Mains findings
The prevalence of dysmenorrhea in our study of 953 French girls aged 15
to 19 years was high at 92.9%. Their dysmenorrhea was moderate for
65.2% and severe for 8.9%. Our findings also show that dysmenorrhea
has a strong impact on daily life, as 43.3% of the girls reported
school absences, 74.9% difficulties in attending classes and 77.2%
difficulties in sports activities.
This high prevalence of dysmenorrhea is in accordance with Parker et al.
who found a prevalence of 93% in a sample of 1,055 girls aged 15 to 19
years old in Australia in 2010 (15). However, reported prevalence of
dysmenorrhea in the literature ranges from an estimated 56 % in 2012 in
Italy (14), 86.6 % in 2012 in Switzerland (9), 94 % in 2011 in
Oman (8), and at 21 % out of 4,203 adolescent girls in the latest
French prevalence study published in 1984 (6). This wide variation is
attributed to different factors, mainly methodological: different
definitions of dysmenorrhea, different study populations with
non-representative samples, a lack of standard methods for assessing the
severity of dysmenorrhea; and sociocultural factors which may have an
impact in the perception of this subjective symptom. The present study
showed independent risk factors of severe dysmenorrhea – a low BMI,
young age at menarche, heavy periods, inter-menstrual pain and the use
of contraception – which have also been identified in previous
publications (4,5,16,17). Similarly, previous studies have also found
that dysmenorrhea has academic, social and professional consequences and
is responsible for limitations in daily life activities, sleep
disorders, concentration difficulties, reduced intellectual capacity,
loss of self-confidence and social withdrawal (15,18).
Our study also highlights ineffective use of drugs by adolescents with
dysmenorrhea: waiting for too long before intake (when the pain was
severe) to be effective; not taking a second dose when the first failed
to relieve the pain; and not changing the drug class if the first one
was ineffective. In our population, nearly 60% of the girls were
self-medicating. Overall, 91% had already taken a pharmacological
treatment, mainly acetaminophen and antispasmodics, and half had taken
an NSAID. This erratic self-medication behavior reflects a lack of
knowledge of therapeutic solutions. Numerous studies have shown that
NSAIDs alone have an efficacy of 70 - 100% to relieve dysmenorrhea
(9,19,20). In our study, although a large majority of the girls asked
their parents for advice, almost half of them had never consulted a
doctor for their dysmenorrhea, illustrating reticence as has previously
been shown (6,9,10,15,21,22). Among those who did consult a doctor,
almost 80% only did so after being advised by someone close to them and
not on their own initiative. Despite this, more than 80% expressed a
real desire for information about dysmenorrhea, and more than 60% would
have liked the subject to be brought up spontaneously by their doctor.
General practitioners are often the first doctors seen and play a
crucial role in the detection and management of dysmenorrhea. Therefore,
it is essential for them to be more aware and better trained to screen
their adolescent girl patients for cycle disorders (5), and not to
misdiagnose secondary dysmenorrhea (23).
Furthermore, among the obstacles to medical consultation, adolescents
reported believing that dysmenorrhea was a normal part of the menstrual
cycle and that there was no effective solution. Suffering from menstrual
pain seems to be accepted as ”normal” in our society as reflected in
literature reporting studies from around the world (6,7,9,22). However,
given the simple and effective therapies available, this currently held
belief deserves to be challenged. Beyond the monthly pain experienced by
girls individually on a collective scale, it is difficult to accept the
consequent negative socio-professional impact in our society in this day
and age, when parity constitutes a major challenge worldwide.
Accordingly, public health measures should be implemented to provide
information and health education in order to improve the management of
dysmenorrhea. Adolescent girls should be better informed through the
media, large-scale information campaigns, and collective actions in
schools carried out by school nurses. It has recently been shown that a
brief information campaign targeting adolescent girls providing simple
self-medication advice significantly reduces the prevalence and severity
of dysmenorrhea, with a benefit on quality of life (24).