Consultation with the Specialist: Dysmenorrhea

Abstract

1. Paula J. Adams Hillard, MD* 1. *Professor, Department of Obstetrics & Gynecology and of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio After completing this article, readers should be able to: 1. Recognize the prevalence of dysmenorrhea in adolescents and its common results. 2. Describe a menstrual history that is most consistent with primary dysmenorrhea. 3. List the mediators of uterine pain and contractions believed to be involved in the pathophysiology of primary dysmenorrhea. 4. Recommend the appropriate evaluation and management of primary dysmenorrhea, including the appropriate choice and dosing of both over-the-counter and prescription medications. 5. Recognize patients who should be referred for evaluation of possible causes of secondary dysmenorrhea. A 15½-year-old girl came to the office with complaints of the recent onset of painful menstrual periods. She experienced her first menstrual period at the age of 13 years and except for an occasional mildly uncomfortable menstrual period, had not experienced significant pain until recently. She reported regular monthly menses, although she did not write down the dates. She described additional symptoms that also had not been present previously, including headache, loose stools, and breast tenderness. She has tried several over-the-counter medications, including acetaminophen, without significant relief. She has missed 3 days of school in the last 6 weeks because of these complaints. She is otherwise healthy, having no major illnesses, no history of surgeries, and no other genitourinary complaints. There is no family history of endometriosis; severe dysmenorrhea; menorrhagia; irregular periods; infertility; uterine fibroids; or breast, ovarian, colon, or uterine cancer. Her mother recalled that she had been prescribed oral contraceptives at the age of 16 years to alleviate her severe menstrual cramps. When spoken with privately, having been assured confidentiality, the girl denied sexual activity or abuse. She was doing well in school, making As and Bs, and felt that the relationship with her parents and one sister were good. She reported that she experienced crampy midline lower abdominal pain that began with the …