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Dysmenorrhea is the most common gynecologic complaint among adolescent females with a prevalence from 60-93%. Of this population however only about 15% will seek care. It is likely caused by an excess production of endometrial prostaglandin F2 alpha (PGF2 alpha), or an elevated PGF2 alpha:prostaglandin E2 (PGE2) ratio which leads to dysrhythmic uterine contractions, hypercontractility, and increased uterine muscle tone.
Dysmenorrhea usually does not occur until a women starts ovulatory menstrual cycles are established:
NSAIDs are the first line of therapy in primary dysmenorrhea with 70-90% of patients having effective pain relief. In general, NSIADs have also been shown to be more effective than acetaminophen in this disease context. Some patients respond better to one class of NSAIDs vs. another (mefenamic acid vs propionic acid) so a trial of the other class may be useful if the patient is not initally improving.
Heat packs, exercise, sexual activity, mindfulness training and yoga have all been shown to be effective in releaving pain in dysmenorrhea. In addition, vitamin B1 (100 mg daily) and vitamin E (500 units daily) have been shown to impove symptoms greater than placebo.
It is unclear if acupuncture is useful in patients with primary dysmenorrhea as a meta-analysis was ineffective secondary to the heterogeneity of data.
OCPs are effective in the treatment of dysmenorrhea often after inital trial of NSAIDs or as the primary method if the patient wishes for contraception at the same time. OCPs are thought to work by suppressing ovulation, thus causing a decrease in uterine prostaglandins. Although not as well tested, other hormonal methods besides pills (patch, ring, injectable/implantable contraceptives, or IUD) may also be effective.