Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1-3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.

译文

:痛经多发生在大多数青春期女孩中,并且是该组中经常性短期缺勤的主要原因。在大多数情况下,可以根据典型的低位前盆腔痛史与月经来潮并持续1-3天(体格检查阴性)做出原发性痛经的推测性诊断。原发性痛经的危险因素包括产后不孕,月经量大和吸烟。不良的心理健康和社会支持是其他协会。无需诊断测试即可开始针对原发性痛经的经验性治疗。有效的疗法包括NSAID,口服避孕药和抑制月经周期的药物。在非典型,严重或难治性病例中,应进行成像和/或腹腔镜检查以调查痛经的继发原因。继发性痛经的最常见原因是子宫内膜异位症,其治疗可能包括医学和手术方法。患有子宫内膜异位症相关疼痛的年轻女性的药物治疗与原发性痛经的治疗相似,但在严重的难治性病例中可能很少使用促性腺激素释放激素激动剂。

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