INTRODUCTION
Dysmenorrhea is the most common gynecological complaint linked to
menstruation in young adult women and adolescents. It can either be
primary (also known as functional) in the absence of pelvic pathology,
or secondary if the pain is attributable to a pelvic pathology such as
endometriosis. Primary dysmenorrhea is defined as cyclical pelvic pain
that precedes and/or occurs during menstruation in the absence of an
underlying organic pathology. It often begins in adolescence, usually
within 6 months to 2 years after menarche, when the menstrual cycles
become ovulatory (1,2). It is characterized by lower abdominal or lower
back cramping pain, which may radiate to the inguinal region or the
legs. Symptoms typically begin with the menstrual flow, or the day
before, last for 2 to 3 days reaching their peak with the maximum
menstrual flow, and are more or less similar from one cycle to another.
Many adolescents suffering from dysmenorrhea also suffer from other
menstruation-associated symptoms like headaches, nausea, vomiting,
motility disorders, asthenia, irritability, and myalgia (1,3). The
pathophysiological mechanisms of dysmenorrhea are well known (4,5):
overproduction of uterotonic and vasoconstrictor agents and an increased
level of circulatory and menstrual rates of PGF2 induce myometrium
ischemia, a perception of cramping pain and systemic symptoms (6,7).
Despite being one of the leading causes of recurrent short-term school
or work absenteeism among female adolescents (1), data about
dysmenorrhea is scarce and contradictory. The reported prevalence of
dysmenorrhea in the literature varies considerably from an estimated
21% in the latest 1984 French study (6) to as high as 94% in a study
conducted in Oman (8). Similarly, the prevalence of severe dysmenorrhea
also varies ranging from 12.4 % in 2002 in Switzerland (9) to 42 % in
1998 in the United States (10). Furthermore, despite the availability of
effective, easy-to-use and accessible therapeutic methods (4), many
girls do not seek medical advice for dysmenorrhea and few use
pharmacological treatment (6,11). Overall, given its prevalence and
impact on quality of life, dysmenorrhea should be both better documented
and managed (7,11).
The main objective of the present study was to determine the prevalence
of dysmenorrhea within adolescent girls in France today. The secondary
objectives were to define the prevalence of severe dysmenorrhea and
identify its risk factors, to assess how girls with dysmenorrhea
experience their menses, the consequences on daily living activities or
at school, physical, psychological and social repercussions, how they
manage their pain and what their expectations are.