Ambulatory office visits and chronic pain comorbidities associated with dysmenorrhea

Dysmenorrhea affects more than 25% of adult women and up to 90% of adolescent girls, and is the leading cause of lost work hours and school absences among females. Research suggests that under-managed dysmenorrhea may exacerbate or increase the risk for subsequent chronic pain conditions (e.g., fibromyalgia and irritable bowel syndrome). Anecdotal reports suggest that only a small number of women with dysmenorrhea seek formal medical care. Little is known about outpatient service utilization related to dysmenorrhea and the prevalence of comorbid chronic pain. The purposes of this study were to describe prevalence of dysmenorrhea-related ambulatory care visits and services rendered in a large representative national sample, and to describe chronic pain comorbidities in this sample. An analysis was performed using the 2006-2010 datasets of the National Ambulatory Medical Care Surveys (NAMCS). The annual prevalence of ambulatory care visits for which dysmenorrhea was cited as a reason for seeking care ranged from .03% to.09%. Forty visits identified dysmenorrhea as the primary reason for the visit. Among those, medications were the most common treatment ordered (n=28, 70%), including analgesics (n=18, 45%), hormonal contraceptives (n=6, 15%), and nutritional supplements (n=3, 8%). Health education was ordered in 19 (48%) visits. No complementary alternative medicine was ordered. Among 232 visits citing a diagnosis of dysmenorrhea, 61 (26%) also reported comorbid pain conditions. To our knowledge, this is the first study that offers information on ambulatory care utilization in women with dysmenorrhea using a national sample. Findings suggest that women with dysmenorrhea may be under-diagnosed and under-managed. Comorbid pain conditions are prevalent among outpatient care seekers with dysmenorrhea. Future research is needed to better understand women’s care-seeking for dysmenorrhea and the risks, mechanisms, and prevention of subsequent chronic pain conditions in this population.