Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 24-year-old woman is evaluated for severe cramps associated with her menstrual periods. The cramps have worsened over the past year, and the discomfort is severe enough that she has periodically missed work. She reports no abnormal vaginal discharge. Menses are unchanged from her baseline pattern. She has tried ibuprofen and naproxen for pain relief, but these medications cause stomach upset. The patient is sexually active with several male partners. She has no history of sexually transmitted infection and is up to date with her immunizations and gynecologic screening. Medical history is otherwise unremarkable, and she takes no medications.
On physical examination, vital signs are normal. On pelvic examination, there is no cervical motion tenderness, adnexal tenderness, masses, or abnormal discharge. The cervix appears normal. Bimanual examination is unremarkable, and the remainder of the physical examination is normal.
A urine pregnancy test is negative. Tests for Chlamydia trachomatis and Neisseria gonorrhoeae are negative.
Which of the following is the most appropriate treatment for this patient’s dysmenorrhea?
A. Combined estrogen-progestin contraceptive pill
B. Depot medroxyprogesterone acetate
C. Low-dose selective serotonin reuptake inhibitor
D. Progestin-only contraceptive pill
E. Tranexamic acid
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
