Guideline No. 345: Primary Dysmenorrhea

OBJECTIVE: This guideline reviews the investigation and treatment of primary dysmenorrhea. TARGET POPULATION: Individuals experiencing menstrual pain for which no underlying cause has been identified. BENEFITS, HARMS, AND COSTS: Primary dysmenorrhea is common and frequently undertreated, despite effective therapy being widely available at a minimal cost. Treatment of primary dysmenorrhea has the potential to improve quality of life and decrease time away from school or work. EVIDENCE: Published clinical trials, randomized controlled trials, observational studies, population studies, and systematic review articles indexed in PubMed and the Cochrane database were identified using search the terms "dysmenorrhea" and "menstrual pain." This search builds on the previous review (January 2005 to March 2016), including new literature between March 2016 and December 2024. VALIDATION METHODS: The author rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: Primary care providers, pediatricians, and obstetrician/gynaecologists. SOCIAL MEDIA ABSTRACT: Although menstrual pain is commonly experienced by women and adolescents, it is often undertreated or unfairly dismissed. If left untreated, persistent menstrual pain may develop into a chronic pain syndrome. Treatment includes non-steroidal anti-inflammatory drugs and hormonal contraceptives and can be provided without the need for pelvic examinations; treatment should not be delayed pending a definitive diagnosis. Effective treatments are available and do not require a pelvic examination or invasive procedures. SUMMARY STATEMENTS: RECOMMENDATIONS.