OB/GYN Group Issues Guidance on Dysmenorrhea, Endometriosis in Adolescents

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The American College of Obstetricians and Gynecologists has issued guidance on managing dysmenorrhea and endometriosis in adolescents. Here are some of the group's conclusions and recommendations:

• Dysmenorrhea in adolescents usually is primary, occurring without pelvic pathology. The initial evaluation should include a medical, gynecologic, menstrual, family, and psychosocial history to help distinguish between primary and secondary dysmenorrhea. Empiric treatment for primary dysmenorrhea may include nonsteroidal anti-inflammatory drugs, hormonal suppression (e.g., with oral contraceptives or an intrauterine device), or both.

• Secondary dysmenorrhea should be considered when the patient reports severe dysmenorrhea right after her first menstrual period, worsening dysmenorrhea, abnormal bleeding, mid-cycle pain, no response to empiric treatment, or family history of endometriosis, among other issues.

• Pelvic ultrasound should be considered when evaluating for secondary dysmenorrhea. The most common cause is endometriosis, and related lesions in adolescents may be clear or red (in contrast to looking like cigarette burns in adults).