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.