Case report of patient with dysmenorrhoea and menorrhagia treated with multimodal analgesia
History
I reviewed a 29 year old lady in the Pain Clinic. She had a history of dysmenorrhoea and menorrhagia. She had brought with her a summary of her extensive history which was particularly helpful. Of note, she had been on a number of different medications including Methanamic Acid, other anti-inflammatories, Codeine and Dihydrocodeine.
She had also had female hormone therapy including oral therapy and implanted coil. She had previously had 3 diagnostic and therapeutic laparoscopies, the last one of which was extremely helpful and in which extensive endometriosis was found inside the pelvis and abdomen.
Symptoms of dysmenorrhoea and menorrhagia
She described her main symptoms as occurring for approximately 9 days peri and most menstrual period. These included sharp, cramping pain and a dull, tiring pain being the worst. These were associated with low level migraines at the same time.
She also got heavy periods associated with dizziness, faintness, lethargy, tiredness, depression, mood swings and severe impedance of thoughts. These pain problems had had a considerable impact on her life. Unfortunately, she was not able to take hormone therapy for the endometriosis due to adverse effects, in particular severe mood swings.
Multimodal analgesia for treatment of dysmenorrhoea and menorrhagia
She was started on an analgesic regime specifically for the 9 days of pain, including Paracetamol 1 g q.d.s., Pregabalin 75 mg nocte, Etoricoxib 90 mg once per day, Oxycodone 10 mg as required and Tramadol 50-100 mg as required. She was reviewed approximately 4 weeks later in the Pain Clinic and I was very pleased to see that she had a pain reduction of between 50-90%.
She did have some persistence of her migraine-type headaches and some nausea, particularly with the Oxycodone and Tramadol. She was started on a new regime including Paracetamol, Pregabalin 75 mg am/150 mg pm, Celecoxib, Oxycontin, Oxycodone, Tramadol, Prochlorperazine and Metoclopramide.
Follow up review
She will be reviewed in the Pain Clinic in approximately one month’s time to see how this new combination has helped.
It is interesting to note that there are a number of patients in the clinic with dysmenorrhoea and menorrhagia who benefit from a strong analgesic regime during their difficult, painful peri menstrual period.
