Warren Alpert Medical School of Brown University, Department of Pediatrics, Division of Adolescent Medicine/Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI 02903, USA.
Expert Opin Pharmacother. 2012 Oct;13(15):2157-70. doi: 10.1517/14656566.2012.725045.
Dysmenorrhea is the most common gynecologic complaint among adolescents/young adults. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Adolescents/young adults with severe dysmenorrhea symptoms may have pelvic abnormalities, such as endometriosis or uterine anomalies (secondary dysmenorrhea).
This review provides an update on treatments and management strategies of dysmenorrhea in adolescents/young adults. Medical literature articles were retrieved using a Medline search on primary and secondary dysmenorrhea. Original articles from peer-reviewed journals were selected based on relevance.
Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the preferred initial treatment for dysmenorrhea in nonsexually active adolescents/young adults. Adolescents/young adults with symptoms that do not respond to NSAIDs for three menstrual periods should be offered hormonal treatment, such as combined estrogen and progestin oral contraceptive pills (OCPs), for three menstrual cycles. If dysmenorrhea does not improve within 6 months of NSAIDs and OCPs, a laparoscopy is indicated to look for endometriosis, which is the most common reason for secondary dysmenorrhea.
痛经是青少年/年轻女性最常见的妇科主诉。痛经通常为原发性，与正常排卵周期相关，无盆腔病变。强效前列腺素和强效白三烯在产生原发性痛经症状方面发挥重要作用。痛经症状严重的青少年/年轻女性可能存在盆腔异常，如子宫内膜异位症或子宫畸形（继发性痛经）。
本文就青少年/年轻女性痛经的治疗和管理策略提供了最新信息。通过对原发性和继发性痛经的 Medline 检索获取医学文献文章。根据相关性选择同行评审期刊的原始文章。
对于无性生活的青少年/年轻女性，非甾体类抗炎药（NSAIDs）治疗是痛经的首选初始治疗方法。对于使用 NSAIDs 治疗三个月经周期仍无缓解的患者，应给予激素治疗，如复方雌孕激素口服避孕药（OCP），治疗三个月经周期。如果使用 NSAIDs 和 OCP 治疗 6 个月后痛经仍未改善，则需要进行腹腔镜检查以寻找子宫内膜异位症，这是继发性痛经最常见的原因。
