French Linda
Department of Family Medicine, University of Toledo, College of Medicine, Toledo, Ohio 43614, USA.
Paediatr Drugs. 2008;10(1):1-7. doi: 10.2165/00148581-200810010-00001.
Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1-3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.
痛经在大多数青春期女孩中都会出现，是该群体反复短期缺课的主要原因。在绝大多数情况下，根据典型的病史，即下腹部前位疼痛与月经初潮同时出现且持续1 - 3天，体格检查阴性，可作出原发性痛经的初步诊断。原发性痛经的危险因素包括未生育、月经量过多和吸烟。心理健康状况差和社会支持不足也是相关因素。原发性痛经无需诊断性检查即可开始经验性治疗。有效的治疗方法包括非甾体抗炎药、口服避孕药以及对月经周期的药物抑制。在非典型、严重或难治性病例中，应进行影像学检查和/或腹腔镜检查以调查痛经的继发性原因。继发性痛经最常见的原因是子宫内膜异位症其治疗可能包括药物和手术方法。患有与子宫内膜异位症相关疼痛的年轻女性的药物治疗与原发性痛经的治疗相似，但在严重难治性病例中可能偶尔会使用促性腺激素释放激素激动剂。
