In their otherwise excellent article (O&G Magazine, Spring 2017) on dysmenorrhoea in adolescents, Moeed and Mellor have made a significant omission, namely the back-up option of depot medroxyprogesterone acetate (DMPA). I do not dispute that the oral contraceptive pill is the first-line treatment, but when it fails to provide sufficient symptom relief, recourse to DMPA will help to prevent a large number of potentially unnecessary laparoscopies.

I am aware of the reluctance of some of our colleagues to promote DMPA, especially for adolescents, because of the occasional side effects (mostly reversible with estrogen) and the fear of loss of bone mineral density, which has been shown to be of little or no long-term clinical significance and is reversible. These considerations pale to insignificance compared with the risks and costs of unnecessary surgery.