Primary dysmenorrhea in adolescents
- Chantay Banikarim, MD, MPH
Chantay Banikarim, MD, MPH
- Director of Adolescent Medicine
- St. Joseph's Hospital & Medical Center, Phoenix
- Section Editors
- Mitchell Geffner, MD
Mitchell Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Professor of Pediatrics
- University of Massachusetts Medical School
Primary dysmenorrhea refers to recurrent, crampy lower abdominal pain that occurs during menstruation in the absence of pelvic pathology. It is the most common gynecologic complaint among adolescent females. Secondary dysmenorrhea refers to painful menstruation in the presence of pelvic pathology. It is more common among women in the fourth and fifth decades of life.
The diagnosis and treatment of primary dysmenorrhea in adolescents will be discussed in this topic review. Treatment of primary dysmenorrhea in adult women is reviewed separately. (See "Treatment of primary dysmenorrhea in adult women".)
Nausea, vomiting, diarrhea, headache, dizziness, or back pain may accompany the crampy abdominal pain. The pain and associated symptoms typically begin several hours prior to the onset of menstruation and continue for one to three days. The severity of the disorder can be categorized by a grading system based upon the degree of menstrual pain, presence of systemic symptoms, and impact on daily activities (table 1) .
Dysmenorrhea generally does not occur until ovulatory menstrual cycles are established. Maturation of the hypothalamic-pituitary-gonadal axis leading to ovulation occurs at different rates; approximately 18 to 45 percent of teens have ovulatory cycles two years postmenarche, 45 to 70 percent by two to four years, and 80 percent by four to five years . Dysmenorrhea occasionally accompanies anovulatory cycles, especially if heavy bleeding and clots are present. (See "Physiology of the normal menstrual cycle".)
The prevalence of dysmenorrhea among adolescent females ranges from 60 to 93 percent [3-6]. Many adolescents report limitations on daily activities, such as missing school, sporting events, and other social activities because of dysmenorrhea [4-7]. However, only 15 percent of females seek medical advice for menstrual pain, signifying the importance of screening all adolescent females for dysmenorrhea .
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- CLINICAL MANIFESTATIONS
- APPROACH TO THE PATIENT
- - Typical symptoms
- - Differential diagnosis
- Physical examination
- First-line treatment
- Second-line treatment
- Treatment failure
- OTHER INTERVENTIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS