Management of Adolescents’ Menstrual Pain

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Published November 8, 2019

Rotimi Adesanya

The adolescent period is the period of life when a child develops into an adult; the period from puberty to maturity, technically categorised as children from ages 10 to 19.

The joy of every parent is that their young girls will not struggle through their adolescence. One major condition that affects the young girl during this period is painful menstrual period medically referred to as dysmenorrhoea.

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A clear case of dysmenorrhoea is a case of a 16-year-old girl who was rushed to the clinic with history of vomiting, headache, severe abdominal pain and weakness. She was said to have collapsed while in school; she was later rushed to hospital and was managed as a case of fainting attack and given a drug to calm her, when she came round, she told the doctor that she suffered from MP, the doctor was wondering what MP could mean, she later clarified that MP was an abbreviation coined for menstrual pain among their peers. The doctor later gave her an anti-inflammatory and analgesic; few hours later she was smiling because she was out of pain.

Dysmenorrhoea refers to pain occurring before or during menstruation or both. It is classified into primary and secondary. Primary dysmenorrhoea occurs when pelvic anatomy and ovarian function are normal and no abnormality found to be causing the pain.

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The exact mechanisms of primary dysmenorrhoea are unclear, but pain has been associated with high levels of prostaglandin in the uterus. This high prostaglandin levels increases uterine muscle contraction, leading to reduction in blood flow to uterine muscles. This occurs more in the teenage adolescent.

Secondary dysmenorrhoea describes pain due to abnormality in the pelvic region. It is not common among the adolescent but most commonly observed in older women who are above 30.

Symptoms

Primary dysmenorrhoea usually coincides with the start of menstruation. The initial onset is usually shortly after first menses. Secondary dysmenorrhoea is associated with a later age of onset, after years of pain free menses and the patient is usually over 30 years of age. The pain begins as a dull pelvic ache three to four days before the menses and becomes more severe during menstruation. Other symptoms that may be associated with secondary dysmenorrhoea include pain during sex, irregular cycles, heavy bleeding, bleeding in between cycles or after sex. It should be noted that all these symptoms can also be caused by other gynaecological conditions.

 

Symptoms experienced may vary in different individuals and these include low midline abdominal pain or pelvic pain, pain may radiate to back or thighs, varies from a dull dragging to a severe cramping pain, maximum pain at beginning of the period, may commence up to 12 hours before the menses appear and usually lasts 24 hours, but may persist for two to three days, may be associated with nausea and vomiting, headache, syncope or flushing, no abnormal findings on examination, pain also associated with psychological distress, anxiety, depression or both.

Ginna Crochets IMG-20190728-WA0000

Diagnosis

Physical examination will include a pelvic examination (an abdominal and internal examination) in order to determine the underlying cause. This will allow differentiation between primary dysmenorrhoea and other causes of pain associated with a medical condition. There are no specific tests to diagnose primary dysmenorrhoea. Specific investigations are ordered based on history, examination findings and severity of pain or other associated symptoms. Investigations are only important if a secondary cause is suspected or in refractory cases of primary dysmenorrhoea. For patients with secondary, investigations should be directed to the most likely cause. Common causes of secondary dysmenorrhoea include endometriosis, uterine fibroids, pelvic adhesions, pelvic inflammatory disease (PID), ovarian cysts, gastrointestinal disturbances and very rare causes such as malignant tumors of the uterus, ovary, bowel or bladder.

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Treatment

Non-medical therapies that have been recommended to relieve pain include regular exercise, avoid smoking and excessive alcohol, recommend relaxation techniques such as yoga, avoid exposure to extreme cold, place a hot water bottle over the painful area and curl the knees onto the chest

Medical

Medical options are still the most reliable and effective treatment for relieving dysmenorrhoea and it includes simple analgesics, prostaglandin inhibitors or anti-inflammatory drugs, combined oral contraceptive pills (COCP) and Vitamin B1 Anti-inflammatory drugs and COCP are the most commonly used therapeutic modalities for the management of primary dysmenorrhoea. 

The health of the girl child is so important in the adolescence period because of the no of hormonal agents at play.

 

Copyright PUNCH.

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