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Dysmenorrhea.

Abstract

Dysmenorrhea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination. Nonsteroidal anti-inflammatory drugs are the initial therapy of choice in patients with presumptive primary dysmenorrhea. Oral contraceptives and depo-medroxyprogesterone acetate also may be considered. If pain relief is insufficient, prolonged-cycle oral contraceptives or intravaginal use of oral contraceptive pills can be considered. In women who do not desire hormonal contraception, there is some evidence of benefit with the use of topical heat; the Japanese herbal remedy toki-shakuyaku-san; thiamine, vitamin E, and fish oil supplements; a low-fat vegetarian diet; and acupressure. If dysmenorrhea remains uncontrolled with any of these approaches, pelvic ultrasonography should be performed and referral for laparoscopy should be considered to rule out secondary causes of dysmenorrhea. In patients with severe refractory primary dysmenorrhea, additional safe alternatives for women who want to conceive include transcutaneous electric nerve stimulation, acupuncture, nifedipine, and terbutaline. Otherwise, the use of danazol or leuprolide may be considered and, rarely, hysterectomy. The effectiveness of surgical interruption of the pelvic nerve pathways has not been established.

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  • Authors+Show Affiliations

    Department of Family Practice, Michigan State University, College of Human Medicine, East Lansing, Michigan 48824, USA. Linda.French@hi.msu.edu

    Source

    American family physician 71:2 2005 Jan 15 pg 285-91

    MeSH

    Anti-Inflammatory Agents, Non-Steroidal
    Complementary Therapies
    Contraceptive Agents, Female
    Dysmenorrhea
    Endometriosis
    Female
    Humans
    Life Style
    Risk Factors
    Vasopressins

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15686299

    Citation

    French, Linda. "Dysmenorrhea." American Family Physician, vol. 71, no. 2, 2005, pp. 285-91.
    French L. Dysmenorrhea. Am Fam Physician. 2005;71(2):285-91.
    French, L. (2005). Dysmenorrhea. American Family Physician, 71(2), pp. 285-91.
    French L. Dysmenorrhea. Am Fam Physician. 2005 Jan 15;71(2):285-91. PubMed PMID: 15686299.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Dysmenorrhea. A1 - French,Linda, PY - 2005/2/3/pubmed PY - 2005/2/23/medline PY - 2005/2/3/entrez SP - 285 EP - 91 JF - American family physician JO - Am Fam Physician VL - 71 IS - 2 N2 - Dysmenorrhea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination. Nonsteroidal anti-inflammatory drugs are the initial therapy of choice in patients with presumptive primary dysmenorrhea. Oral contraceptives and depo-medroxyprogesterone acetate also may be considered. If pain relief is insufficient, prolonged-cycle oral contraceptives or intravaginal use of oral contraceptive pills can be considered. In women who do not desire hormonal contraception, there is some evidence of benefit with the use of topical heat; the Japanese herbal remedy toki-shakuyaku-san; thiamine, vitamin E, and fish oil supplements; a low-fat vegetarian diet; and acupressure. If dysmenorrhea remains uncontrolled with any of these approaches, pelvic ultrasonography should be performed and referral for laparoscopy should be considered to rule out secondary causes of dysmenorrhea. In patients with severe refractory primary dysmenorrhea, additional safe alternatives for women who want to conceive include transcutaneous electric nerve stimulation, acupuncture, nifedipine, and terbutaline. Otherwise, the use of danazol or leuprolide may be considered and, rarely, hysterectomy. The effectiveness of surgical interruption of the pelvic nerve pathways has not been established. SN - 0002-838X UR - https://www.unboundmedicine.com/medline/citation/15686299/full_citation L2 - http://www.aafp.org/link_out?pmid=15686299 DB - PRIME DP - Unbound Medicine ER -