Approach to dysmenorrhea Quiz: Ace Your Exams
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A previously healthy 13-year-old adolescent girl presents to urgent care with her parent due to menstrual pain that began yesterday and is currently rated as a 9 on a 10-point scale. The pain is crampy and radiates to the pelvis, lower back, and upper thighs. She reports a severe headache and nausea since waking up. Her first menstrual period was 9 months ago. Initially, her periods were irregular, light, and associated with minimal pain. However, as her cycles have become more regular, the menstrual pain has intensified. Cycles now come every 30 to 35 days, and she has severe cramping that typically begins the day before menses and lasts for 3 days. The patient is not sexually active. Her mother experienced similar symptoms when she was a teenager. Vital signs are normal, and the girl’s body mass index is 18 kg/m2. She appears uncomfortable and is curled in the fetal position on the exam table. There is no distention, rebound tenderness, or guarding on abdominal exam. The patient consents to a urine pregnancy test, which is negative. Which of the following is the most appropriate next step in management?
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