A longitudinal study of adolescent dysmenorrhoea into adulthood

Knox, Benita; Ong, Yi Chen; Bakar, Mardiha Abu; Grover, Sonia

doi:10.1007/s00431-019-03419-3

Cited by 31 publications

(15 citation statements)

References 48 publications

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“…We propose that in patients presenting with dysmenorrhea and/or pelvic pain, complete menstrual suppression be included in a trial of medical therapy prior to moving onto to considering surgical investigation. The long‐term follow‐up of our cohort has been reported in a separate study and sheds further encouraging, positive light on this conservative approach to dysmenorrhea in young patients 14 …”

Section: Resultssupporting

confidence: 72%

“…A placebo effect of up to 30% has been reported in the literature, whereas up to 20% of women describe no improvement in symptoms 13 . Medical treatment is proven to be effective for symptom control in adolescents with dysmenorrhea 14‐16 and recently has been shown to be associated with a reduction in size of endometriotic nodules in cases of moderate to severe rectovaginal endometriosis 17 . Furthermore, there is a cohort of women who develop pain syndromes and myofascial pain following surgery 1,18 .…”

Section: Introductionmentioning

confidence: 99%

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Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Sachedina

Bakar²,

Dunford

et al. 2020

J of Obstet and Gynaecol

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AimTo describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions.MethodsA retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain.ResultsOf 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self‐reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P < 0.005). At follow‐up, therapeutic interventions included nonsteroidal anti‐inflammatory drugs, tranexamic acid and cyclic or continuous combined oral contraceptive pills. Laparoscopies were undertaken in 12 (8.1%) patients, with normal findings in 8 (66.7%). Secondary dysmenorrhea was identified in 10 patients: of these, endometriosis was identified in one patient and unilateral obstructive Müllerian anomalies in six. Overall, 92.2% of patients had improvement in symptoms after treatment.ConclusionLaparoscopy and endometriosis rates in patients presenting to a tertiary center were lower than previously reported, with most patients achieving symptom improvement without laparoscopy.

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Section: Resultssupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Sachedina

Bakar²,

Dunford

et al. 2020

J of Obstet and Gynaecol

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“…In adolescents that can tolerate a single digit vaginal exam, the bladder neck, levator ani, cervix, adnexa and uterosacral ligaments should be palpated for tenderness. Uterosacral nodules indicative of deep invasive endometriosis are rare adolescents (6,18). If there is concern about obstruction, a moistened cotton swab can be gently inserted into the vagina (19).…”

Section: Physical Examinationmentioning

confidence: 99%

Dysmenorrhea, Endometriosis and Chronic Pelvic Pain in Adolescents

Sachedina¹,

Todd²

2020

Jcrpe

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Most adolescents will experience discomfort during menstruation. Due to normalization of dysmenorrhea, there is delay to diagnosis and treatment. Non-steroidal anti-inflammatories are a first line treatment. Adolescents can safely be offered menstrual suppression with combined hormonal contraception, and progestin-only options. When the above are ineffective, gonadotropin releasing hormone agonists with add back treatment can be considered. Transabdominal ultrasound is indicated when first line treatments do not improve symptoms. Endometriosis should be considered in adolescents who experience ongoing pain despite medical treatment. If laparoscopy is performed and endometriosis visualized, it should be treated with either excision or ablation. Women with endometriosis should be counselled on menstrual suppression until fertility is desired. Management of chronic pain requires the involvement of a multidisciplinary team.

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“…They can be histologically inactive, macroscopically fibrotic and clinically no longer actively growing when diagnosed ( Koninckx et al, 2019a ). Without repetitive laparoscopies, it is not clear whether medical treatment or pregnancies prevent the progression of endometriosis lesions ( Koninckx et al, 2018 ; Knox et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

The severity and frequency distribution of endometriosis subtypes at different ages: a model to understand the natural history of endometriosis based on single centre/single surgeon data

Koninckx¹,

Ussia²,

Wattiez³

et al. 2021

Facts Views Vis ObGyn

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Background and Objective: to study the natural history of endometriosis. Materials and methods: the analysis of all women (n=2086) undergoing laparoscopy for pelvic pain and endometriosis between 1988 and 2011 at University Hospital Gasthuisberg. Main outcome measures: the severity of subtle, typical, cystic and deep endometriosis in adult women, with or without a pregnancy, as estimated by their pelvic area and their volume. Results: the number of women undergoing a laparoscopy increased up to 28 years of age and decreased thereafter. Between 24 and 44 years, the severity and relative frequencies of subtle, typical, cystic and deep lesions did not vary significantly. The number of women younger than 20 years was too small to ascertain the impression of less severe lesions. The severity of endometriosis lesions was not less in women with 1 or more previous pregnancies or with previous surgery. There was no bias over time since the type and severity of endometriosis lesions remained constant between 1988 and 2011. Conclusions: severity of endometriosis does not increase between 24 and 44 years of age, suggesting that growth is limited by intrinsic or extrinsic factors. Severity was not lower in women with a previous pregnancy. What is new: considering the time needed for lesions to become symptomatic together with the diagnostic delay, the decreasing number of laparoscopies after age 28 is compatible with a progressively declining risk of initiating endometriosis lesions after menarche, the remaining women being progessively less susceptible.

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A longitudinal study of adolescent dysmenorrhoea into adulthood

Cited by 31 publications

References 48 publications

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Dysmenorrhea, Endometriosis and Chronic Pelvic Pain in Adolescents

The severity and frequency distribution of endometriosis subtypes at different ages: a model to understand the natural history of endometriosis based on single centre/single surgeon data

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