Dysmenorrhea in adolescents: diagnosis and treatment.
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.
French
Linda
L
Department of Family Medicine, University of Toledo, College of Medicine, Toledo, Ohio 43614, USA. linda.french@utoledo.edu
D000293:Adolescent; D004358:Drug Therapy / Q000379:methods; D004412:Dysmenorrhea / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D004715:Endometriosis / Q000150:complications; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D008280:Magnetics / Q000627:therapeutic use; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects