Dysmenorrhea in the Adolescent

As a common medical issue for adolescents both in the United States and worldwide, dysmenorrhea is a leading cause of visits to primary care providers and gynecologic specialists. The prevalence of dysmenorrhea in women is highest in the adolescent population affecting 20-90% of females in this age group. Primary dysmenorrhea is the most common form of dysmenorrhea and is defined as painful menstruation in the absence of pelvic pathology. Secondary dysmenorrhea is explained by an underlying pathology such as endometriosis or genital tract obstruction. The differential diagnosis of dysmenorrhea includes other etiologies of pelvic pain such as gastrointestinal, genitourinary, or other gynecologic pathologies. Symptoms refractory to first and second line treatments warrant further evaluation and management. As the second most common cause of pelvic pain in adolescents after primary dysmenorrhea, endometriosis may manifest itself differently in adolescents when compared to adults. Non-steroidal anti-inflammatory agents (NSAIDS) are first line medical management for dysmenorrhea. Hormonal agents are second line medical management though are often initiated concomitantly with NSAID therapy. Complex imaging and surgery are reserved for refractory cases of pelvic pain. This document outlines the recommended evaluation and management of adolescents with dysmenorrhea and highlights important medical advances that have contributed to treatment.   This review contains 5 figures, 8 tables, and 34 references. Keywords: dysmenorrhea, pelvic pain, endometriosis, menstruation, menses, Premenstrual Syndrome, tranexamic acid, menstrual suppression, menstrual disorders