Dysmenorrhea, Pelvic Pain, Endometriosis and Functional Abdominal Pain

This chapter reviews differential diagnosis and evaluation of pelvic pain in postmenarchal adolescent females, with particular emphasis on endometriosis and functional abdominal pain, outlining definitions, etiologic concepts, risk factors, and approaches to history, examination (including tools like menstrual diaries and Carnett’s sign), diagnostic evaluation, and intervention options. It states that secondary dysmenorrhea is often due to endometriosis and that adolescent presentations frequently involve non-cyclic pain, while also noting that diagnosis of endometriosis can be delayed by years, contributing to stigma and distress. The chapter emphasizes that its discussion is limited by reliance on cited prevalence estimates and diagnostic-laparoscopy–based findings, as well as evolving evidence that may differ by population access to care and sociocultural factors. This paper is centrally about endometriosis and adenomyosis-related pelvic pain in adolescents—specifically its differential diagnosis and evaluation framework for dysmenorrhea, chronic pelvic pain, and functional abdominal pain.

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