Menstrual Disorders in the Adolescent: Dysmenorrhea and Dysfunctional Uterine Bleeding

Dysmenorrhea Dysmenorrhea, or painful menstruation, is the most common gynecologic problem that occurs during adolescence. It is estimated that 75% of menstruating women experience dysmenorrhea, making it the leading cause of school and work absenteeism among young women. Primary dysmenorrhea is defined as painful menses with no identifiable pelvic pathology. Secondary dysmenorrhea refers to painful menses resulting from a pelvic abnormality, such as endometriosis or fibroids. This is an important distinction because treatment is based on the cause of the dysmenorrhea. Evaluation of the adolescent who has dysmenorrhea begins with questioning about the timing, character, and location of the pain as well as the presence of associated systemic symptoms. A history of pelvic infection, menorrhagia, or intermenstrual bleeding suggests that the dysmenorrhea is secondary to pelvic pathology. Pelvic pain at times other than menstruation (eg, mid-cycle, during intercourse, with defecation) may indicate endometriosis. The onset of dysmenorrhea soon after menarche with rapid worsening over several cycles suggests an outlet obstruction, which may result from a partially imperforate hymen or uterine malformation. A pelvic examination should be performed before initiating treatment for dysmenorrhea. Abnormal uterine size, position, or shape suggest uterine malformation rather than fibroids, which are uncommon during adolescence. Cervical cultures for gonorrhea and chlamydia should be performed because chronic pelvic inflammatory disease (PID) may appear as dysmenorrhea.