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A longitudinal study of adolescent dysmenorrhoea into adulthood


Dysmenorrhoea is the most common gynaecological symptom in adolescents. Secondary dysmenorrhoea is mostly due to endometriosis. There are no known follow-up studies of dysmenorrhoea into adulthood. Cases of endometriosis often have a long history of dysmenorrhea; however, studies to date have been retrospective. This longitudinal cohort study aimed at analysing the long-term outcomes of dysmenorrhoea and associated rate of endometriosis identified in this cohort. Participants of a study of adolescents seen for dysmenorrhoea were followed-up at an average of 10.24 years. Of those contactable (74), 70 (94.6%) were included. As adults, 19 (27.1%) had slight or no pain with menstruation. Increased age of menarche was found to be associated with no menstrual pain in adulthood (OR 2.10, p = 0.034). No adolescent characteristic studied was found to be associated with severe or very severe dysmenorrhoea as an adult. At follow-up, 13 young women (18.6%) had been diagnosed with endometriosis. All cases of endometriosis were mild. The use of the oral contraceptive pill as an adolescent and feeling an improvement in symptoms with treatment as an adolescent were found to be associated with a diagnosis of endometriosis.

Conclusion: These findings are important for counselling adolescents regarding this common presentation.

What is Known:

Dysmenorrhoea is the most common gynaecological complaint for adolescents

What is New:

Dysmenorrhoea from adolescence resolves in 1 in 4 of young women and no adolescent characteristics predict severe or very severe pain with menstruation in adults.

•Only 1 in 5 of women were found to have endometriosis (all mild disease), despite a mean of 10 years of preceding dysmenorrhoea.

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Fig. 1
Fig. 2



Deep infiltrating endometriosis


Heavy menstrual bleeding


Non-steroidal anti-inflammatory drugs


Oral contraceptive pill


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Authors and Affiliations



Benita Knox performed the literature search and data analysis, and wrote the final manuscript draft. Yi Chen Ong was involved in the initial conceptualisation of the study and literature review, and undertook the follow-up study collecting all the data for the study. Mardiha Abu Bakar undertook the original cohort study and hence provided the comparison data from adolescence. Sonia R Grover conceptualised and designed the study, and contributed to and supervised the literature review, data analysis and manuscript completion.

Corresponding author

Correspondence to Sonia R Grover.

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Communicated by Mario Bianchetti

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Knox, B., Ong, Y.C., Bakar, M.A. et al. A longitudinal study of adolescent dysmenorrhoea into adulthood. Eur J Pediatr 178, 1325–1332 (2019).

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  • Adolescents
  • Dysmenorrhoea
  • Endometriosis
  • Gynaecology
  • Laparoscopy