title: Dysmenorrhea in adolescents and young adults: an update on pharmacological treatments and management strategies.
abstract: BACKGROUND
  Dysmenorrhea is the most common gynecologic complaint among adolescents/young adults. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Adolescents/young adults with severe dysmenorrhea symptoms may have pelvic abnormalities, such as endometriosis or uterine anomalies (secondary dysmenorrhea).
  
  
  METHODS
  This review provides an update on treatments and management strategies of dysmenorrhea in adolescents/young adults. Medical literature articles were retrieved using a Medline search on primary and secondary dysmenorrhea. Original articles from peer-reviewed journals were selected based on relevance.
  
  
  CONCLUSIONS
  Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the preferred initial treatment for dysmenorrhea in nonsexually active adolescents/young adults. Adolescents/young adults with symptoms that do not respond to NSAIDs for three menstrual periods should be offered hormonal treatment, such as combined estrogen and progestin oral contraceptive pills (OCPs), for three menstrual cycles. If dysmenorrhea does not improve within 6 months of NSAIDs and OCPs, a laparoscopy is indicated to look for endometriosis, which is the most common reason for secondary dysmenorrhea.
authors.affiliation: Warren Alpert Medical School of Brown University, Department of Pediatrics, Division of Adolescent Medicine/Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI 02903, USA. Zharel@Lifespan.org
authors.forename: Zeev
authors.initials: Z
authors.lastname: Harel
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000627:therapeutic use; D004412:Dysmenorrhea / Q000188:drug therapy* / Q000378:metabolism; D004715:Endometriosis / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003276:Contraceptives, Oral