The pain of dysmenorrhea may be experienced in the pelvis, abdomen and lower back, or anterior thighs.
NSAIDs are the first-line treatment for dysmenorrhea.
In a normal menstrual cycle there is an average of 5 to 80 mL of blood loss.
Abnormal uterine bleeding (AUB) involves any disturbance in regularity, frequency, duration, or volume of menstrual flow.
Up to 20% of adolescents with dysfunctional uterine bleeding will have a coagulopathy.
First line treatment for AUB is medical management, with most adolescents responding to oral contraceptive pills (OCPs).
DEFINITION AND EPIDEMIOLOGY
Dysmenorrhea is defined as cyclic menstrual cramps and pain associated with menstruation. It may be classified by pathophysiology (primary or secondary) or by intensity (mild, moderate, or severe) (Table 102-1).1 The term primary dysmenorrhea refers to pain with menses in the absence of pelvic pathology. It typically begins in adolescence once regular ovulatory cycles are established. Secondary dysmenorrhea, by definition, is associated with underlying pelvic pathology. It can occur any time after menarche but most commonly affects older women.2
TABLE 102-1Classification of Dysmenorrhea |Favorite Table|Download (.pdf) TABLE 102-1 Classification of Dysmenorrhea
|Pathophysiology ||Intensity |
|Primary (No Pelvic Pathology) ||Mild |
Secondary (Pelvic Pathology)
Uterine fibroids and adenomyosis
Ovarian cyst or tumors
Pelvic inflammatory disease
Intrauterine device use
Gastrointestinal disorders: irritable bowel disease, celiac disease
Malformation of the Müllerian ducts
Obstruction of menstrual flow: bicornuate or septate uterus, vaginal septum, imperforate hymen
No systemic symptoms
Medication rarely required
Work rarely affected
Few systemic symptoms
Work moderately affected
Poor medication response
The estimated prevalence of primary dysmenorrhea is 43% to 93%, and up to 50% to 70% of adolescents in the United States suffer from this debilitating condition.1,3–5 According to one study, only 14% of adolescents in the United States, aged 12 to 17 years with dysmenorrhea, sought help from a physician. Self-treatment for dysmenorrhea is common among adolescent girls and young women, with 30% to 60% of girls reporting self-medicating with over-the-counter preparations.6
Approximately one-third to one-half of females with primary dysmenorrhea are missing school or work at least once per menstrual cycle, with 5% to 14% of these women missing more frequently.1 This symptom burden has been estimated to account for 600 million lost working hours and 2 billion dollars in lost productivity annually in the United States.3–8 Moreover, females with dysmenorrhea are at increased risk for developing additional chronic pain disorders such as fibromyalgia, which further increases the long-term burden of this condition.2
The cause of primary dysmenorrhea is unclear. However, the condition is associated with prostaglandin F2-alpha release in the endometrium during menstruation. Sloughing endometrial cells release prostaglandins causing myometrial contraction ...