**6. Ovulatory cycles**

They are related to disorders or inadequacy of local hemostasis mechanisms and decreased spiral arteriolar density. Endometrial histology varies from productive and secretory to menstrual, and the changes are not different from the corresponding premenstrual women with normal cycles. There is an increased blood flow to the endometrium whereas the levels of circulating ovarian steroids are normal. The endometrial prostaglandin production is increased with a priority to vasodilator PGF2a and angiopathic PGE2 types. Prolonged vasodilation leads to decreased platelet aggregation and increased overexpression of potential parathyroid-related vasodilatory protein. High proteolytic activity of lysosomal enzymes in the endometrium as well as fibrinolysis through increased local secretion of agents with heparin analog activity. The mechanism that triggers all these disorders is present unknown [9, 35].

**9. Explanatory theories**

dysmenorrhea [38, 39].

history.

**9.1. Psychological factors**

**9.2. Clinical features of dysmenorrhea**

**9.3. Treatment of dysmenorrhea**

PGs is maintained.

**9.4. Pelvic pain**

Theory of Hippocrates: Cervical lumen stenosis and the induced posture of stomach blood are responsible for the occurrence of dysmenorrhea. Myometric factor: increased myometrial activity and increased endometrial pressure. Neuromic factors: changing neuromuscular activity in the uterus after pregnancy may explain the reduction in menstruation pain after childbirth.

Causes of Visiting Teenagers in the Pediatric and Adolescence Examining Room

http://dx.doi.org/10.5772/intechopen.72979

195

Increased levels of PGF2a and PGE2 and increased PGF2a/PGE2 ratio are observed in adolescents with PD. Also increased levels of LTC4, LTD4, and LTE4 angiotensins, stimulation of myometrial contractility, and increase in plasma hormone concentrations in women with

Subjectivity and fluctuation of the pain, dysmenorrhoea very often presented in family

Subabdominal pain, nausea, vomiting, diarrhea, irritability, headache, flatulence payment of

PGs synthetase inhibitors, non-steroidal anti-inflammatory agents act by lowering levels of PGs by reducing levels of PGs, tolfenamic acid, naproxen, and mefenamic acid. The release of PGs into the menstruation blood is maximal in the first 48–72 hours of EGFR. Contraceptive pills reduce the amount of menstruation blood, through the controlled increase of the thickness of endometrial tissue. By inhibiting of ovulation, an endocrine environment with low levels of

Other therapeutic proposals are spasmolytics, analgesics, calcium inhibitors, progesterone, magnesium, GnRH analogues, leukotriene antagonists, cervical curettage, acupuncture, elec-

Primary care of the gynecologist specialized in child and adolescent gynecology is the investigation of women with chronic pelvic pain. The rate of disease varies among teenagers between rarity and 19–47% [41, 42]. Typical forms of chronic pelvic pain are relatively common and non-recognition may underestimate their incidence. Mostly have primary secondary dyspnea and dysmenorrheal. In girls, the gynecological examination is not feasible and the rectal examination provides little information. The ultrasound provides information on a

tricity stimulation, and psychotherapeutic methods [39, 40].

forces, depression, and inability to concentrate are clinical features of dysmenorrhea.

• Hormonal effect: women with anorexic cycles do not show painful menstruation. • Prostaglandins: high levels of PGs are currently the most accepted causal theory

#### **6.1. Diagnostic approach**

History, gynecological examination, laboratory test such as blood generation, coagulation factors, βhCG, ultrasound through genital organs, parthenoscopy, magnetic resonance, and laparoscopy.

#### **6.2. Treatment**

Adolescent medium degree functional disorders of uterus: Hb > 9gr cyclic providing of progesterones, contraceptive pills, and iron preparations. In cases of Hb < 9gr, intravenous hydration, blood transfusion, high dosage of contraceptive pills per os, potential intravenous providing available estrogens continuing usage of contraceptive pills, and iron preparations.

Activity of the estrogen-progesterinoides agents in haemostasis led to: increasing of TXA2, platelet agglutination, prothrombin, Factors VIII and X, reduction of fibronolysis, PGI<sup>2</sup> in endometrium.
