Adolescent dysmenorrhea has long been considered a minor problem of menarche. Its relative frequency, the various degrees of severity, the minimizing attitudes of other family members, multigenerational patterns of selfmedication - all these are factors that have contributed to the lack of interest shown by physicians themselves! In 1981, Dawood began to sensitize American physicians to the extent of the problem by attracting their attention to the social and economic repercussions of both school and work absenteeism because of dysmenorrhea. Since then, the demonstration of a hyperproduction of uterine prostaglandins (PGF2α) has led to the development of a specific treatment whose prototype, flurbiprofene (of the propionate group), has been found to have a remarkable efficacy in treating this adolescent syndrome.
Dysmenorrhea, because it is a pain syndrome, is essentially evaluated by subjective report. We have thus defined it as the ensemble of symptoms whose total score is >5; that is, greater than simple pelvic discomfort. Using this criterion, the prevalence of dysmenorrhea in a population of 4,203 adolescents from 14 to 18 years was found to be 21%. It is difficult to compare this result with those of other groups, in part because the definition of dysmenorrhea varies considerably in the literature, rendering quantitative comparison highly questionable. Given the wide differences in definition, it is not surprising to note that the prevalence varies (
table 2) from 43 to 80% - and up to 91% in one group of American adolescents!
The relationship between dysmenorrhea and ovulation is unknown, with much contradictory data. The establishment of ovulatory cycles is a perquisite for dysmenorrhea for some groups. Conversely, Balbi et al. reported that early menarche was related to an increase in its prevalence and its severity.
In our experience, 31% of the adolescents reported dysmenorrhea at menarche; 34% reported dysmenorrhea appearing 1 year later, and 20%, 2 years later. It therefore seems that neither age of menarche nor the establishment of ovulatory cycles determines the presence of adolescent dysmenorrhea.
Conversely, in line with our own observations, several authors have noted that dysmenorrhea included in an adolescent premenstrual syndrome (associating breast tenderness and mood swings) signals the existence of a psychological phenotype specific to the dysmenorrheic adolescent (indolence, lack of athletic activity, mother-daughter symbiosis, familial oversensitivity, and so on).
In conclusion, dysmenorrhea leads to important undertreated morbidity in adolescent girls. It is regrettable that, at a time when there are simple, specific and efficacious medications available for the symptoms of dysmenorrhea, they are used by only a third of the adolescents who suffer regularly from this syndrome. This speaks clearly of the need for pediatricians, gynecologists and generalists to better inform their patients of the help that is available!
Revision date: June 20, 2011
Last revised: by Jorge P. Ribeiro, MD