02/22/20 Nathaelf Hyppolite 2 Primary dysmenorrhea, which is defined as painful menses in women with normal pelvic anatomy,
usually begins during adolescence. It is characterized by crampy pelvic pain beginning shortly before or at the onset of menses and lasting one to three days. 02/22/20 Nathaelf Hyppolite 3
The prevalence of dysmenorrhea is highest in adolescent women, with estimates ranging from 20 to 90 percent, depending on the measurement method used. A longitudinal study of a representative cohort of Swedish women found a prevalence of dysmenorrhea of 90 percent in women 19 years of age and 67 percent
in women 24 years of age. 02/22/20 Nathaelf Hyppolite 4 Dysmenorrhea is thought to be caused by the release of prostaglandins in the menstrual
fluid, which causes uterine contractions and pain. Vasopressin also may play a role by increasing uterine contractility and causing ischemic pain as a result of vasoconstriction. Elevated vasopressin levels have been reported in women with primary dysmenorrhea. 02/22/20 Nathaelf Hyppolite
5 Age < 20 years Attempts to lose weight Depression/anxiety Disruption of social networks Heavy menses Nulliparity Smoking
02/22/20 Nathaelf Hyppolite 6 History and physical examination perform only an abdominal examination in young
adolescents with a typical history who have never been sexually active Always R/O secondary dysmenorrhea Pelvic mass, abnormal vaginal discharge Ultrasonography laparoscopy 02/22/20
or laparotomy with biopsy Nathaelf Hyppolite 7 A = consistent, good-quality, patient-oriented evidence B = inconsistent or limited quality patientoriented evidence C = consensus, disease-oriented evidence,
usual practice, opinion, or case series. 02/22/20 Nathaelf Hyppolite 8 02/22/20 Nathaelf Hyppolite
are the initial therapy of choice in patients with presumptive primary dysmenorrhea.Because all NSAIDs are equal in efficacy, agent selection should be guided by cost, convenience, and patient preference,with ibuprofen or naproxen being a good choice for most patients. 02/22/20
Nathaelf Hyppolite 13 American Family Physician January 15, 2005 Volume 71, Number 2 02/22/20
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