Primary dysmenorrhea — menstrual pain without a pelvic pathology — is one of the most common gynecological complaints among adolescent patients.

Primary dysmenorrhea typically does not occur until ovulatory cycles are established, which occurs months to several years after menarche. Endometriosis is a common cause of secondary dysmenorrhea — defined as resulting from pelvic pathology or another medical condition.

Most adolescents with primary dysmenorrhea will respond well to nonsteroidal anti-inflammatories, hormonal therapies or both.

“If anti-inflammatories or first- or second- line hormonal therapies aren’t effective against persistent and significant dysmenorrhea after three or six months and the patient has been adhering to the therapy, consideration should be given for a referral to an adolescent gynecologist to further assess for underlying pelvic pathology,” said Audra Campbell, APRN, nurse practitioner with Norton Children’s Gynecology, affiliated with the UofL School of Medicine. In the absence of other potential causes of chronic pain and no indication from the patient’s history,  physical exam and ultrasound, further evaluation for endometriosis is warranted.

Adolescent patients need to understand that hormonal therapy works best if it is taken at the same time every day. For those who may not be able to keep up with a rigid schedule, consider other means of delivery such as injections, patches, vaginal rings, under-skin implants and intrauterine devices.

Be mindful that parents and patients may only hear “birth control” and may have difficulty with this suggestion of treatment. It is beneficial to use this opportunity for a conversation about sexual maturity and activity. Encourage parents to maintain an open and welcoming line of communication so that their adolescent is comfortable talking about sex and keeps parents informed about relationships.

It is also a time to make sure the patient understands that hormonal therapy does not protect against sexually transmitted diseases.