There are two types of dysmenorrhea:

    * Primary dysmenorrhea is menstrual pain that’s not a symptom of an underlying gynecologic disorder but related to the normal process of menstruation. Primary dysmenorrhea is common, affecting more than 50% of women, and quite severe in about 10%. This is the most common type of dysmenorrhea.
    * Secondary dysmenorrhea is menstrual pain that’s related to some kind of gynecologic disorder.

Dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. At some time, more than half of all teenage girls and young women experience dysmenorrhea.

Primary dysmenorrhea is painful and sometimes debilitating for brief periods of time, but it’s not harmful. Although secondary dysmenorrhea, can be associated with gynecological conditions, most of these can be easily treated.

Medical Care

    * Grading dysmenorrhea according to severity of pain and limitation of daily activity may help guide the treatment strategy.
    * In addition to pain relief, other mainstays of treatment include reassurance and education.

Surgical Care

    * Surgery is generally not indicated for patients with primary dysmenorrhea.
    * In patients with secondary dysmenorrhea, treatment of the underlying pathology may necessitate surgical intervention.
    * In refractory cases of dysmenorrhea, laparoscopic presacral neurectomy (PSN) or uterosacral nerve ablation (LUNA) have been efficacious in some patients for as long as 12 months after treatment.37,38,39

Consultations

In patients with refractory symptoms, a multidisciplinary approach may be indicated.

 

Primary Dysmenorrhea is usually treated with anti prostaglandins medication. Most patients show improvement with drugs called – Non- steroidal anti – inflammatory (NSAID) drugs.

Certain general measures can help to reduce the severity of the symptoms and avoid medications.

General measures

Heat – Apply a heating pad to the lower abdomen.

Self-massage – Do circular massage with the fingertips around lower abdomen.

Exercise – Walk or exercise regularly.

Diet – Eat light and frequent meals. Increase intake of complex carbohydrates and decrease intake of salt, sugar, alcohol and caffeine.

 

Adolescent Dysmenorrhea Treatment

NSAIDs are the most common pharmacologic treatment for dysmenorrhea: NSAIDs, which are able to inhibit prostaglandin synthetase, have significantly alleviated symptoms of dysmenorrhea in 75% of adolescents.

Propionates such as ibuprofen (400 mg/4 h), naproxen (500 mg: half a pill every 6 h) are usually prescribed the day before menstruation and during the acute pain. Funamates, also potent inhibitors of PG synthetase, are better tolerated.
Progestagen (dydrogesterone) has also been proved helpful in relieving the symptoms of dysmenorrhea.

One small randomized controlled trial including adolescents demonstrated an improvement in dysmenorrhea with high-dose combined oral contraceptive treatment (COC) compared to placebo. The efficacy of low-dose COC in the treatment of adolescent dysmenorrhea has yet to be determined. If effective, well-established safety and non-contraceptive health benefits may make COC an ideal treatment for dysmenorrhea in adolescent girls, according to these authors. In our opinion, COC should be reserved for older adolescents who need a contraceptive method, also, it lessens dysmenorrhea by reducing endometrial development.