We conducted an epidemiological study of the prevalence of dysmenorrhea in the middle and high schools in Montpellier, France. As part of a systematic medical examination, participating school physicians established a medical record for every female student. Each record provided detailed information on the clinical sign score and age at menarche, age at onset of dysmenorrhea, clinical severity, frequency, family antecedents, premenstrual syndrome, psychological problems, parents’ professions, and type of medication used for symptom relief (if applicable). Dysmenorrhea was considered to be mild to moderate if the score was >5, severe was >9, and very severe >14.
We examined a total of 4,203 adolescents aged between 14 and 18 years. The prevalence of dysmenorrhea was 21%, with 902 dysmenorrheic adolescents.
When we divided the population into two age groups, the frequency was as follows: (1) 14 - 16 years: 2,207 students, 453 with dysmenorrhea, or 20.5% and (2) 16 - 18 years: 1,996 students; 449 with dysmenorrhea, or 22%.
The intensity of each clinical sign of dysmenorrhea is shown in
Pelvic pain, low-back pain, severe asthenia and a degree of emotional instability were the four cardinal signs of adolescent dysmenorrhea. When the different symptoms were ranked in descending order, the following could be seen (
table 2): 96% of the adolescents reported pelvic pain, 70% asthenia, 59% lowback pain, 57% irritability, and 30% reported nausea and vomiting. Moreover, 29% reported headache, 28% dizziness, 27% myalgia, 20% diarrhea or irritable bowel, and 17% reported faintness.
In terms of the frequency of dysmenorrhea, the following was noted: (a) regularly (every cycle): 57% of cases; (b) frequently (1 out of 2): 28% (c) and occasionally: 15%. The association of dysmenorrhea with breast tenderness and emotional instability, which are typical of premenstrual syndrome, was noted in 26% of the cases.
School absenteeism was high: 35% of the dysmenorrheic students reported missing classes on the first days of menses. Family antecedents were noted in 39% of the adolescents (grandmother, mother, sister).
Age of onset: Dysmenorrhea appeared at a chronological age of 10 years in 31 adolescents, 11 years in 136 adolescents, 12 years in 303, 13 years in 249, 14 years in 114, 15 years in 39 and 16 years in 11. When we considered the onset of dysmenorrhea in terms of menarche, we observed that dysmenorrhea accompanied menarche in 31%, and that it appeared at a gynecological age of 1 year in 34%, 2 years for 19%, 3 years for 8%, 4 years for 4%, and 5 years 0.6%.
Evaluation of the therapeutic care of dysmenorrhea in each adolescent revealed that analgesics were used in 29% of the cases, anti-inflammatories in 11%, contraceptives in 4%, and homeopathic treatment in 4%. This seems to indicate that more than half of these adolescents considered dysmenorrhea as either a normal phenomenon or a fatality!
Psychological problems were noted in 24% and these ranged from motherdaughter tensions and school problems up to an extreme refusal of femininity.
The socioeconomic status of the family was evaluated by the father’s or both parents’ professions. The following was noted: unskilled workers (221), office employees (146), middle management (137), self-employed (129), skilled craftsmen, small-business owners (82), farmers (64), retired (26), company executives (7) and unemployed (90).
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD