22.     A sixteen year old girl has primary dysmenorrhoea. Suitable treatments are:

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a. D&C False
b. paracervical block False
c. pre-sacral neurectomy False
d. the oral contraceptive True
e. non-steroidal anti-inflammatory drugs True
f. GnRH analogue False
g. laser ablation of the endometrium False
h. uterine artery ligation False

The first thing is to reassure the patient and her mother that there is no serious pathology.

An ultrasound scan is useful for this purpose.

Cervical dilatation used to be popular.

But it was ineffective and ran the risk of causing cervical incompetence in subsequent pregnancies.

Division of the utero-sacral ligaments has also been tried, but largely abandoned.

The mainstays of treatment now are the Pill and NSAIs.

If a patient fails to respond, laparoscopy to exclude endometriosis has to be considered.

It is uncommon in this age group, but occurs and treatment may prevent impairment of fertility.

GnRH analogues are effective, through abolition of ovarian function, but produce bone loss, so they are not very practical.

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