Article

Dysmenorrhea in adolescents and young adults: An update on pharmacological treatments and management strategies

Warren Alpert Medical School of Brown University, Department of Pediatrics, Division of Adolescent Medicine/Hasbro Children's Hospital/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 , USA +1 401 444 5188
Expert Opinion on Pharmacotherapy (Impact Factor: 3.09). 10/2012; 13(15):2157-70. DOI: 10.1517/14656566.2012.725045
Source: PubMed

ABSTRACT Introduction: Dysmenorrhea is the most common gynecologic complaint among adolescents/young adults. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Adolescents/young adults with severe dysmenorrhea symptoms may have pelvic abnormalities, such as endometriosis or uterine anomalies (secondary dysmenorrhea). Areas covered: This review provides an update on treatments and management strategies of dysmenorrhea in adolescents/young adults. Medical literature articles were retrieved using a Medline search on primary and secondary dysmenorrhea. Original articles from peer-reviewed journals were selected based on relevance. Expert opinion: Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the preferred initial treatment for dysmenorrhea in nonsexually active adolescents/young adults. Adolescents/young adults with symptoms that do not respond to NSAIDs for three menstrual periods should be offered hormonal treatment, such as combined estrogen and progestin oral contraceptive pills (OCPs), for three menstrual cycles. If dysmenorrhea does not improve within 6 months of NSAIDs and OCPs, a laparoscopy is indicated to look for endometriosis, which is the most common reason for secondary dysmenorrhea.

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    • "Dysmenorrhea has been shown to be one of the most common gynecological complaints of young women and may result in short - term absence from school or work ( Parker , Sneddon , & Arbon , 2010 ) . Research has shown that menstrual pain in young women is usu - ally primary and is accompanied by normal ovulatory cycles with no pathological background ( Harel , 2012 ) . Although some individuals may prefer to treat their menstrual pain with chemical medications ( Parker et al . "
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    ABSTRACT: The literature survey 2012 is based on 1426 papers found in the databases MEDLINE and EMBASE with the keywords “thermography” or “thermometry” “temperature measurement” or “thermotherapy” or ‘skin temperature’ or ‘core temperature’ and restricted to “human” and “included in the databases between 01.01 and 31.12. 2012”. 37.9 percent of papers of this review are originated from Europe and 95.3 percent of all papers are written in English. 238 controlled studies using some kind of temperature measurement were included in this survey. Pharmacology, Internal Medicine, Cancer andNeurology&Psychiatry were the predominant fields of applications of temperature measurement in medicine. As in previous years, therapeutic hypothermia and hyperthermia treatment was the topic of many papers. Fever attracted also a high number of publications. Although the term “breast” appeared in 77 publications, only minority of those were related to breast thermography. Some articles were found for the complex regional pain syndrome and Raynaud´s phenomenon and new applications of medical thermography have been reported.
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    ABSTRACT: BACKGROUND Endometriosis associated with pain symptoms in adolescents has been extensively reported, but the exact prevalence is unclear because pain symptoms may be atypical and endometriosis can only be diagnosed by laparoscopy. The aim of this paper is to provide a systematic review of the prevalence of endometriosis diagnosed by laparoscopy in adolescents.METHODSA systematic literature search was carried out for relevant articles published between 1980 and 2011 in the databases PUBMED and EMBASE, based on the keywords 'endometriosis', 'laparoscopy', 'adolescents' and 'chronic pelvic pain (CPP)'. In addition, the reference lists of the selected articles were examined.RESULTSBased on 15 selected studies, the overall prevalence of visually confirmed endometriosis was 62% (543/880; range 25-100%) in all adolescent girls undergoing laparoscopic investigation, 75% (237/314) in girls with CPP resistant to treatment, 70% (102/146) in girls with dysmenorrhea and 49% (204/420) in girls with CPP that is not necessarily resistant to treatment. Among the adolescent girls with endometriosis, the overall prevalence of American Society of Reproductive Medicine classified moderate-severe endometriosis was 32% (82/259) in all girls, 16% (17/108) in girls with CPP resistant to treatment, 29% (21/74) in girls with dysmenorrhea and 57% (44/77) in girls with CPP that is not necessarily resistant to treatment. Due to the quality of the included papers an overestimation of the prevalence and/or severity of endometriosis is possible.CONCLUSIONS About two-thirds of adolescent girls with CPP or dysmenorrhea have laparoscopic evidence of endometriosis. About one-third of these adolescents with endometriosis have moderate-severe disease. The value of early detection of endometriosis in symptomatic adolescents and the indications for laparoscopic investigation in adolescents require more research.
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