Materiały źródłowe

• #1 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Dysmenorrhea is one of the most common causes of pelvic pain. It negatively affects patients’ quality of life and sometimes results in activity restriction. A history and physical examination, including a pelvic examination in patients who have had vaginal intercourse, may reveal the cause. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. Abnormal uterine bleeding, dyspareunia, noncyclic pain, changes in intensity and duration of pain, and abnormal pelvic examination findings suggest underlying pathology (secondary dysmenorrhea) and require further investigation. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus.

• #1 Dysmenorrhea: Painful Periods | ACOG

  https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods

  Pain associated with menstruation is called dysmenorrhea. More than half of women who menstruate have some pain for 1 to 2 days each month. Usually, the pain is mild. But for some women, the pain is so severe that it keeps them from doing their normal activities for several days a month. […] Most women have some pain with their menstrual periods. For some women, severe pain comes with other symptoms, including diarrhea, nausea, vomiting, headache, and dizziness. […] There are two types of dysmenorrhea: primary and secondary. […] Primary dysmenorrhea is the cramping pain that comes before or during a period. This pain is caused by natural chemicals called prostaglandins that are made in the lining of the uterus. Prostaglandins cause the muscles and blood vessels of the uterus to contract. On the first day of a period, the level of prostaglandins is high. As bleeding continues and the lining of the uterus is shed, the level goes down. This is why pain tends to lessen after the first few days of a period.

• #1 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Characteristic symptoms of primary dysmenorrhea include lower abdominal or pelvic pain with or without radiation to the back or legs, with initial onset six to 12 months after menarche. Pain typically lasts eight to 72 hours and usually occurs at the onset of menstrual flow. Other associated symptoms may include low back pain, headache, diarrhea, fatigue, nausea, or vomiting. A family history may be helpful in differentiating primary from secondary dysmenorrhea; patients with a family history of endometriosis in first-degree relatives are more likely to have secondary dysmenorrhea. […] The diagnosis of primary dysmenorrhea is based on the clinical history and physical examination. Laparoscopy is indicated if the etiology remains unknown after an appropriate noninvasive evaluation has been completed. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. It has a 91% sensitivity and 98% specificity, a positive likelihood ratio of 30, and a negative likelihood ratio of 0.09 for detection of bowel endometriosis. It also has a high degree of accuracy for detection of ovarian endometriomas.

• #1 Dysmenorrhea: Painful Periods | ACOG

  https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods

  Secondary dysmenorrhea is caused by a disorder in the reproductive organs. The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. For example, the pain may begin a few days before a period starts. The pain may get worse as the period continues and may not go away after it ends. […] Yes, if you have painful periods you and your obstetrician-gynecologist (ob-gyn) should talk about your symptoms and your menstrual cycle. If needed, your ob-gyn may recommend a pelvic exam. A first step in treatment may be medications. If medications do not relieve your pain, treatment should focus on finding the cause of your pain. […] An ultrasound exam may be done when pain is not relieved with medications. In some cases, an ob-gyn may recommend a laparoscopy. This is a procedure that lets an ob-gyn view the organs in the pelvis. With laparoscopy, a small incision (cut) is made near the belly button. A thin, lighted cameraa laparoscopeis inserted into the abdomen. Laparoscopy often is done with general anesthesia in a surgery center or hospital.

• #1 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8943241/

  Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. […] While its diagnosis is based on patients history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed. […] The diagnosis of PD is made mainly by retrieving a focused medical history and performing a physical examination to exclude the presence of pelvic pathology. […] Since females with typical symptoms of PD can be diagnosed solely on the basis of their medical information, without any physical or pelvic examination, empiric treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs) and/or oral contraceptives should be initiated.

• #1 Diagnosis and management of dysmenorrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1459624/

  The prevalence of dysmenorrhoea (painful menstrual cramps of uterine origin) is difficult to determine because of different definitions of the conditionprevalence estimates vary from 45% to 95%. However, dysmenorrhoea seems to be the most common gynaecological condition in women regardless of age and nationality. […] Dysmenorrhoea, especially when it is severe, is associated with a restriction of activity and absence from school or work. Yet despite this substantial effect on their quality of life and general wellbeing, few women with dysmenorrhoea seek treatment as they believe it would not help. […] A focused history and physical examination are usually sufficient to diagnosis primary dysmenorrhoea. Information about the onset, location, duration, and characteristics of pain, plus any aggravating or relieving factors, should be sought from the patient.

• #1 Dysmenorrhea – What You Need to Know

  https://www.drugs.com/cg/dysmenorrhea.html

  How is dysmenorrhea diagnosed? […] Your healthcare provider can usually diagnose dysmenorrhea by your signs and symptoms. Tell him or her when your symptoms started and if you have pain between your monthly periods. He or she may ask if anything relieves your pain, such as heat or medicine. Tell your provider if you are sexually active or have ever been pregnant. You may need any of the following: […] A blood test will check for pregnancy. […] A pelvic exam may be needed to check the size and shape of your uterus and ovaries. Your healthcare provider gently inserts a warmed speculum into your vagina. A speculum is a tool that opens your vagina to show your cervix. […] A cervical culture may be needed to check for infection. Your healthcare provider will use a swab to collect a sample of cells from your cervix. This will be sent to a lab for tests. […] An ultrasound will show abnormal structure of your reproductive organs. Sound waves are used to show pictures on a monitor.

• #1 Diagnosis and Management of Primary Dysmenorrhea

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-primary-dysmenorrhea

  A diagnosis can often be reached by obtaining a detailed medical, family, psychosocial, and gynecologic (including menstrual and sexual) history. […] A complete menstrual history includes age at menarche, duration of bleeding, intervals between menses, and assessment of menstrual flow; associated symptoms such as pain, nausea, diarrhea, and fatigue; and the timing of onset, severity of pain, and effect on daily activities. […] The onset of primary dysmenorrhea typically begins 6 to 24 months after menarche. […] Symptoms frequently associated with dysmenorrhea include nausea, vomiting, diarrhea, headaches, muscle cramps, and poor sleep quality, though these can also be found with secondary causes such as endometriosis. […] A pelvic examination is recommended in adult women presenting for the first time with dysmenorrhea because the likelihood of secondary causes is much higher in this population.

• #1 Period pain

  https://www.nhs.uk/conditions/period-pain/

  Period pain usually happens to women around the start of their period. It can affect anyone who has periods. […] You may have period pain if: you have pain in your tummy at the start of your period, or several days before your period; you have painful cramps in your tummy that spread to your back and thighs; you have a sharp pain or a dull ache in your tummy. […] Period pain usually lasts for up to 3 days and can affect your daily activities. […] Period pain happens when your womb tightens during your period. It’s often a normal part of the menstrual cycle. […] Sometimes painful periods can be caused by a condition such as: womb tissue growing in other places (endometriosis and adenomyosis); growths in and around the womb (fibroids); an infection of the womb, fallopian tubes and ovaries (pelvic inflammatory disease).

• #1 Diagnosis and management of dysmenorrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1459624/

  Secondary dysmenorrhoea can occur at any time after menarche, but may arise as a new symptom when a woman is in her 30s or 40s, after the onset of an underlying causative condition. […] If any of the following conditions are present then secondary dysmenorrhoea may be indicated: dysmenorrhoea during the first one or two cycles after menarche; first occurrence of dysmenorrhoea after age 25; late onset of dysmenorrhoea after no history of pain with menstruation; pelvic abnormality on physical examination; infertility (consider endometriosis, pelvic inflammatory disease, or other causes of scarring); heavy menstrual flow or irregular cycles (consider adenomyosis, fibroids, polyps); dyspareunia; and little or no response to treatment with non-steroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, or both.

• #1 Dysmenorrhea: Menstrual Cramps, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea

  Dysmenorrhea is the medical term for painful menstrual periods. […] Primary dysmenorrhea refers to recurrent pain with no identifiable cause. Secondary dysmenorrhea results from conditions like endometriosis. […] Pain usually begins one or two days before you get your period or when the bleeding actually starts. […] If you have painful periods because of a condition or an infection in your reproductive organs, its secondary dysmenorrhea. […] Pain from secondary dysmenorrhea usually begins earlier in your menstrual cycle and lasts longer than typical menstrual cramps. […] About 5% to 15% of people report period pain thats so severe that it affects their daily activities. […] If you have severe or unusual menstrual cramps or cramps that last for more than three days, contact a healthcare provider.

• #1 Menstrual cramps – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944

  Your health care provider will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your provider checks for anything unusual with the reproductive organs and looks for signs of infection. […] Your provider may also recommend certain tests, including: […] Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries. […] Other imaging tests. A computed tomography (CT) scan or Magnetic resonance imaging (MRI) scan provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. CT combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body. MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.

• #1 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html/1000

  A pelvic examination should be performed in adolescents who have had vaginal intercourse because of the high risk of PID in this population. A pelvic examination is not essential for adolescents with symptoms of primary dysmenorrhea who have never had vaginal intercourse. However, if endometriosis is suspected, pelvic and rectovaginal examinations should be performed. […] Adenomyosis is the presence of endometrial glands and stroma within the myometrium. Symptoms and signs include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Diagnosis is usually confirmed through transvaginal ultrasonography and magnetic resonance imaging. […] One or more findings of uterine tenderness, adnexal tenderness, or cervical motion tenderness should raise the suspicion for PID. Additional criteria include oral temperature greater than 101F (38.3C), abnormal cervical or vaginal mucopurulent discharge, abundant white blood cells on saline microscopy of vaginal fluid, elevated erythrocyte sedimentation rate, elevated C-reactive protein level, and laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis.

• #1 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  A pelvic examination should be performed in adolescents who have had vaginal intercourse because of the high risk of PID in this population. A pelvic examination is not essential for adolescents with symptoms of primary dysmenorrhea who have never had vaginal intercourse. However, if endometriosis is suspected, pelvic and rectovaginal examinations should be performed. Pelvic examination has a 76% sensitivity, 74% specificity, 67% positive predictive value, and 81% negative predictive value for endometriosis. Findings are usually normal in patients with primary dysmenorrhea. Findings in those with secondary dysmenorrhea include a fixed uterus or reduced uterine mobility, adnexal masses, and uterosacral nodularity in patients with endometriosis; mucopurulent cervical discharge in those with PID; and uterine enlargement or asymmetry in patients with adenomyosis. […] Adenomyosis is the presence of endometrial glands and stroma within the myometrium. Symptoms and signs include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Diagnosis is usually confirmed through transvaginal ultrasonography and magnetic resonance imaging.

• #1

  https://asktia.com/article/painful-period-cramps

  Dysmenorrhea. Even the word looks painful. What is it? The medical term for the painful cramps associated with menstruation. […] This discussion will explore the various aspects of period cramps, including causes (sometimes dysmenorrhea has a secondary cause, like endometriosis or uterine fibroids), diagnostic methods, management tips, and treatments. […] How do doctors diagnose and treat period cramps? […] Often, your provider can diagnose dysmenorrhea by reviewing your medical history, performing a physical and pelvic exam, and using clinical experience and intuition. But, in some instances, your provider might recommend further testing, such as: […] Ultrasound This test uses harmless sound waves to create images of your pelvic organs and is the quickest and easiest way to get a first look at the uterus, fallopian tubes, and ovaries. […] CT or MRI These scans provide much greater detail than ultrasound and can help your provider diagnose any underlying cause(s) of secondary dysmenorrhea. […] Laparoscopy In more extreme cases, your provider might recommend an outpatient surgical procedure to get a better look at your abdominal cavity and reproductive organs. Laparoscopy, which entails making small incisions in the belly and inserting a thin camera, is the gold standard for diagnosing (and often treating) endometriosis, adhesions, fibroids, ovarian cysts, and other possible causes of secondary dysmenorrhea.

• #1 Period Pain- Symptoms, Diagnosis, And Treatment | 24-7Medcare

  https://24-7medcare.com.au/pain/period-pain/

  Magnetic resonance imaging uses powerful magnets to take detailed 2D and 3D images inside the body. Similarly to ultrasound, it is used to diagnose other relevant conditions, especially if the different tests are not conclusive. […] GPs may also recommend blood tests in some situations. If heavy bleeding is associated with unusual period pain, anaemia (low red blood cells) could occur. […] A swab of your vagina or cervix may be taken for further laboratory testing. These tests are used to look for infections, such as chlamydia and gonorrhoea, that could be responsible for unusual period pain. […] A hysteroscopy is performed by looking inside the cervix and uterus using an instrument called a hysteroscope. Biopsies (tissue samples) can be taken for further analysis to determine a diagnosis or cause of the period pain.

• #1 Painful Periods and Heavy Bleeding | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/heavy-bleeding-and-painful-periods/

  UT Southwestern specialists have extensive experience in diagnosing the causes of irregular menstrual bleeding. […] For women who experience heavy bleeding and painful periods, our specially trained gynecologists can determine if there is a cause for concern. […] UT Southwesterns experienced gynecologists conduct a thorough evaluation, which includes a: […] Physical exam […] Review of personal medical history, including details of the patients menstrual cycle […] Discussion of symptoms. […] To diagnose heavy bleeding and painful periods, our doctors usually recommend one or more tests, such as: […] Blood tests to look for signs of iron deficiency, thyroid disorders, or blood-clotting abnormalities […] Ultrasound: Diagnostic tools that use sound waves to produce images of the pelvic organs. Used to look for any abnormalities

• #1 Dysmenorrhea Workup: Approach Considerations, Laboratory Studies, Ultrasonography and Other Imaging Studies

  https://emedicine.medscape.com/article/253812-workup

  In cases of well-established primary dysmenorrhea, imaging studies are of little value. However, if pelvic pathology is suspected, abdominal and transvaginal ultrasonography are inexpensive and effective modalities. […] On occasion, other more invasive studies, including laparoscopy, hysteroscopy, and dilatation and curettage (DC), may be required. Laparoscopic examination is the single most useful procedure. It involves a complete diagnostic survey of the pelvis and reproductive organs to ascertain the presence of any pathology that may account for the clinical symptoms.

• #1 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #1 Dysmenorrhea: Painful Periods | ACOG

  https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods

  If fibroids are causing your pain, the first step may be to try NSAIDs, a birth control method, or GnRH agonists. If these do not work, a treatment called uterine artery embolization (UAE) may be recommended. […] If adenomyosis is causing your pain, NSAIDs, a birth control method, or other medications may be recommended. UAE also can be done to treat adenomyosis. […] If other treatments do not relieve pain, surgery may be recommended. The type of surgery depends on the cause of your pain: […] Fibroids can sometimes be removed with surgery. […] Endometriosis tissue can be removed with surgery. In some cases, the tissue returns after the surgery, but removing it can reduce the pain in the short term. Taking hormonal birth control or other medications after surgery for endometriosis may delay or prevent the return of pain. […] Hysterectomy may be done for adenomyosis if other treatments have not worked. Hysterectomy also may be recommended for other conditions when they cause severe pain. This surgery usually is a last resort.

• #1 Period (Menstrual) Cramps: Severe Dysmenorrhea Relief

  https://www.verywellhealth.com/period-cramps-8662719

  Period cramps occur when the uterus contracts to shed its inner lining. More than half of people who menstruate experience painful periods (dysmenorrhea). […] An underlying health condition like endometriosis or uterine fibroids may cause severe pain during your period. […] Period cramps are different from premenstrual syndrome (PMS), which occurs before bleeding starts. […] Secondary dysmenorrhea refers to painful periods caused by an underlying health condition that affects the reproductive organs. The pain usually gets worse over time and may continue after your period ends. […] Unbearable period cramps are not normal, and it’s essential to work with your healthcare provider to determine the cause. Chronic health conditions that may cause severe period cramps include: Endometriosis, Ovarian cysts, Pelvic tumors, Uterine fibroids, Irritable bowel disease (IBD), Ovarian torsion.

• #1 Period pain

  https://www.nhs.uk/conditions/period-pain/

  An intrauterine device (IUD) can also cause period pain, particularly during the first 3 to 6 months after it’s put in. […] Your pelvic pain or period pain is severe or worse than usual, and painkillers have not helped. […] If you have severe period pain, a GP may recommend: anti-inflammatory medicines like naproxen, flurbiprofen or mefenamic acid; a TENS machine a small device that uses mild electrical impulses to reduce pain; contraception like the pill, implant or injection these thin the womb lining, making your period lighter and easing the pain. […] The GP may refer you to a specialist (gynaecologist) if your period pain does not get better. […] You might need tests, such as an ultrasound scan, to find out what’s causing your period pain. If a condition is found, treating it will help.

• #1 Dysmenorrhea: Menstrual Cramps, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea

  The goal of the exam is to determine if a medical condition is causing painful periods. […] However, if your provider thinks you may have secondary dysmenorrhea (caused by another health condition), you may need additional tests. […] If those tests show you have a medical condition causing painful menstruation, your healthcare provider will discuss treatment with you. […] Pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first treatment for dysmenorrhea. […] If testing shows that you have secondary dysmenorrhea, your provider will discuss treatment for the condition causing you pain. […] Contact your healthcare provider if you have painful periods that prevent you from doing your normal tasks. […] If you get extremely painful periods dysmenorrhea you dont have to suffer silently.

• #1 Period (Menstrual) Cramps: Severe Dysmenorrhea Relief

  https://www.verywellhealth.com/period-cramps-8662719

  When you see your healthcare provider about painful period cramps, they will perform a physical exam and conduct a thorough medical history. They will likely perform a pelvic exam and may use ultrasound or other imaging tests to determine the cause of your pain. […] If treatments have not been successful or there is no known cause for your severe period pain, your healthcare provider may recommend seeing a pain management specialist. […] Period cramps are abnormal when they affect your ability to function in your daily life. Call your healthcare provider if: Treatment options have not been effective, Your cramps suddenly get much worse, You develop severe cramps after age 25, You experience a fever with the cramps, The painful cramps continue after your period is over.

• #1 Dysmenorrhea and Endometriosis in the Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

  Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women. Most adolescents experiencing dysmenorrhea have primary dysmenorrhea, defined as painful menstruation in the absence of pelvic pathology. When the patients history suggests primary dysmenorrhea, empiric treatment should be initiated. When a patient does not experience clinical improvement for her dysmenorrhea within 36 months of therapy initiation, her obstetriciangynecologist should investigate for possible secondary causes and for treatment adherence. Secondary dysmenorrhea refers to painful menses due to pelvic pathology or a recognized medical condition. Endometriosis is the leading cause of secondary dysmenorrhea in adolescents. Endometriosis should be considered in patients with persistent, clinically significant dysmenorrhea despite treatment with hormonal agents and nonsteroidal antiinflammatory drugs, particularly if no other etiology for chronic pelvic pain or secondary dysmenorrhea has been identified based on history, physical examination, and pelvic ultrasonography.

• #1 Painful periods (dysmenorrhoea) | healthdirect

  https://www.healthdirect.gov.au/painful-periods

  Period pain is pain in your lower abdomen (tummy) around the time of your period. […] Sometimes period pain can be caused by an underlying health problem. […] It’s important to see your doctor if you have any change in your period pain or bleeding pattern. […] How is the cause of period pain diagnosed? […] Your doctor will ask about your symptoms and may do a physical examination. They may recommend tests for some people, such as blood or urine tests and an ultrasound scan. […] See your doctor if your period pain stops you going to work or school. […] You should also see your doctor if you have any of the following: you start to get period pain when you haven’t had it in the past, your period pain gets worse, your period pain lasts longer than it used to, you have pain (similar to period pain) between periods, you have pain during sex, you bleed between periods or have irregular periods. […] Your doctor should do their best to listen to you and take your concerns seriously. If this doesn’t happen, do not be afraid to find a new doctor.

• #1 Diagnosis and Management of Primary Dysmenorrhea

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-primary-dysmenorrhea

  The goals of treatment are to provide satisfactory pain and symptom relief and reduce the disturbance in daily activities. […] Therapeutic options should take into account a patient’s contraceptive needs, as both nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives are considered first-line agents, either separately or in combination. […] Patients are encouraged to continue first-line therapy for 3 to 6 months, and their response to therapy should be monitored 2 to 3 months after its initiation. […] If adequate relief of symptoms is not achieved, further evaluation or referral to gynecologic specialists is recommended. […] Gynecologists play an important role in building patient and community awareness of the condition, and in its diagnosis and management. […] Progressive worsening of symptoms or suboptimal symptom control with first-line agents warrants further evaluation for secondary causes, including endometriosis.

• #1 Dysmenorrhea and Endometriosis in the Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

  The most common cause of secondary dysmenorrhea is endometriosis. […] Although the true prevalence of endometriosis in adolescents is unknown, at least two thirds of adolescent girls with chronic pelvic pain or dysmenorrhea unresponsive to hormonal therapies and NSAIDs will be diagnosed with endometriosis at the time of diagnostic laparoscopy. […] Endometriosis is the leading cause of secondary dysmenorrhea in adolescents. Endometriosis should be considered in patients with persistent, clinically significant dysmenorrhea despite treatment with hormonal agents and NSAIDs, particularly if no other etiology for chronic pelvic pain or secondary dysmenorrhea has been identified based on history, physical examination, and pelvic ultrasonography. […] Endometriosis remains a surgical and pathologic diagnosis in adolescents requiring the presence of endometrial glands and stroma in the biopsy specimen from a location outside of the endometrial cavity. Patients with persistent dysmenorrhea despite treatment and no other identified etiologies should be counseled about the high likelihood of endometriosis and the risks and benefits of diagnostic laparoscopy.

• #1 Diagnosis and management of dysmenorrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1459624/

  The different formulations of NSAIDs have similar efficacy for dysmenorrhoea, and pain relief is achieved in most women. […] Good quality clinical trials of oral contraceptives for dysmenorrhoea are lacking. […] The levonorgestrel releasing intrauterine system releases levonorgestrel (20 /day) into the uterine cavity for at least five years, thus preventing the thickening of the lining of the uterus. […] A combination of analgesics and the oral contraceptive or the Mirena intrauterine device is also an option in cases that do not respond to a single treatment. […] In all, 10-20% of women with primary dysmenorrhoea do not respond to treatment with NSAIDs or oral contraceptives. […] Research is needed to determine whether there are features of dysmenorrhoea in adolescence that predict whether a woman will have fertility problems and endometriosis in her 20s and 30s.

• #1 Endometriosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/10857-endometriosis

  Sometimes, you find endometriosis by accident. Not all people who have endometriosis will experience symptoms. In these cases, your provider might discover the condition during a different procedure. […] Your healthcare provider will help create a treatment plan for endometriosis based on a few factors, including: The severity of the endometriosis. Your plans for future pregnancies. Your age. The severity of your symptoms (often, pain). […] In many cases, your treatment plan will focus primarily on managing your pain and improving fertility issues (if you’re planning on a future pregnancy). Medication and surgery (or both) are possible treatment options. […] In some cases, your provider might recommend surgery to treat endometriosis. There are always risks to a surgical procedure. But surgery for endometriosis can be an effective way to relieve pain and, in some cases, improve your fertility. The goal of surgery is to remove the endometriosis tissue. […] Over time, the endometrial-like tissue that grows outside of your uterus can cause cysts, adhesions and scar tissue. This can cause you to experience long-term, severe pain, especially during your period. Many people with endometriosis also have difficulties getting pregnant.

• #1 5 Signs Your Period Pain May Actually Be Endometriosis, According to Doctors

  https://www.health.com/period-pain-endometriosis-11684837

  Endometriosis is a condition that affects millions of women worldwide, but is difficult to identify and diagnose. […] Severe period pain, pelvic pain, painful sex, infertility, and fatigue may signal endometriosis. […] Because it’s often misidentified as period pain, endometriosis is hard to catch and diagnose. […] Experts say if you experience severe pain during your period—enough to interfere with your daily activities—it’s important to get evaluated by a doctor. […] Endometriosis is typically diagnosed with surgery, which can be done through laparoscopy, a minimally invasive procedure that allows a surgeon to examine the abdominal or pelvic organs through small incisions. […] According to Ahmad, doctors may suspect endometriosis based on reported symptoms or imaging, but the gold standard for definitive diagnosis is surgical visualization, removal of endometriotic implants, and histological confirmation. […] Unfortunately, for many women, it can take years—an average of 7.5 years—to be diagnosed with endometriosis, said Ahmad. […] However, doctors don’t need to wait for surgical confirmation to start treating endometriosis, said Ahmad.

• #1

  https://www.nhs.uk/conditions/periods/period-problems/

  If problems with your periods are affecting your life, there’s help and support available. […] Before you see your GP about period problems, it can be useful to keep a diary of your symptoms throughout the menstrual cycle. This can give your doctor a detailed idea of what happens, and when, during your cycle. […] See your GP if the pain is so severe that it affects your daily life. […] Your GP can investigate why you’re experiencing heavy bleeding. These investigations may include a physical examination, blood tests or scans. […] If your periods stop and you’re concerned, see your GP. […] See a GP if you get menstrual migraines. They can advise you about medicines that can help. […] See your GP if you have symptoms of endometriosis, especially if they’re having a big impact on your life. […] If you’re in a lot of discomfort, see your GP about other treatment options.

• #1 Period Pain Treatment | Hazel

  https://www.hazelhealth.com.au/treatment/dysmenorrhea

  New or unexpected symptoms: Pain accompanied by unusual symptoms like digestive issues, extreme fatigue, or unexplained weight gain may suggest a medical condition that requires treatment. […] Pain that affects your ability to function: If the pain leaves you unable to go about your daily life such as causing problems with work, relationships, or self-care it’s time to seek medical advice. […] Diagnosing dysmenorrhoea involves more than just identifying period pain it’s also about ruling out other potential causes to get to the heart (or uterus) of the issue. […] This diagnostic journey typically starts with a thorough evaluation to distinguish between primary dysmenorrhoea, where pain is linked to menstrual cramps, and secondary dysmenorrhoea, which is associated with underlying conditions like endometriosis or fibroids. […] By assessing these factors, healthcare providers can pinpoint whether the pain stems from an identifiable condition and tailor treatment strategies accordingly.

• #1 Period pain (dysmenorrhoea) | NHS inform

  https://www.nhsinform.scot/healthy-living/womens-health/girls-and-young-women-puberty-to-around-25/periods-and-menstrual-health/period-pain-dysmenorrhoea/

  A lot of people experience pain with their periods. The medical name for period pain is dysmenorrhoea. This can be anything from dull achy cramps to intense pain that feels unmanageable and cannot be easily relieved. […] Period pain should not be severe. Speak to your doctor if you’re experiencing pain which is affecting your day to day life. […] It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor who can decide if any tests or treatments might be needed. […] If you experience severe period pain that stops you from doing day-to-day things, or that worries you at all, you should speak to your doctor. It’s important to get checked if you have any worries you don’t need to suffer. […] Your doctor will usually examine you if they think that you have secondary dysmenorrhoea. This may involve an internal examination to check your womb (uterus) and pelvis as well as your tummy (abdomen).

• #1 Period pain – dysmenorrhoea | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstruation-pain-dysmenorrhoea

  Some period pain is caused by other conditions, such as endometriosis, fibroids or adenomyosis. […] If you have painful periods, you can try: pain-relief medicine (e.g. ibuprofen) when the pain starts, regular exercise, which releases natural chemicals (endorphins) that relieve pain, putting a heat pack or hot water bottle on your abdomen and lower back to help relax the muscles, relaxation techniques (e.g. meditation) to relieve stress, complementary therapies like acupuncture or naturopathy, or supplements like fish oil and magnesium. […] You can talk to your doctor about hormonal treatments such as the pill or the Mirena intrauterine device (IUD). […] Talk to your doctor if simple treatments for period pain dont help or if your symptoms are so painful they impact your quality of life. […] It can be helpful to record information about your periods so you can discuss this with your doctor. Things to record include when you get your period, how long it lasts, how heavy it is and how it impacts your daily life.

• #1 Premenstrual syndrome (PMS) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787

  There are no unique physical findings or lab tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to premenstrual syndrome (PMS) if it’s part of your predictable premenstrual pattern. […] To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. […] Certain conditions may mimic PMS, including chronic fatigue syndrome, thyroid disorders and mood disorders, such as depression and anxiety. Your health care provider may order tests, such as a thyroid function test or mood screening tests to help provide a clear diagnosis.

• #1 Cramps but No Period: Causes and Diagnosis

  https://www.webmd.com/women/cramps-but-no-period

  Cramps but No Periods: Diagnosis […] Always call a doctor if you have cramps that wont go away, whether or not you have your period. (Get medical help right away if you have sudden, severe belly pain that continues to get worse.) […] Your doctor will want to know if your pain is sudden or ongoing. The more details you can give, the faster they may be able to diagnose and treat you. Youll be asked questions about your symptoms and your periods. […] Your doctor may do tests or procedures to learn the cause of your cramps. If your doctor suspects it is related to your uterus, or ovaries, common tests are: Pelvic exam, Ultrasound, Laparoscopy, a type of exploratory surgery to look at the structures inside your pelvic area, including your uterus, cervix, ovaries, and fallopian tubes. […] Your doctor may refer you to someone who specializes in stomach or intestinal disorders or a urologist if they suspect that cramps are caused by any of those areas.

• #1 Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/painful-menstrual-periods-dysmenorrhea-beyond-the-basics

  If you try one of these treatments but it does not sufficiently relieve pain within two to three months, your health care provider might recommend switching treatments or combining approaches (for example, adding birth control if you already use NSAIDs, or vice versa). […] Surgery to identify a cause – Diagnostic laparoscopy may be recommended to determine if endometriosis, or another condition, could be causing the pain. […] If your provider thinks your pain is related to endometriosis, they might recommend treatment with a gonadotropin-releasing hormone (GnRH) agonist, such as nafarelin (brand name: Synarel) or leuprolide (brand name: Lupron), or a GnRH antagonist, such as elagolix (brand name: Orilissa) or relugolix (brand name: Myfembree). […] At least two surgical procedures have been developed to treat dysmenorrhea. Both of these surgeries involve cutting or destroying the uterine nerves, which prevents the transmission of pain signals.

• #1 Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/painful-menstrual-periods-dysmenorrhea-beyond-the-basics

  Painful menstruation, also known as dysmenorrhea, is a common problem. […] This topic review discusses the causes, symptoms diagnosis, and treatment of dysmenorrhea in people who do not have an underlying cause for their pain (eg, endometriosis, uterine fibroids, uterine adenomyosis, bowel or bladder disease, etc). […] To diagnose dysmenorrhea, your health care provider will review your medical history and do a physical examination. […] Physical examination — This involves a complete abdominal and pelvic examination. During the examination, your provider will observe and feel the size and shape of your vagina, cervix, and uterus; they will also attempt to feel the ovaries. […] Depending on your situation, your provider may also do a pelvic ultrasound (performed vaginally if possible). This can be useful in determining if you have another condition that can cause pain, such as uterine fibroids, uterine adenomyosis, or endometriosis.

• #1 Period Pain Treatment | Hazel

  https://www.hazelhealth.com.au/treatment/dysmenorrhea

  Here are some signs that it’s time to seek medical attention: Pain that’s unusually intense: If your period pain is severe enough to require you to miss work, school, or social events, or if it causes nausea, vomiting, or fainting, it may be more than just regular cramps. […] Pain that lasts longer than usual: Period pain usually lasts for 12 days, but if it’s lasting longer or getting worse, it might indicate a condition like endometriosis, fibroids, or adenomyosis. […] Pain that doesn’t improve with typical treatments: Over-the-counter pain relievers like ibuprofen or heat therapy usually help relieve period pain. If they don’t, this could suggest a more serious issue requiring professional evaluation. […] Heavy bleeding: If you’re experiencing bleeding so heavy that you need to change your pad or tampon every hour, or if you pass large blood clots, you may have conditions like fibroids or endometrial polyps that need medical intervention.

• #1 Diagnosis and Management of Primary Dysmenorrhea

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-primary-dysmenorrhea

  Primary dysmenorrhea is a prevalent, underdiagnosed, but treatable condition. […] Primary dysmenorrhea is defined as painful menstruation in the absence of an identifiable cause. […] The management of primary dysmenorrhea is directed toward diagnosing other causes of symptoms and identifying medical therapies that satisfactorily control the patients symptoms. […] Despite its high prevalence, dysmenorrhea is often underdiagnosed, inadequately treated, and normalized even by patients themselves, who may accept the symptoms as an inevitable response to menstruation. […] All clinicians, and specifically gynecologists, should proactively inquire about the impact of menstrual-related symptoms on quality of life. […] Evaluating and diagnosing primary dysmenorrhea does not require specialization in women’s health or pelvic pain, and initial complaints frequently are presented to pediatricians and primary care physicians.

• #1 Endometriosis: It’s time to change the pattern of pain, stigma and barriers to diagnosis and treatment

  https://theconversation.com/endometriosis-its-time-to-change-the-pattern-of-pain-stigma-and-barriers-to-diagnosis-and-treatment-217881

  Endometriosis is a debilitating disease that affects an estimated one million Canadians. […] This much-needed, long-awaited funding will go far to address the many challenges that endometriosis patients face, including struggling to get a diagnosis in the first place, dismissal of their symptoms, related stigma, and ineffective treatments. […] One of the significant challenges faced by people with endometriosis is receiving a diagnosis. Patients experience an average delay of 5.4 years from the onset of symptoms to diagnosis. […] Research with endometriosis patients has shown that most cases of endometriosis are not diagnosed by primary care providers, but by specialists namely OBGYNs to whom they are referred. […] Another barrier is that women often have difficulty convincing care providers their pain is real and a cause of concern.

• #1

• #1 Menstrual cramps – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944

  Laparoscopy. Although not usually necessary to diagnosis menstrual cramps, laparoscopy can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. […] For menstrual cramps, basic questions include: […] Do I need any tests done?

• #2 Diagnosis and management of dysmenorrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1459624/

  The prevalence of dysmenorrhoea (painful menstrual cramps of uterine origin) is difficult to determine because of different definitions of the conditionprevalence estimates vary from 45% to 95%. However, dysmenorrhoea seems to be the most common gynaecological condition in women regardless of age and nationality. […] Dysmenorrhoea, especially when it is severe, is associated with a restriction of activity and absence from school or work. Yet despite this substantial effect on their quality of life and general wellbeing, few women with dysmenorrhoea seek treatment as they believe it would not help. […] A focused history and physical examination are usually sufficient to diagnosis primary dysmenorrhoea. Information about the onset, location, duration, and characteristics of pain, plus any aggravating or relieving factors, should be sought from the patient.

• #2 Dysmenorrhea: Menstrual Cramps, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea

  Dysmenorrhea is the medical term for painful menstrual periods. […] Primary dysmenorrhea refers to recurrent pain with no identifiable cause. Secondary dysmenorrhea results from conditions like endometriosis. […] Pain usually begins one or two days before you get your period or when the bleeding actually starts. […] If you have painful periods because of a condition or an infection in your reproductive organs, its secondary dysmenorrhea. […] Pain from secondary dysmenorrhea usually begins earlier in your menstrual cycle and lasts longer than typical menstrual cramps. […] About 5% to 15% of people report period pain thats so severe that it affects their daily activities. […] If you have severe or unusual menstrual cramps or cramps that last for more than three days, contact a healthcare provider.

• #2 Dysmenorrhea: Painful Periods | ACOG

  https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods

  Pain associated with menstruation is called dysmenorrhea. More than half of women who menstruate have some pain for 1 to 2 days each month. Usually, the pain is mild. But for some women, the pain is so severe that it keeps them from doing their normal activities for several days a month. […] Most women have some pain with their menstrual periods. For some women, severe pain comes with other symptoms, including diarrhea, nausea, vomiting, headache, and dizziness. […] There are two types of dysmenorrhea: primary and secondary. […] Primary dysmenorrhea is the cramping pain that comes before or during a period. This pain is caused by natural chemicals called prostaglandins that are made in the lining of the uterus. Prostaglandins cause the muscles and blood vessels of the uterus to contract. On the first day of a period, the level of prostaglandins is high. As bleeding continues and the lining of the uterus is shed, the level goes down. This is why pain tends to lessen after the first few days of a period.

• #2 Menstrual cramps – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944

  Your health care provider will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your provider checks for anything unusual with the reproductive organs and looks for signs of infection. […] Your provider may also recommend certain tests, including: […] Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries. […] Other imaging tests. A computed tomography (CT) scan or Magnetic resonance imaging (MRI) scan provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. CT combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body. MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.

• #2 Diagnosis and Management of Primary Dysmenorrhea

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-primary-dysmenorrhea

  A diagnosis can often be reached by obtaining a detailed medical, family, psychosocial, and gynecologic (including menstrual and sexual) history. […] A complete menstrual history includes age at menarche, duration of bleeding, intervals between menses, and assessment of menstrual flow; associated symptoms such as pain, nausea, diarrhea, and fatigue; and the timing of onset, severity of pain, and effect on daily activities. […] The onset of primary dysmenorrhea typically begins 6 to 24 months after menarche. […] Symptoms frequently associated with dysmenorrhea include nausea, vomiting, diarrhea, headaches, muscle cramps, and poor sleep quality, though these can also be found with secondary causes such as endometriosis. […] A pelvic examination is recommended in adult women presenting for the first time with dysmenorrhea because the likelihood of secondary causes is much higher in this population.

• #2 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Characteristic symptoms of primary dysmenorrhea include lower abdominal or pelvic pain with or without radiation to the back or legs, with initial onset six to 12 months after menarche. Pain typically lasts eight to 72 hours and usually occurs at the onset of menstrual flow. Other associated symptoms may include low back pain, headache, diarrhea, fatigue, nausea, or vomiting. A family history may be helpful in differentiating primary from secondary dysmenorrhea; patients with a family history of endometriosis in first-degree relatives are more likely to have secondary dysmenorrhea. […] The diagnosis of primary dysmenorrhea is based on the clinical history and physical examination. Laparoscopy is indicated if the etiology remains unknown after an appropriate noninvasive evaluation has been completed. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. It has a 91% sensitivity and 98% specificity, a positive likelihood ratio of 30, and a negative likelihood ratio of 0.09 for detection of bowel endometriosis. It also has a high degree of accuracy for detection of ovarian endometriomas.

• #2 Dysmenorrhea: Painful Periods | ACOG

  https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods

  Secondary dysmenorrhea is caused by a disorder in the reproductive organs. The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. For example, the pain may begin a few days before a period starts. The pain may get worse as the period continues and may not go away after it ends. […] Yes, if you have painful periods you and your obstetrician-gynecologist (ob-gyn) should talk about your symptoms and your menstrual cycle. If needed, your ob-gyn may recommend a pelvic exam. A first step in treatment may be medications. If medications do not relieve your pain, treatment should focus on finding the cause of your pain. […] An ultrasound exam may be done when pain is not relieved with medications. In some cases, an ob-gyn may recommend a laparoscopy. This is a procedure that lets an ob-gyn view the organs in the pelvis. With laparoscopy, a small incision (cut) is made near the belly button. A thin, lighted cameraa laparoscopeis inserted into the abdomen. Laparoscopy often is done with general anesthesia in a surgery center or hospital.

• #2 Diagnosis and management of dysmenorrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1459624/

  Secondary dysmenorrhoea can occur at any time after menarche, but may arise as a new symptom when a woman is in her 30s or 40s, after the onset of an underlying causative condition. […] If any of the following conditions are present then secondary dysmenorrhoea may be indicated: dysmenorrhoea during the first one or two cycles after menarche; first occurrence of dysmenorrhoea after age 25; late onset of dysmenorrhoea after no history of pain with menstruation; pelvic abnormality on physical examination; infertility (consider endometriosis, pelvic inflammatory disease, or other causes of scarring); heavy menstrual flow or irregular cycles (consider adenomyosis, fibroids, polyps); dyspareunia; and little or no response to treatment with non-steroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, or both.

• #2 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html/1000

  A pelvic examination should be performed in all sexually active patients with dysmenorrhea and in those in whom endometriosis is suspected. […] Characteristic symptoms of primary dysmenorrhea include lower abdominal or pelvic pain with or without radiation to the back or legs, with initial onset six to 12 months after menarche. Pain typically lasts eight to 72 hours and usually occurs at the onset of menstrual flow. Other associated symptoms may include low back pain, headache, diarrhea, fatigue, nausea, or vomiting. A family history may be helpful in differentiating primary from secondary dysmenorrhea; patients with a family history of endometriosis in first-degree relatives are more likely to have secondary dysmenorrhea. […] The diagnosis of primary dysmenorrhea is based on the clinical history and physical examination. Laparoscopy is indicated if the etiology remains unknown after an appropriate noninvasive evaluation has been completed. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. It has a 91% sensitivity and 98% specificity, a positive likelihood ratio of 30, and a negative likelihood ratio of 0.09 for detection of bowel endometriosis.

• #2 Diagnosis and Management of Primary Dysmenorrhea

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-primary-dysmenorrhea

  However, a pelvic exam is not necessary in nonsexually active patients specifically adolescents if the elicited history is descriptive of primary dysmenorrhea, and in the absence of other symptoms such as infection or abnormal bleeding. […] The pelvic exam should be normal in patients with primary dysmenorrhea when not menstruating. […] Dysmenorrhea associated with adnexal pathology or uterine abnormalities (such as leiomyoma, adenomyosis, and some Müllerian anomalies) can be diagnosed with ultrasound. […] Although endometriosis is a common cause of secondary dysmenorrhea, routine pelvic ultrasound is frequently unremarkable in affected patients unless there is anatomic distortion, endometrioma, or evidence of deep infiltrative endometriosis. […] Delays in diagnosis and treatment are common and should be avoided.

• #2 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  A pelvic examination should be performed in adolescents who have had vaginal intercourse because of the high risk of PID in this population. A pelvic examination is not essential for adolescents with symptoms of primary dysmenorrhea who have never had vaginal intercourse. However, if endometriosis is suspected, pelvic and rectovaginal examinations should be performed. Pelvic examination has a 76% sensitivity, 74% specificity, 67% positive predictive value, and 81% negative predictive value for endometriosis. Findings are usually normal in patients with primary dysmenorrhea. Findings in those with secondary dysmenorrhea include a fixed uterus or reduced uterine mobility, adnexal masses, and uterosacral nodularity in patients with endometriosis; mucopurulent cervical discharge in those with PID; and uterine enlargement or asymmetry in patients with adenomyosis. […] Adenomyosis is the presence of endometrial glands and stroma within the myometrium. Symptoms and signs include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Diagnosis is usually confirmed through transvaginal ultrasonography and magnetic resonance imaging.

• #2 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8943241/

  Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. […] While its diagnosis is based on patients history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed. […] The diagnosis of PD is made mainly by retrieving a focused medical history and performing a physical examination to exclude the presence of pelvic pathology. […] Since females with typical symptoms of PD can be diagnosed solely on the basis of their medical information, without any physical or pelvic examination, empiric treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs) and/or oral contraceptives should be initiated.

• #2 Dysmenorrhea | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/dysmenorrhea.html

  Painful periods are menstrual periods with severe and frequent cramps and pain. […] The symptoms of a painful period may look like other health problems. Always talk with your healthcare provider for a diagnosis. […] To diagnose painful periods, your healthcare provider will ask about your health history. They will do a physical and pelvic exam. Other tests may include: […] Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs. […] MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. […] Laparoscopy. This minor procedure uses a laparoscope. This is a thin tube with a lens and a light. It’s put into a cut (incision) in the belly (abdominal) wall. The healthcare provider uses this tool to see into the pelvic and abdomen area. They may find abnormal growths. […] Hysteroscopy. This test looks at the canal of the cervix and the inside of the uterus. It uses a viewing tool (hysteroscope) put through the vagina.

• #2 Dysmenorrhea – What You Need to Know

  https://www.drugs.com/cg/dysmenorrhea.html

  How is dysmenorrhea diagnosed? […] Your healthcare provider can usually diagnose dysmenorrhea by your signs and symptoms. Tell him or her when your symptoms started and if you have pain between your monthly periods. He or she may ask if anything relieves your pain, such as heat or medicine. Tell your provider if you are sexually active or have ever been pregnant. You may need any of the following: […] A blood test will check for pregnancy. […] A pelvic exam may be needed to check the size and shape of your uterus and ovaries. Your healthcare provider gently inserts a warmed speculum into your vagina. A speculum is a tool that opens your vagina to show your cervix. […] A cervical culture may be needed to check for infection. Your healthcare provider will use a swab to collect a sample of cells from your cervix. This will be sent to a lab for tests. […] An ultrasound will show abnormal structure of your reproductive organs. Sound waves are used to show pictures on a monitor.

• #2 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #2 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Dysmenorrhea is one of the most common causes of pelvic pain. It negatively affects patients’ quality of life and sometimes results in activity restriction. A history and physical examination, including a pelvic examination in patients who have had vaginal intercourse, may reveal the cause. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. Abnormal uterine bleeding, dyspareunia, noncyclic pain, changes in intensity and duration of pain, and abnormal pelvic examination findings suggest underlying pathology (secondary dysmenorrhea) and require further investigation. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus.

• #2 Period (Menstrual) Cramps: Severe Dysmenorrhea Relief

  https://www.verywellhealth.com/period-cramps-8662719

  When you see your healthcare provider about painful period cramps, they will perform a physical exam and conduct a thorough medical history. They will likely perform a pelvic exam and may use ultrasound or other imaging tests to determine the cause of your pain. […] If treatments have not been successful or there is no known cause for your severe period pain, your healthcare provider may recommend seeing a pain management specialist. […] Period cramps are abnormal when they affect your ability to function in your daily life. Call your healthcare provider if: Treatment options have not been effective, Your cramps suddenly get much worse, You develop severe cramps after age 25, You experience a fever with the cramps, The painful cramps continue after your period is over.

• #2 Painful periods (dysmenorrhoea) | healthdirect

  https://www.healthdirect.gov.au/painful-periods

  Period pain is pain in your lower abdomen (tummy) around the time of your period. […] Sometimes period pain can be caused by an underlying health problem. […] It’s important to see your doctor if you have any change in your period pain or bleeding pattern. […] How is the cause of period pain diagnosed? […] Your doctor will ask about your symptoms and may do a physical examination. They may recommend tests for some people, such as blood or urine tests and an ultrasound scan. […] See your doctor if your period pain stops you going to work or school. […] You should also see your doctor if you have any of the following: you start to get period pain when you haven’t had it in the past, your period pain gets worse, your period pain lasts longer than it used to, you have pain (similar to period pain) between periods, you have pain during sex, you bleed between periods or have irregular periods. […] Your doctor should do their best to listen to you and take your concerns seriously. If this doesn’t happen, do not be afraid to find a new doctor.

• #2 When Endometriosis Causes Mental Illness | Think Global Health

  https://www.thinkglobalhealth.org/article/when-endometriosis-causes-mental-illness

  For 15 years, Evelyn Scott, age 37, endured excruciating menstrual pain without receiving a diagnosis. Doctors repeatedly dismissed her symptoms, telling her that „to be female is to be in pain.” […] Finally, a laparoscopic procedure confirmed her diagnosis: endometriosis. […] A 2020 study of U.S. patients revealed a troubling pattern: Nearly half of endometriosis patients surveyed reported that health-care providers had initially attributed their symptoms to mental health issues before correctly diagnosing them with endometriosis. […] An international study published in 2023, surveying more than 2,000 women across 63 countries, revealed that patients waited an average of 9.6 years for an endometriosis diagnosis. […] „It’s very common for physicians not to know the symptoms of endometriosis,” says Amanda Della Giustina, a clinical research associate who recently completed her post-doctoral research at the Ottawa Hospital Research Institute.

• #2 5 Signs Your Period Pain May Actually Be Endometriosis, According to Doctors

  https://www.health.com/period-pain-endometriosis-11684837

  Endometriosis is a condition that affects millions of women worldwide, but is difficult to identify and diagnose. […] Severe period pain, pelvic pain, painful sex, infertility, and fatigue may signal endometriosis. […] Because it’s often misidentified as period pain, endometriosis is hard to catch and diagnose. […] Experts say if you experience severe pain during your period—enough to interfere with your daily activities—it’s important to get evaluated by a doctor. […] Endometriosis is typically diagnosed with surgery, which can be done through laparoscopy, a minimally invasive procedure that allows a surgeon to examine the abdominal or pelvic organs through small incisions. […] According to Ahmad, doctors may suspect endometriosis based on reported symptoms or imaging, but the gold standard for definitive diagnosis is surgical visualization, removal of endometriotic implants, and histological confirmation. […] Unfortunately, for many women, it can take years—an average of 7.5 years—to be diagnosed with endometriosis, said Ahmad. […] However, doctors don’t need to wait for surgical confirmation to start treating endometriosis, said Ahmad.

• #2

  https://www.nhs.uk/conditions/periods/period-problems/

  If problems with your periods are affecting your life, there’s help and support available. […] Before you see your GP about period problems, it can be useful to keep a diary of your symptoms throughout the menstrual cycle. This can give your doctor a detailed idea of what happens, and when, during your cycle. […] See your GP if the pain is so severe that it affects your daily life. […] Your GP can investigate why you’re experiencing heavy bleeding. These investigations may include a physical examination, blood tests or scans. […] If your periods stop and you’re concerned, see your GP. […] See a GP if you get menstrual migraines. They can advise you about medicines that can help. […] See your GP if you have symptoms of endometriosis, especially if they’re having a big impact on your life. […] If you’re in a lot of discomfort, see your GP about other treatment options.

• #2 Period pain – dysmenorrhoea | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstruation-pain-dysmenorrhoea

  Some period pain is caused by other conditions, such as endometriosis, fibroids or adenomyosis. […] If you have painful periods, you can try: pain-relief medicine (e.g. ibuprofen) when the pain starts, regular exercise, which releases natural chemicals (endorphins) that relieve pain, putting a heat pack or hot water bottle on your abdomen and lower back to help relax the muscles, relaxation techniques (e.g. meditation) to relieve stress, complementary therapies like acupuncture or naturopathy, or supplements like fish oil and magnesium. […] You can talk to your doctor about hormonal treatments such as the pill or the Mirena intrauterine device (IUD). […] Talk to your doctor if simple treatments for period pain dont help or if your symptoms are so painful they impact your quality of life. […] It can be helpful to record information about your periods so you can discuss this with your doctor. Things to record include when you get your period, how long it lasts, how heavy it is and how it impacts your daily life.

• #2 Period Pain Treatment | Hazel

  https://www.hazelhealth.com.au/treatment/dysmenorrhea

  Here are some signs that it’s time to seek medical attention: Pain that’s unusually intense: If your period pain is severe enough to require you to miss work, school, or social events, or if it causes nausea, vomiting, or fainting, it may be more than just regular cramps. […] Pain that lasts longer than usual: Period pain usually lasts for 12 days, but if it’s lasting longer or getting worse, it might indicate a condition like endometriosis, fibroids, or adenomyosis. […] Pain that doesn’t improve with typical treatments: Over-the-counter pain relievers like ibuprofen or heat therapy usually help relieve period pain. If they don’t, this could suggest a more serious issue requiring professional evaluation. […] Heavy bleeding: If you’re experiencing bleeding so heavy that you need to change your pad or tampon every hour, or if you pass large blood clots, you may have conditions like fibroids or endometrial polyps that need medical intervention.

• #3 Diagnosis and management of dysmenorrhoea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1459624/

  The prevalence of dysmenorrhoea (painful menstrual cramps of uterine origin) is difficult to determine because of different definitions of the conditionprevalence estimates vary from 45% to 95%. However, dysmenorrhoea seems to be the most common gynaecological condition in women regardless of age and nationality. […] Dysmenorrhoea, especially when it is severe, is associated with a restriction of activity and absence from school or work. Yet despite this substantial effect on their quality of life and general wellbeing, few women with dysmenorrhoea seek treatment as they believe it would not help. […] A focused history and physical examination are usually sufficient to diagnosis primary dysmenorrhoea. Information about the onset, location, duration, and characteristics of pain, plus any aggravating or relieving factors, should be sought from the patient.

• #3 Diagnosis and Management of Primary Dysmenorrhea

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-primary-dysmenorrhea

  A diagnosis can often be reached by obtaining a detailed medical, family, psychosocial, and gynecologic (including menstrual and sexual) history. […] A complete menstrual history includes age at menarche, duration of bleeding, intervals between menses, and assessment of menstrual flow; associated symptoms such as pain, nausea, diarrhea, and fatigue; and the timing of onset, severity of pain, and effect on daily activities. […] The onset of primary dysmenorrhea typically begins 6 to 24 months after menarche. […] Symptoms frequently associated with dysmenorrhea include nausea, vomiting, diarrhea, headaches, muscle cramps, and poor sleep quality, though these can also be found with secondary causes such as endometriosis. […] A pelvic examination is recommended in adult women presenting for the first time with dysmenorrhea because the likelihood of secondary causes is much higher in this population.

• #3 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Characteristic symptoms of primary dysmenorrhea include lower abdominal or pelvic pain with or without radiation to the back or legs, with initial onset six to 12 months after menarche. Pain typically lasts eight to 72 hours and usually occurs at the onset of menstrual flow. Other associated symptoms may include low back pain, headache, diarrhea, fatigue, nausea, or vomiting. A family history may be helpful in differentiating primary from secondary dysmenorrhea; patients with a family history of endometriosis in first-degree relatives are more likely to have secondary dysmenorrhea. […] The diagnosis of primary dysmenorrhea is based on the clinical history and physical examination. Laparoscopy is indicated if the etiology remains unknown after an appropriate noninvasive evaluation has been completed. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. It has a 91% sensitivity and 98% specificity, a positive likelihood ratio of 30, and a negative likelihood ratio of 0.09 for detection of bowel endometriosis. It also has a high degree of accuracy for detection of ovarian endometriomas.

• #3 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  A pelvic examination should be performed in adolescents who have had vaginal intercourse because of the high risk of PID in this population. A pelvic examination is not essential for adolescents with symptoms of primary dysmenorrhea who have never had vaginal intercourse. However, if endometriosis is suspected, pelvic and rectovaginal examinations should be performed. Pelvic examination has a 76% sensitivity, 74% specificity, 67% positive predictive value, and 81% negative predictive value for endometriosis. Findings are usually normal in patients with primary dysmenorrhea. Findings in those with secondary dysmenorrhea include a fixed uterus or reduced uterine mobility, adnexal masses, and uterosacral nodularity in patients with endometriosis; mucopurulent cervical discharge in those with PID; and uterine enlargement or asymmetry in patients with adenomyosis. […] Adenomyosis is the presence of endometrial glands and stroma within the myometrium. Symptoms and signs include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Diagnosis is usually confirmed through transvaginal ultrasonography and magnetic resonance imaging.

• #3 Menstrual cramps – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944

  Your health care provider will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your provider checks for anything unusual with the reproductive organs and looks for signs of infection. […] Your provider may also recommend certain tests, including: […] Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries. […] Other imaging tests. A computed tomography (CT) scan or Magnetic resonance imaging (MRI) scan provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. CT combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body. MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.

• #3 Menstrual cramps – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944

  Laparoscopy. Although not usually necessary to diagnosis menstrual cramps, laparoscopy can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. […] For menstrual cramps, basic questions include: […] Do I need any tests done?

• #3 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #3 Period (Menstrual) Cramps: Severe Dysmenorrhea Relief

  https://www.verywellhealth.com/period-cramps-8662719

  When you see your healthcare provider about painful period cramps, they will perform a physical exam and conduct a thorough medical history. They will likely perform a pelvic exam and may use ultrasound or other imaging tests to determine the cause of your pain. […] If treatments have not been successful or there is no known cause for your severe period pain, your healthcare provider may recommend seeing a pain management specialist. […] Period cramps are abnormal when they affect your ability to function in your daily life. Call your healthcare provider if: Treatment options have not been effective, Your cramps suddenly get much worse, You develop severe cramps after age 25, You experience a fever with the cramps, The painful cramps continue after your period is over.

• #4 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  A pelvic examination should be performed in adolescents who have had vaginal intercourse because of the high risk of PID in this population. A pelvic examination is not essential for adolescents with symptoms of primary dysmenorrhea who have never had vaginal intercourse. However, if endometriosis is suspected, pelvic and rectovaginal examinations should be performed. Pelvic examination has a 76% sensitivity, 74% specificity, 67% positive predictive value, and 81% negative predictive value for endometriosis. Findings are usually normal in patients with primary dysmenorrhea. Findings in those with secondary dysmenorrhea include a fixed uterus or reduced uterine mobility, adnexal masses, and uterosacral nodularity in patients with endometriosis; mucopurulent cervical discharge in those with PID; and uterine enlargement or asymmetry in patients with adenomyosis. […] Adenomyosis is the presence of endometrial glands and stroma within the myometrium. Symptoms and signs include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Diagnosis is usually confirmed through transvaginal ultrasonography and magnetic resonance imaging.

• #4 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #4 Period (Menstrual) Cramps: Severe Dysmenorrhea Relief

  https://www.verywellhealth.com/period-cramps-8662719

  When you see your healthcare provider about painful period cramps, they will perform a physical exam and conduct a thorough medical history. They will likely perform a pelvic exam and may use ultrasound or other imaging tests to determine the cause of your pain. […] If treatments have not been successful or there is no known cause for your severe period pain, your healthcare provider may recommend seeing a pain management specialist. […] Period cramps are abnormal when they affect your ability to function in your daily life. Call your healthcare provider if: Treatment options have not been effective, Your cramps suddenly get much worse, You develop severe cramps after age 25, You experience a fever with the cramps, The painful cramps continue after your period is over.

• #5 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #6 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #7 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

• #8 Dysmenorrhea Differential Diagnoses

  https://emedicine.medscape.com/article/253812-differential

  The key diagnostic issue in dysmenorrhea is differentiating primary dysmenorrhea from secondary dysmenorrhea. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Peritonitis, Pregnancy or pregnancy loss, Uterine neoplasm, benign or malignant, Iatrogenic causes. […] Differential Diagnoses: Adenomyosis, Appendicitis, Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females, Ectopic Pregnancy, Endometriosis, Inflammatory Bowel Disease, Irritable Bowel Syndrome (IBS), Ovarian Cancer, Ovarian Cysts, Pelvic Inflammatory Disease.

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