Definition and Criteria for Diagnosing Primary Dysmenorrhea: A Modified Delphi Procedure

Area of Science:

• Gynecology
• Adolescent Medicine
• Pain Management

Background:

• Primary dysmenorrhea significantly impacts quality of life for many individuals.
• Lack of standardized diagnostic criteria has historically led to diagnostic challenges and delays.

Purpose of the Study:

• To establish a globally recognized, standardized definition and diagnostic criteria for primary dysmenorrhea.
• To improve consistency in the diagnosis and management of primary dysmenorrhea.

Main Methods:

• A modified Delphi procedure involving 20 international experts in pediatric and adolescent gynecology.
• Three rounds of consensus-building with a predefined agreement rate of 70% or higher.

Main Results:

• Primary dysmenorrhea is defined as dysmenorrhea without pelvic pathology; onset can be before or during menstruation, not necessarily at menarche.
• Diagnosis requires excluding conditions like endometriosis, PID, and STIs; pelvic exams are not mandatory.
• Ultrasound is the preferred initial imaging, with MRI for inconclusive cases; no minimum duration is required, but severity assessment (VMSS grade ≥2) is key.

Conclusions:

• Consensus was achieved on a clear definition and diagnostic criteria for primary dysmenorrhea.
• These standardized criteria will aid in more accurate and consistent diagnosis and management.