Dysmenorrhea in the adolescent

Alternative names
Periods - painful (adolescent); Adolescent dysmenorrhea; Menstrual pain - adolescent; Painful menstrual periods - adolescent

Definition
Dysmenorrhea is defined as painful menses.

Causes, incidence, and risk factors

Primary dysmenorrhea in adolescents usually begins 2 to 3 years following the onset of menses. It consists of crampy lower abdominal pain that generally begins several hours prior to the onset of a menstrual period, but may begin as much as 1 or 2 days in advance.

The pain lasts 1 or more days into the period and then subsides. Pain may be mild to severe, and may be associated with nausea and vomiting and changes in bowel habits (either constipation or diarrhea). Primary dysmenorrhea is caused by prostaglandin-induced uterine contractions.

Dysmenorrhea is a common gynecological complaint in adolescents, but the majority of cases are not associated with a disease, and the physical examination is normal. Dysmenorrhea has been reported to be significantly increased among mothers and sisters of women with dysmenorrhea.

Abnormal conditions associated with secondary dysmenorrhea include endometriosis, pelvic inflammatory disease, vaginal agenesis, and others. Secondary dysmenorrhea most commonly begins in women in their 20s. Increasing frequency of sexually transmitted diseases among adolescents has increased the percentage of dysmenorrhea cases associated with disease.

Symptoms

• Lower abdominal crampy pain that occurs before the beginning of the menstrual period and lasts 1 or 2 days into the period
  
• Nausea
  
• Vomiting
  
• Diarrhea
  
• Constipation

A history and physical examination by the health care provider will often differentiate between functional dysmenorrhea and those rare cases associated with a medical condition. Younger adolescents who have not become sexually active may require a pelvic examination (performed through the rectum rather than through the vagina).

Treatment

Initial treatment is focused on relief of pain. Anti-inflammatory medications can be helpful. This includes over-the-counter medications such as aspirin, nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (available over-the-counter or in prescription strengths), and prescription-only medications such as indomethacin.

In some severe cases, and with disorders such as endometriosis, oral contraceptives can be helpful. They are used in this case to regulate the hormone levels in the body (they may be prescribed even for girls who are not sexually active).

Women who continue to have severe dysmenorrhea despite the use of NSAIDS and/or oral contraceptives may require laparoscopy for further evaluation.

Expectations (prognosis)

Mild analgesics are usually effective in treating dysmenorrhea and oral contraceptives generally control severe cases. Dysmenorrhea associated with a disease state responds to treatment of the primary problem.

Complications

There are no complications from functional dysmenorrhea. Complications may develop from disease-induced dysmenorrhea based on the disease or condition present.

Calling your health care provider

If you (or your daughter) experience painful menstrual periods and the pain disrupts your life, occurs frequently, or is not relieved by over-the-counter medications, see your primary health care provider or gynecologist.

Prevention

There are no specific preventive measures for dysmenorrhea. Avoiding sexually transmitted diseases will decrease disease-associated dysmenorrhea.

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