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).