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Dysmenorrhea in Adolescents

What is dysmenorrhea?

Dysmenorrhea is a menstrual condition. It causes severe and frequent menstrual cramps and pain with menstruation. It may be primary or secondary.

  • Primary dysmenorrhea. This starts soon after regular periods are established.  It's usually lifelong but may improve with time, severe and frequent menstrual cramping caused by severe and abnormal uterine contractions.

  • Secondary dysmenorrhea. This type is due to some physical cause and usually starts later. Painful menstrual periods are caused by another condition in the body (like pelvic inflammatory disease or endometriosis).

What causes dysmenorrhea?

The cause of dysmenorrhea depends on whether it is primary or secondary. In general, females with primary dysmenorrhea have abnormal uterine contractions as a result of a hormone imbalance in the body (particularly prostaglandin which controls the contractions of the uterus). Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. This is a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. This often results in internal bleeding, infection, and pelvic pain. Other possible causes of secondary dysmenorrhea include:

  • Pelvic inflammatory disease (PID)

  • Uterine fibroids

  • Abnormal pregnancy (like miscarriage, ectopic)

  • Infection, tumors, or polyps in the pelvic cavity

What are the symptoms of dysmenorrhea?

These are the most common symptoms of dysmenorrhea. Symptoms usually start every month in the days before your period starts. 

  • Cramping in the lower abdomen

  • Pain in the lower abdomen

  • Low back pain

  • Pain spreading down the legs

  • Nausea

  • Vomiting

  • Diarrhea

  • Fatigue

  • Weakness

  • Fainting

  • Headaches

The symptoms of dysmenorrhea may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is dysmenorrhea diagnosed?

First, your teen's healthcare provider will evaluate her medical history and do a physical exam including a pelvic exam. Your teen's healthcare provider may need to rule out other menstrual disorders, medical conditions, or medicines that may be causing or worsening the condition. Other tests may include:

  • Ultrasound. This imaging test uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function. And to assess blood flow through various vessels.

  • Laparoscopy. This minor procedure uses a laparoscope, a thin tube with a lens and a light, inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the healthcare provider can often find abnormal growths.

  • Hysteroscopy. A visual exam of the canal of the cervix and the inside of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.

Treatment for dysmenorrhea

Talk with your teen's healthcare provider about symptoms to help her understand how to learn relaxation methods, which can also improve symptoms. Other possible treatment for managing symptoms may include:

  • Prostaglandin inhibitors, for example, NSAIDs (nonsteroidal anti-inflammatory drugs), like aspirin or ibuprofen, to reduce pain

  • Acetaminophen

  • Oral birth control pills 

  • Progesterone (hormone)

  • IUD with progesterone

  • Dietary changes (to increase protein and to decrease sugar, fat,  and caffeine intake)

  • Adequate sleep

  • Vitamin supplements

  • Regular exercise

  • Heating pad across the stomach

  • Hot bath or shower

  • TENS unit (transcutaneous electrical nerve stimulation)

  • Surgery

  • Acupuncture

  • Abdominal massage

Online Medical Reviewer: Burd, Irina, MD, PhD
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Date Last Reviewed: 5/1/2017
© 2000-2017 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.