Primary or functional dysmenorrhea in the adolescent is a painful paroxysmal syndrome that precedes and may accompany menses, but it is without pelvic pathology. Secondary or acquired dysmenorrhea, on the other hand, is caused by pelvic alteration such as endometriosis, adenomyosis genital infection or ovarian cysts. Although dysmenorrhea is the most frequent gynecological complaint of adolescents, it is often revealed only when the medical history of the young patient is taken. In fact, fewer than 15% of affected adolescents consult a physician specifically for this pain syndrome.
Long considered as an epiphenomenon, primary dysmenorrhea has received greater attention in recent years because of the discovery of the central role of the prostaglandins in myometrium hypercontractility and arteriolar vasoconstriction (
fig. 1). In addition, certain non-steroidal antiinflammatory drugs (NSAIDs) (propionates) have been found to be remarkably efficacious in treating this adolescent syndrome. Adolescent care providers have the important role of educating adolescent girls about menstruationassociated symptoms, as well as of evaluating and effectively treating patients with dysmenorrhea.
The intensity of the crampy pain is variable. Usually, the pain starts within 1 - 4 h of menses onset and lasts for 24 - 48 h. In some cases, the pain starts 1 - 2 days before menses and continues for 2 - 3 days. It ranges from a dull ache to a sensation of tightening, contractions, or intolerable colicky pain. In terms of functional manifestations, dysmenorrhea is at times handicapping. The pain is usually pelvic, though it may radiate to the inguinal region, the lower back or the legs. It is accompanied by systematic symptoms including headache, nausea and vomiting, diarrhea, asthenia, irritability, dizziness, myalgia, and absenteeism from school. As with any phenomenon of an essentially subjective nature, it is difficult to analyze. To better quantify the dysmenorrhea syndrome, we developed a clinical scale that scores all symptoms from 0 to 3 in terms of intensity (
table 1). Such a scale was necessary not only to standardize assessment of dysmenorrhea, but also to evaluate objectively the efficacy of the therapies proposed to patients. Pelvic examination is normal in the adolescent with primary dysmenorrhea.
Revision date: July 4, 2011
Last revised: by Jorge P. Ribeiro, MD