How should I approach the management of dysmenorrhoea in adolescents compared to adult patients?

Management of dysmenorrhoea in adolescents and adults follows similar principles but requires age-appropriate considerations.

For both adolescents and adults with primary dysmenorrhoea (menstrual pain without underlying pelvic pathology), first-line treatment is a nonsteroidal anti-inflammatory drug (NSAID) unless contraindicated. Paracetamol can be offered if NSAIDs are not tolerated or insufficient alone. If the patient does not wish to conceive, a 3–6 month trial of hormonal contraception, typically a combined oral contraceptive (COC) containing 30–35 micrograms of ethinylestradiol, is recommended as an alternative or adjunct treatment.

In adolescents, particular attention should be given to using age-appropriate pain assessment and management strategies, including non-pharmacological measures such as local heat application and transcutaneous electrical nerve stimulation (TENS), alongside pharmacological treatments.

For adolescents, it is important to consider developmental stage and communication ability when assessing pain and to involve parents or carers as appropriate. A stepwise analgesic approach starting with paracetamol or ibuprofen is advised, escalating as needed based on pain severity.

In both groups, if symptoms are severe, persistent beyond 3–6 months, or if secondary causes are suspected (e.g., endometriosis, pelvic inflammatory disease), referral to a gynaecologist is indicated.

Secondary dysmenorrhoea management depends on the underlying cause and is similar in adolescents and adults, but clinicians should be vigilant for red flags such as abnormal bleeding, pelvic masses, or signs suggestive of malignancy, warranting urgent referral.

Overall, while the pharmacological treatments are largely the same, management in adolescents requires a more tailored approach to pain assessment, communication, and support, with careful monitoring and involvement of family as appropriate.

Patient information and support resources should be provided to all ages to aid understanding and self-management.

Summary:

• NSAIDs first-line for primary dysmenorrhoea in both adolescents and adults.
• Paracetamol as alternative or adjunct.
• Hormonal contraception (COCs or progestogen-only methods) offered if contraception desired or pain persists.
• Non-pharmacological measures (heat, TENS) recommended adjuncts.
• Age-appropriate pain assessment and involvement of carers important in adolescents.
• Referral to specialist if severe, persistent, or secondary causes suspected.

These recommendations are based on expert opinion and evidence synthesized in UK guidelines and clinical knowledge summaries ¹,²,³.