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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Differential diagnosis of dysmenorrhea in an adolescent

Differential diagnosis of dysmenorrhea in an adolescent
  Key clinical features
Gynecologic (secondary dysmenorrhea)
Endometriosis Endometriosis often presents with menstrual pain that progressively worsens over time. The pain may be cyclic (menses-related) or noncyclic.
Adenomyosis Heavy periods.
Ovarian cysts Depending on the size, ovarian cysts may cause pelvic pain, constipation, and/or urgency.
Intrauterine or pelvic adhesions Associated with a history of PID.
Silent PID History consistent with undiagnosed and untreated PID, which can lead to scarring and adhesions, causing chronic pain.
Congenital anatomic abnormalities
  • Imperforate/incomplete hymenal fenestration
  • Cervical stenosis
  • Other congenital obstructive müllerian malformations
Congenital malformations that obstruct menstrual flow tend to cause cyclic pain that commences at menarche. This pattern of pain is unlikely to be primary dysmenorrhea because most females are anovulatory for several months to several years after menarche.
Use of an IUD For the first 6 months after IUD placement, can have cramping with bleeding. Check for strings to exclude the possibility that the IUD has been expelled.
Nongynecologic
Inflammatory bowel disease History of bloody diarrhea or watery stools, often with attenuated growth, weight loss, or fever.
Irritable bowel syndrome History of intermittent abdominal pain with constipation and diarrhea; weight loss is unusual.
Psychogenic disorders Pelvic pain with a normal examination and negative review of systems, especially if the pain is associated with mood symptoms and psychosocial stressors.
PID: pelvic inflammatory disease; IUD: intrauterine contraceptive device.
Graphic 112838 Version 3.0

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