Alternative names :- Periods - painful (adolescent); Adolescent dysmenorrhea; Menstrual pain - adolescent; Painful menstrual periods - adolescent
Dysmenorrhea is painful menstruation associated with ovulation that isn't related to pelvic disease. It's the most common gynecologic complaint and a leading cause of absenteeism from school (affecting 10% of high school girls each month) and work (an estimate of 140 million work hours lost annually). The incidence peaks in women in their early 20s and then slowly decreases.
Dysmenorrhea can occur as a primary disorder or secondary to an underlying disease. Because primary dysmenorrhea is self-limiting, the prognosis is generally good. The prognosis for secondary dysmenorrhea depends on the underlying disease.
What causes dysmenorrhea?
Although primary dysmenorrhea is unrelated to an identifiable cause, possible contributing factors include:
Dysmenorrhea may also be secondary to such gynecologic disorders as:
The pain of dysmenorrhea probably results from increased prostaglandin secretion in menstrual blood. which intensifies normal uterine contractions. Prostaglandins intensify myometrial smooth muscle contraction and uterine blood vessel constriction. thereby worsening the uterine hypoxia normally associated with menstruation. This combination of intense muscle contractions and hypoxia causes the intense pain of dysmenorrhea. Prostaglandins and their metabolites can also cause GI disturbances. headache. and syncope.
Because dysmenorrhea usually follows an ovulatory cycle. both the primary and secondary forms are rare during the anovulatory cycle of menses. After age 20, dysmenorrhea is generally secondary.
Symptoms of dysmenorrhea
Possible signs and symptoms of dysmenorrhea include sharp, intermittent. cramping. lower abdominal pain, usually radiating to the back. thighs, groin. and vulva. Such pain typically starts with or immediately before menstrual flow and peaks within 24 hours.
Dysmenorrhea may also be associated with signs and symptoms that suggest premenstrual syndrome. including:
A possible but rare complication of dysmenorrhea is dehydration due to nausea, vomiting. and diarrhea.
Differential diagnosis must rule out other causes of pelvic pain, including pregnancy, impending abortion. or various other disorders. Methods used to diagnose dysmenorrhea may include:
Treatment of dysmenorrhea
Initial treatment aims to relieve pain and may include:
For primary dysmenorrhea:
Treatment of secondary dysmenorrhea is designed to identify and correct the underlying cause and may include surgical treatment of underlying disorders, such as endometriosis or uterine leiomyomas (after conservative therapy fails).
Special considerations or prevention
Effective management of the patient with dysmenorrhea focuses on relief of symptoms, emotional support, and appropriate patient teaching. especially for the adolescent.
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