Dysmenorrhea in Adolescents
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Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1–3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.
KeywordsEndometriosis Anastrozole Goserelin Transcutaneous Electrical Nerve Stimulation Sham Acupuncture
No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.
- 19.US Preventive Services Task Force, Agency for Healthcare Research and Quality. Screening for gonorrhea: summary of recommendations [online]. Available from URL: http://www.ahrq.gov/clinic/uspstf/uspsgono.htm [Accessed 2007 Nov 21]
- 24.Practice Committee of the American Society of Reproductive Medicine. Treatment of pelvic pain associated with endometriosis. Fertil Steril 2006 Nov; 86(5 Suppl.): S18–27Google Scholar
- 26.Proctor ML, Farquhar CM. Dysmenorrhoea. In: Group BP, editor. Clinical evidence. London: BMJ Publishing Group, 2003: 2058–78Google Scholar
- 31.Edelman AB, Gallo MF, Jensen JT, et al. Continuous or extended cycle vs. cyclic use of combined oral contraceptives for contraception. Cochrane Database Syst Rev 2005; (3): CD004695Google Scholar
- 40.Selak V, Farquhar C, Prentice A, et al. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 2001; (4): CD000068Google Scholar
- 51.Vitamin E for dysmenorrhea. Bandolier, 2005 [online]. Available from URL: http://www.jr2.ox.ac.uk/bandolier/bandl36/bl36-6.html [Accessed 2007 Nov 14]
- 61.Proctor ML, Smith CA, Farquhar CM, et al. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev 2002; (1): CD002123Google Scholar
- 64.Proctor ML, Hing W, Johnson TC, et al. Spinal manipulation for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2001; (4): CD002119Google Scholar
- 65.Wilson ML, Farquhar CM, Sinclair OJ, et al. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2000; (2): CD001896Google Scholar