Menstrual Cycle Pain Is Independent of Ovulation in Adolescents With Primary Dysmenorrhea

Study Objective: This study aimed to evaluate the presence of anovulation in adolescents with primary dysmenorrhea (PD). Design: Prospective cohort study. Setting: Hacettepe University Children's Hospital, Adolescent Medicine outpatient clinic between September 2018 and September 2019. Participants: Healthy female adolescents (between 11 and 18 years of age), with regular menstruation with a score of 1-3 according to the Numerical Rating Scale (NRS) and grade 0 (no limitation for daily activities, no analgesic need and systemic symptoms) according to the Verbal Multidimensional Scoring System (VBSS) were recruited as a control group. The participants who met the diagnostic criteria for PD with an NRS score >= 4, had analgesic need in at least the last 3 menstrual cycles, had defined moderate-to-severe PD according to VMSS (Grade 2-3), and had analgesic need every time were accepted as the PD group. Intervention and Main Outcome Measures: For the determination of ovulation, suprapubic pelvic ultrasound and luteal SP levels were used. The first day of menstruation (DOM) was accepted as the first day of the menstrual cycle. The participants were called to the outpatient clinic for a total of 3 visits during 1 cycle; the first visit was for the suprapubic pelvic ultrasound imaging on the 12th-18th DOM, the second visit was for the first SP level measurement on the 21st-24th DOM, and the third visit was for the second SP level measurement on the 28th-31st DOM, if the next expected menstruation has not started yet. Participants' anthropometric measurements, menstrual history, family history of dysmenorrhea, and additional symptoms accompanying pain were recorded. Results: Anovulatory cycle rates according to 2 different references for SP threshold values (3 and 5 ng/mL) were 31.7% and 36.6% in the PD group, and 44.4% and 55.6% in the control group, respectively (P=.250, P=.095). In the PD group, NRS scores were similar for the ovulatory and anovulatory cycles for both SP threshold values (P=.320, P= .205). When the reference value for SP threshold was accepted as >= 5 ng/mL, the NRS score was significantly higher in the ovulatory group (P=.0017). When the distribution percentages of SP levels were evaluated among all participants, the median value was 5.5 ng/mL. Conclusion: Contrary to classical information, anovulatory cycles are not rare in PD patients, and pain severity is at the same level in these cycles. The pathogenesis of PD in adolescents requires further study.