Most adolescents who present with dysmenorrhea have primary dysmenorrhea and will respond well to empiric treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal suppression, or both. However, when a patient does not experience clinical improvement for her dysmenorrhea with 3-6 months of therapy initiation, obstetricians-gynecologists should investigate for possible secondary causes and for treatment adherence. This according to new recommendations from the American College of Obstetricians and Gynecologists (ACOG) regarding dysmenorrhea and endometriosis in the adolescent. Among the recommendations and conclusions:
- Most adolescents experiencing dysmenorrhea have primary dysmenorrhea, defined as painful menstruation in the absence of pelvic pathology.
- Secondary dysmenorrhea refers to painful menses due to pelvic pathology or a recognized medical condition.
- The most common cause of secondary dysmenorrhea is endometriosis.
- Most adolescents who present with dysmenorrhea have primary dysmenorrhea and will respond well to empiric treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal suppression, or both. However, some patients either present initially with symptoms suggesting secondary dysmenorrhea or they fail empiric treatment for primary dysmenorrhea and require further evaluation.
- Pelvic imaging with ultrasonography, regardless of findings on pelvic examination, also should be considered during evaluation for secondary dysmenorrhea.
- Although the true prevalence of endometriosis in adolescents is unknown, at least two thirds of adolescent girls with chronic pelvic pain or dysmenorrhea unresponsive to hormonal therapies and NSAIDs will be diagnosed with endometriosis at the time of diagnostic laparoscopy.
- Recommended treatment for endometriosis in adolescents is conservative surgical therapy for diagnosis and treatment combined with ongoing suppressive medical therapies to prevent endometrial proliferation.
- Patients with endometriosis who have pain refractory to conservative surgical therapy and suppressive hormonal therapy often benefit from at least 6 months of gonadotropin-releasing hormone (GnRH) agonist therapy with add-back medicine.
- Nonsteroidal anti-inflammatory drugs should be the mainstay of pain relief for adolescents with endometriosis.
Dysmenorrhea and endometriosis in the adolescent. ACOG Committee Opinion No. 760. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;132:e249-58.