Dysmenorrhea in Adolescents
What is dysmenorrhea?
Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.
Primary dysmenorrhea. From the beginning and usually lifelong; severe and frequent menstrual cramping caused by severe and abnormal uterine contractions.
Secondary dysmenorrhea. Due to some physical cause and usually of later onset; painful menstrual periods caused by another medical condition present in the body (i.e., pelvic inflammatory disease, endometriosis).
What causes dysmenorrhea?
The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, females with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid—both chemicals which control the contractions of the uterus). Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis (a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity—often resulting in internal bleeding, infection, and pelvic pain). Other possible causes of secondary dysmenorrhea include the following:
Pelvic inflammatory disease (PID)
Abnormal pregnancy (for instance, miscarriage, ectopic)
Infection, tumors, or polyps in the pelvic cavity
Who is at risk for dysmenorrhea?
While any female can develop dysmenorrhea, the following females may be at an increased risk for the condition:
Females who smoke
Females who drink alcohol during menses (alcohol tends to prolong menstrual pain)
Females who are overweight
Females who started menstruating before the age of 11
Consult your adolescent's health care provider for more information.
What are the symptoms of dysmenorrhea?
The following are the most common symptoms of dysmenorrhea. However, each adolescent may experience symptoms differently. Symptoms may include:
Cramping in the lower abdomen
Pain in the lower abdomen
Low back pain
Pain radiating down the legs
The symptoms of dysmenorrhea may resemble other conditions or medical problems. Always consult your adolescent's health care provider for a diagnosis.
How is dysmenorrhea diagnosed?
Diagnosis begins with a health care provider evaluating a female's medical history and a complete physical examination including a pelvic examination. A diagnosis of dysmenorrhea can only be certain when the health care provider rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, diagnostic procedures for dysmenorrhea may include:
Ultrasound (also called sonography). A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Laparoscopy. A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.
Hysteroscopy. A visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Treatment for dysmenorrhea
Specific treatment for dysmenorrhea will be determined by your adolescent's health care provider based on:
Her age, overall health, and medical history
Extent of the condition
Cause of the condition (primary or secondary)
Her tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Counseling with your adolescent's health care provider regarding symptoms may increase understanding and lead to activities for stress management. Other possible treatment protocols for managing dysmenorrhea symptoms in young women may include the following:
Prostaglandin inhibitors; for instance, nonsteroidal anti-inflammatory medications, such as aspirin or ibuprofen, to reduce pain
Oral contraceptives (ovulation inhibitors)
Progesterone (hormone treatment)
Dietary modifications (to increase protein and decrease sugar and caffeine intake)
Heating pad across the abdomen
Hot bath or shower