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New Guidance on Diagnosing and Reducing Period Pain Can Help Adolescents Thrive

November 20, 2018

Washington, D.C. -  Early diagnosis of dysmenorrhea, or painful periods, is key to ensuring that adolescents and women are able to effectively manage their symptoms and continue with their everyday activities with minimal disruption, according the latest guidance released today by the American College of Obstetricians and Gynecologists.  The new Committee Opinion, “Dysmenorrhea and Endometriosis in the Adolescent,” is meant to aid ob-gyns in diagnosis of dysmenorrhea and its causes as early as possible so patients can successfully manage symptoms. 

Dysmenorrhea is typically broken into two categories, primary and secondary. Most adolescents experience primary dysmenorrhea, defined as painful menstruation in the absence of another pelvic disease. Pain is caused by excessive levels of prostaglandins, hormones that make the uterus contract, causing intense cramping and discomfort. Second dysmenorrhea refers to painful menstruation caused by a recognized medical condition or disease. The most common cause of secondary dysmenorrhea is endometriosis, but it can also result from adenomyosis, infection, myomas, obstructions in the reproductive tract, congenital malformations, or ovarian cysts. 

Symptoms of dysmenorrhea range, but often include nausea, vomiting, diarrhea, headaches, and muscle cramps. It also commonly affects sleep, creating difficulty falling asleep or waking patients throughout the night. 

“No matter the cause of dysmenorrhea, it has a profound effect on our patients’ lives, especially adolescent patients,” said Geri Hewitt, M.D., Committee Opinion author. “It is the leading cause of recurrent short-term absences from school for adolescent girls to the detriment of their learning and socializing. By quickly identifying and diagnosing dysmenorrhea, ob-gyns can help relieve patients’ pain and enable them to resume normal order in their lives.” 

Too often, adolescents may face a delay in diagnosis because of problems with insurance coverage, cultural attitudes about menstruation, or perceived lack of interest from health care providers. To help expedite diagnosis, ob-gyns must be sensitive to delays in seeking care and consider the importance of quick diagnosis and effective treatment to improving an adolescent’s quality of life. 

Most patients with primary dysmenorrhea respond positively to a combination of medical therapies, like nonsteroidal anti-inflammatory agents or hormonal agents to alleviate pain. Additionally, some patients and families may seek complementary or alternative therapies, including an exercise routine or hot water bottles or heating pads. 

For adolescents whose dysmenorrhea does not improve or worsens while using these therapies, or who present with other symptoms immediately indicating secondary dysmenorrhea (e.g. a family history of endometriosis, abnormal or irregular bleeding, or severe pain immediately following their first period) should be evaluated for secondary dysmenorrhea. As endometriosis is the most common cause of secondary dysmenorrhea in adolescents, patients with persistent dysmenorrhea despite treatment and no other identified etiologies should be counseled on the high likelihood of endometriosis as the cause. 

The Committee Opinion outlines the key goals of endometriosis treatment as relieving symptoms, suppressing disease progression, and protecting future fertility. Notably, endometriosis often presents differently in adolescent patients than in adults, so the new guidance details key differences in the symptoms and appearance ob-gyns should be aware of when evaluating and treating endometriosis in adolescents. 

Conservative surgical therapy for diagnosis and treatment, combined with ongoing suppressive medical therapies to prevent endometrial proliferation, are the recommended treatments for adolescents diagnosed with endometriosis. Some patients may have recurrent pain following conservative surgical treatment and hormone therapy, in which case GnRH agonist therapy (i.e., leuprolide acetate) may be an appropriate additional treatment. 

“Endometriosis is a chronic condition, and it’s important that we address immediate and long-term treatments and considerations with adolescents,” said Hewitt. “This includes having education about the disease available to patients and their families, as well as encouraging or assisting in identifying complementary therapies, such as acupuncture, that may help with management of symptoms over time.”

Committee Opinion #760, “Dysmenorrhea and Endometriosis in the Adolescent” is published in the December issue of Obstetrics & Gynecology. 

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The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org

American College of Obstetricians and Gynecologists
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