Channel: Menstruation – dysmenorrhoea.
2013. At: www.betterhealth.vic.gov.au/bhcv2/bhcarticles.
12. Calis KA. Dysmenorrhea. 2013. At: http://emedicine.
13. Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane
Database of Systematic Reviews 2010, Issue 2. Art. No.:
CD004142. DOI: 10.1002/14651858.CD004142.pub2.
1. NSAIDS are frequently used to
treat dysmenorrhoea. Which of the
following statements is CORRECT?
a) NSAIDs and paracetamol have
comparable efficacy for the treatment of
b) Mefenamic acid and naproxen may
be preferred for the treatment of
c) There is no evidence that one NSAID is
superior to another for the treatment of
d) Ibuprofen is indicated for the treatment
of heavy menstrual bleeding.
2. Different NSAIDs have different
treatment regimens. Appropriate
treatment regimens for
a) Naproxen 500 mg immediately, then
250 mg 6–8h.
b) Naproxen sodium 550 mg immediately
then 275 mg 6–8h.
c) Mefenamic acid 1000 mg three
d) a) and b).
3. NSAIDs have serious side effects that
may limit their use. Which of the
following statements is CORRECT?
a) Diclofenac has a higher risk of
cardiovascular side effects than
b) Stroke is a common side effect
c) Naproxen is less likely to cause GI side
effects than diclofenac.
d) Side effects of NSAIDs are not
4. NSAIDs may interact with ACE
a) Both drugs have the potential to cause
b) NSAIDs may increase blood pressure
and reduce the anti-hypertensive effects
of ACE inhibitors.
c) When used with a diuretic, the
combination has the potential to cause
d) All of the above.
5. Bree, 34, has requested something
for period pain. She has only noticed
the pain in the last few months,
previously she had relatively painless
cycles. She tells you the pain is quite
severe, and stops her from going to
work some days. Her pain usually
persists well into her cycle, after
bleeding has finished. She has no
other medical conditions and takes
no regular medications. With respect
to referral, which of the following
statements is MOST correct?
a) It is likely that Bree has primary
dysmenorrhoea, and she should be
b) Referral is not required. As Bree has no
medical conditions and takes no regular
medications, self-care with an NSAID is
appropriate to treat her symptoms.
c) Bree has risk factors for secondary
dysmenorrhoea and should be referred
for further investigation.
d) Bree requires referral because she is 34.
COUNSELLING IN PRACTICE
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