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    Managing dysmenorrhea

    For women in their late teens and early 20s, dysmenorrhea represents the single greatest cause of time lost from work or school. The incidence of dysmenorrhea in this group may be as high as 70%, with up to half of women experiencing loss of ability to perform daily activities.1 The true overall incidence of dysmenorrhea is difficult to estimate, but most authors feel that between 50% and 90% of women will suffer disability (ie, interruption of normal activity or function) at least once during their reproductive years.

    The magnitude of this problem can be appreciated considering that there are more than 40 million women of reproductive age in the United States.

    This article looks at current evidence for established strategies for treating primary and secondary dysmenorrhea, ranging from nonsteroidal anti-inflammatory drugs (NSAIDs) to transcutaneous electrical nerve stimulation (TENS), and also reviews a new medical therapy on the horizon.

    Treatment strategies

    Successful treatment of primary dysmenorrhea is predicated on a correct initial diagnosis and understanding of the underlying pathophysiology. When secondary dysmenorrhea is identified, the best therapeutic approach is one directed toward the clinically identified pathology.

    Only when the definitive therapy is not practical or available (eg, multiple fibroids in a patient wishing to avoid hysterectomy or impaired fertility) are analgesics or modifications of the menstrual cycle indicated. These latter interventions are often adequate but they are frequently less than completely successful.

    See also: IUDs and dysmenorrhea

     

    Roger P. Smith, MD
    Dr. Smith is the Robert A. Munsick Professor of Clinical Obstetrics & Gynecology, Vice Chair for Faculty Development, and Director, ...

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