Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Primary dysmenorrhea in adolescents

Chantay Banikarim, MD, MPH
Section Editors
Mitchell E Geffner, MD
Diane Blake, MD
Deputy Editor
Alison G Hoppin, MD


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) [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 [2]. 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 [5].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Apr 2017. | This topic last updated: Nov 10, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982; 144:655.
  2. Hertweck SP. Dysfunctional uterine bleeding. Obstet Gynecol Clin North Am 1992; 19:129.
  3. Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med 1997; 151:905.
  4. Wilson CA, Keye WR Jr. A survey of adolescent dysmenorrhea and premenstrual symptom frequency. A model program for prevention, detection, and treatment. J Adolesc Health Care 1989; 10:317.
  5. Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics 1981; 68:661.
  6. Johnson J. Level of knowledge among adolescent girls regarding effective treatment for dysmenorrhea. J Adolesc Health Care 1988; 9:398.
  7. Hillen TI, Grbavac SL, Johnston PJ, et al. Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health 1999; 25:40.
  8. Willman EA, Collins WP, Clayton SG. Studies in the involvement of prostaglandins in uterine symptomatology and pathology. Br J Obstet Gynaecol 1976; 83:337.
  9. Smith RP. Primary dysmenorrhea and the adolescent patient. Adolesc Pediatr Gynecol 1988; 1:23.
  10. Alvin PE, Litt IF. Current status of the etiology and management of dysmenorrhea in adolescence. Pediatrics 1982; 70:516.
  11. Chan WY, Dawood MY, Fuchs F. Prostaglandins in primary dysmenorrhea. Comparison of prophylactic and nonprophylactic treatment with ibuprofen and use of oral contraceptives. Am J Med 1981; 70:535.
  12. Henzl MR, Buttram V, Segre EJ, Bessler S. The treatment of dysmenorrhea with naproxen sodium: a report on two independent double-blind trials. Am J Obstet Gynecol 1977; 127:818.
  13. Larkin RM, Van Orden DE, Poulson AM, Scott JR. Dysmenorrhea: treatment with an antiprostaglandin. Obstet Gynecol 1979; 54:456.
  14. Proctor M, Farquhar C. Dysmenorrhoea. Clin Evid 2003; :1994.
  15. Zhang WY, Li Wan Po A. Efficacy of minor analgesics in primary dysmenorrhoea: a systematic review. Br J Obstet Gynaecol 1998; 105:780.
  16. French L. Dysmenorrhea. Am Fam Physician 2005; 71:285.
  17. Smith RP. Cyclic pelvic pain and dysmenorrhea. Obstet Gynecol Clin North Am 1993; 20:753.
  18. Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2010; :CD001751.
  19. Budoff PW. Use of mefenamic acid in the treatment of primary dysmenorrhea. JAMA 1979; 241:2713.
  20. Davis AR, Westhoff C, O'Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: a randomized trial. Obstet Gynecol 2005; 106:97.
  21. Wong, CL, Farquhar, C, Roberts, H, Proctor, M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev 2009; :CD002120.