Painful periods in adolescents

Olga Kciuk, Sari Kives
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021 · doi:10.1503/cmaj.201972 · PMID:33875460 · PMC8084563
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

Adolescent dysmenorrhea, affecting one-third of menstruating youth, can be managed with NSAIDs or hormonal contraceptives, with gynecologist referral indicated for persistent pain or concerning symptoms.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This paper reviews dysmenorrhea in menstruating adolescents, highlighting that about one-third miss school or sports because of period pain. It summarizes approaches for initial assessment (including features suggestive of secondary dysmenorrhea that prompt pelvic ultrasonography and possible gynecologic referral) and compares first-line treatments, reporting that NSAIDs are equally effective for primary dysmenorrhea (NNT=3) and that combined oral contraceptives also provide benefit (NNT=5), with continuous dosing described as more effective than cyclic use. It notes a major caveat that first-line treatment may begin before a specific diagnosis is made, while persistent symptoms beyond 3 months despite adequate first-line therapy warrant referral. Relevance to endometriosis: the paper states that endometriosis is found in up to 70% of adolescents undergoing laparoscopy for dysmenorrhea refractory to NSAIDs and hormonal therapy, though the paper’s main focus is management of painful periods in adolescents.

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Features suggestive of secondary dysmenorrhea ( Box 1 ) should prompt pelvic ultrasonography and may warrant referral to a gynecologist. 2 , 3 Onset immediately with menarche Progressively worsening dysmenorrhea Abnormal bleeding (including irregular bleeding) with pain Family or personal history of renal or other congenital anomalies (including spine, cardiac, or gastrointestinal) Midcycle or acyclic pain Dyspareunia Family history of endometriosis

Combined

Combined oral contraceptives have an NNT of 5 for treating primary dysmenorrhea. 5 Combined oral contraceptives with doses of ethinylestradiol above 30 μg should be chosen for adolescents, for maintenance of bone health. 6 Continuous dosing provides more effective relief than standard cyclic use. 2 , 3 Levonorgestrel-containing intrauterine systems and the etonogestrel implant are also safe and effective first-line options. 2 , 3 , 7

First Line

Naproxen, ibuprofen and other NSAIDs are equally effective, with a number needed to treat (NNT) of 3 to achieve pain relief in people with primary dysmenorrhea. 4 Full-strength doses should be taken with food, on a regular schedule with no skipped administrations starting 1–2 days before the onset of menses (if predictable) or at the first sign of bleeding or pain, and continued for the first 2–3 days of bleeding. 2 , 3

Dysmenorrhea

One-third of menstruating adolescents miss school or sports because of dysmenorrhea. 1 To minimize impact on academic and social development, physicians should proactively counsel patients on options for managing period pain. 1 – 3 First-line treatment can be started before a specific diagnosis is made. 2

Endometriosis

Endometriosis is found in as many as 70% of adolescents who undergo laparoscopy for dysmenorrhea refractory to treatment with NSAIDs and hormonal therapy. 3 If dysmenorrhea persists beyond 3 months despite adequate first-line treatment, referral to a gynecologist is warranted.

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Condition tags

dysmenorrheadyspareuniaendometriosis

MeSH descriptors

Dysmenorrhea Dysmenorrhea Adolescent Anti-Inflammatory Agents, Non-Steroidal Anti-Inflammatory Agents, Non-Steroidal Contraceptives, Oral Contraceptives, Oral Dysmenorrhea Dyspareunia Dyspareunia Endometriosis Endometriosis Female Humans Pain Pain Prostaglandins Prostaglandins Schools

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