Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge.
Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge.
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发表时间：
2015-12
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通讯作者：
V. De Sanctis;A. Soliman;S. Bernasconi;L. Bianchin;G. Bona;M. Bozzola;F. Buzi;C. de Sanctis;G. Tonini,;F. Rigon;E. Perissinotto
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作者：
V. De Sanctis;A. Soliman;S. Bernasconi;L. Bianchin;G. Bona;M. Bozzola;F. Buzi;C. de Sanctis;G. Tonini,;F. Rigon;E. Perissinotto
背景和解释痛经通常分为两种类型：原发性和继发性。原发性痛经（PD）是这方面的审查重点。PD定义为疼痛的月经，下腹部有痉挛感，通常伴有其他症状，如出汗、头痛、恶心、呕吐、腹泻和颤抖。所有这些症状都发生在盆腔解剖正常的女性月经前或月经期间。在青少年中，PD的患病率在16%至93%之间变化，2%至29%的研究女孩感到剧烈疼痛。一些研究表明，严重的月经疼痛与缺课或工作以及其他日常活动的限制有关。三分之一至一半的PD女性每个周期至少有一次缺课或工作，其中5%至14%的女性缺课或工作更频繁。流行率的巨大差异可能归因于使用选定的受试者群体。许多危险因素与痛经的严重程度增加有关，包括初潮年龄较早，月经周期长，月经量大，吸烟和阳性家族史。使用口服避孕药（OCP）的年轻女性报告痛经不太严重。青少年中痛经的发病率相当高，这证明这种情况是一个重大的公共卫生问题，需要给予高度重视。主要结果总结：在对痛经相关疼痛的严重程度进行量化和分级的过程中遇到了许多方法学问题。量化和评估工具依赖于妇女的自我报告，可能存在偏见。关于痛经的自然史以及许多可改变的危险因素的可能影响的纵向研究很少。此外，现有研究的随访持续时间相对较短。因此，有几个方面仍有待研究。痛经的药物治疗包括抗炎药（NSAID），OCP或手术干预。使用NSAID和OCP的常规治疗的疗效很高。然而，除了药物相关不良反应的发生外，失败率可能高达20%~ 25%。只有6%的青少年接受治疗痛经的医疗建议，而70%的青少年实行自我管理。不幸的是，一些女孩甚至滥用这些药物（非治疗性高剂量）来快速缓解疼痛。尽管使用OCP和/或NSAID药物，痛经的持续性是器质性盆腔疾病的强有力指标。这种情况要求适当转诊给妇科医生，并对子宫内膜异位症和/或其他盆腔疾病进行适当的腹腔镜诊断。结论：痛经是一个重要的健康问题，青少年，学校和职业以及从业人员，不利地影响日常活动和生活质量的青春期妇女。由于诊断标准的多样性和症状的主观性，痛经的准确患病率很难确定。在青少年中，影响生活方式且对药物治疗无反应的中度至重度痛经需要专业关注并正确诊断潜在的盆腔疾病。因此，青少年保健提供者应更多地了解和积极参与痛经的护理。
BACKGROUND AND OBJECTIVES Dysmenorrhea is commonly categorized into two types; primary and secondary. Primary dysmenorrhea (PD) is the focus of this review. PD is defined as painful menses with cramping sensation in the lower abdomen that is often accompanied by other symptoms, such as sweating, headache, nausea, vomiting, diarrhea, and tremulousness. All these symptoms occur just before or during the menses in women with normal pelvic anatomy. In adolescents the prevalence of PD varies between 16% and 93%, with severe pain perceived in 2% to 29% of the studied girls. Several studies suggest that severe menstrual pain is associated with absenteeism from school or work and limitation of other daily activities. One-third to one-half of females with PD are missing school or work at least once per cycle, and more frequently in 5% to 14% of them. The wide variation in the prevalence rates may be attributed to the use of selected groups of subjects. Many risk factors are associated with increased severity of dysmenorrhea including earlier age at menarche, long menstrual periods, heavy menstrual flow, smoking and positive family history. Young women using oral contraceptive pills (OCP) report less severe dysmenorrhea. The considerably high prevalence of dysmenorrhea among adolescents verified that this condition is a significant public health problem that requires great attention. SUMMARY OF MAIN RESULTS: Many methodological problems are encountered during quantifying and grading severity of pain related to dysmenorrhea. Quantifying and assessment tools depend on women's self-reporting with potential bias. There is a scarcity of longitudinal studies on the natural history of dysmenorrhea as well as the possible effects of many modifiable risk factors. In addition, the duration of follow-up in the available studies is relatively short. Therefore, several aspects are still open for research. Medical treatment for dysmenorrhea includes anti-inflammatory drugs (NSAIDs), OCP or surgical intervention. The efficacy of conventional treatments using NSAIDs and OCP is high. However, failure rate may reach up to 20% to 25%, besides the occurrence of drug-associated adverse effects. Only 6% of adolescents receive medical advice to treat dysmenorrhea while 70% practice self-management. Unfortunately, some girls even abuse these medications (non-therapeutic high doses) for quick pain relief. The persistence of dysmenorrhea despite the use of OCP and/or NSAIDs drugs is a strong indicator of an organic pelvic disease. This condition mandates an appropriate referral to a gynecologist with proper laparoscopic diagnosis of endometriosis and/or other pelvic diseases. CONCLUSIONS Dysmenorrhea is an important health problem for adolescents, school and occupational as well as practitioners that adversely affects the daily activities and quality of life for adolescent women. The accurate prevalence of dysmenorrhea is difficult to establish due to the variety of diagnostic criteria and the subjective nature of the symptoms. In adolescents, moderate to severe dysmenorrhea that affects lifestyle and does not respond to medical treatment requires professional attention and proper diagnosis of possible underlying pelvic disease. Therefore, adolescent care providers should be more knowledgeable and actively involved in the care of dysmenorrhea.