Early Diagnosis Of Dysmenorrhea in Teens Is Key to Effective Management: ACOG

By Marilynn Larkin

November 30, 2018

NEW YORK (Reuters Health) - The American College of Obstetrics and Gynecology (ACOG) has released new guidance on diagnosing and relieving dysmenorrhea in adolescents.

"Our goal in developing the committee opinion was to raise awareness regarding adolescent patients who experience menstrual pain," said coauthor Dr. Geri Hewitt. "We wanted the clinicians who care for these patients to feel confident in best steps moving forward - primarily, how much to do and when."

"We know the condition often is under-reported and often not optimally treated, (and) it's the most common reason for school absenteeism in adolescent girls," she told Reuters Health by email. "We also wanted to emphasize there is no role for opioid use for this diagnosis, outside of a specialized pain clinic. We too frequently see adolescent girls using or seeking opioids for menstrual pain."

"In most cases, menstrual pain is primary dysmenorrhea, due to prostaglandins, and can be diagnosed with a good medical history and often successfully treated with medications - primarily NSAIDs and hormonal interventions," she said. "If the clinician suspects primary dysmenorrhea, neither a pelvic exam nor pelvic ultrasound is indicated."

Dr. Hewitt noted other key points of the guidance, posted online November 20 in Obstetrics and Gynecology:

- Beyond primary dysmenorrhea, additional etiologies to consider include obstructive Mullerian anomalies and endometriosis. The guidelines explain when to perform a pelvic exam or pelvic ultrasound, and when to consider a diagnostic laparoscopy.

- Endometriosis should be considered in adolescents with persistent menstrual pain despite normal ultrasound and failed medical therapy with NSAIDs and hormonal interventions. "We believe there is value in early diagnosis and treatment - to alleviate symptoms, decrease risk of adhesive disease, and protect future fertility," Dr. Hewitt said.

The guidance notes that the appearance of endometriosis may be different in an adolescent than in an adult woman. "In adolescents, endometriotic lesions are typically clear or red and can be difficult to identify for gynecologists unfamiliar with endometriosis in adolescents."

"Therapy must be individualized," the guidance states, "and obstetrician-gynecologists should consider patient choice, the need for contraception, contraindications to hormone use, and potential adverse effects and counsel the adolescent and her family on treatment options."

Dr. Hewitt concluded, "Our hope is that practicing clinicians who care for adolescent girls will find the document (which includes an algorithm on clinical evaluation) helpful in evaluating teens, counseling their families, and optimally treating their symptoms."

Dr. Kecia Gaither, Director of Perinatal Services at NYC Health and Hospitals/Lincoln in the Bronx, New York, told Reuters Health the guidance "is very much in keeping with how my patients are diagnosed and treated."

Many factors stand in the way of diagnosing endometriosis in young adolescents, she said by email, "including reticence to discuss with parents or health care providers, shame about body functions, and cultural beliefs."

Sharing the information in the guidance with parents of adolescents would enable parents to provide evidence-based explanations to their child, Dr. Gaither suggested.

SOURCE: http://bit.ly/2P9riRW

Obstet Gynecol 2018.