Primary dysmenorrhea is the most common adolescent gynecological complaint. It is a painful period without any disease of the pelvis or obvious cause. Usually the first signs of dysmenorrhea appear with the first few periods.
Secondary dysmenorrhea is caused by some disease process and appears after a regular ovulatory cycle or cycles. Secondary dysmenorrhea follows a long period of painless menses. Conditions that contribute to this dysmenorrhea are infections like pelvic inflammatory disease, complications of pregnancy, endometriosis or uterine or vaginal congenital conditions which cause blockage or adhesions.
At least 60% of adolescent females have menstrual pain. Half of these women have moderate or severe pain and 1/8th of all painful periods contribute to missed days of school and work.
Other conditions can mimic painful periods or dysmenorrhea such as tumors, spontaneous abortions, pelvic infections, inflammatory bowel disease, and urinary tract infections. You should contact my office if the cramps don’t get better and interfere with activities. The period should not last more than 10 days. If the flow is very heavy requiring more than 6 pads a day, this is abnormal. Be concerned if one period is missed after they were regular and you believe pregnancy is possible. She should see a doctor if she becomes sexually active or see believes she could have any sexually transmitted diseases.
Adolescents can get relief with over the counter pain relievers like ibuprofen (Advil™), aspirin or Tylenol™. Regular exercise and heat applied to the lower abdomen do help and should be tried. For those with moderate to severe pain, nonsteroidal anti-inflammatory drugs help about 75% of the time. For those who are helped little by this treatment, a pelvic exam is recommended. I refer to a gynecologist if that is necessary.
Oral contraceptives are used in some cases, especially sexually active adolescents. This method reduces pain by stopping ovulation and reducing endometrial growth.