Evaluation of ovulation frequency in adolescents with and without primary dysmenorrhea

Primary dysmenorrhea (PD) is the most common gynecological problem that often starts in the adolescent age group. In the pathogenesis, the critical effect of corpus luteum induced progesterone on endometrial tissue is the most plausible mechanism. Few studies have reported that there are anovulatory cycles in PD and a more complex mechanism other than ovulation may be effective in its pathogenesis. Besides, studies that are considered as the reference for serum progesterone threshold determining ovulation in the literature are old and few, and especially in adolescents, these values should be determined with new studies. In our study; it was aimed to evaluate the presence of ovulation in adolescent girls with and without PD using serum progesterone levels and suprapubic pelvic ultrasound follicle size and to determine the menstrual characteristics of the individuals and the serum progesterone threshold value as an ovulation marker in adolescents. 'Numerical rating scale' (NRS) was used for PD pain severity, and the adolescents with a NRS score of 4 or above (moderate-pain severity PD) constituted the PD group and the adolescents with a NRS score below 4 constituted the control group. Participants were invited to the outpatient clinic for a total of 3 visits in 1 cycle; the tests of suprapubic pelvic ultrasound (for follicle evaluation) at visit 1 (12-18th day of menstruation), first serum progesterone level at visit 2 (21-24th day of menstruation), second serum progesterone level at visit 3 (28-31st day of menstruation) were evaluated. The average age of the PD group (n = 41) was 15.9 ± 1.3 years, and the average age of the control group (n = 36) was 15.4 ± 1.5 years. The participants were invited to the outpatient clinic for a total of 3 visits in 1 cycle; the visualization of suprapubic pelvic ultrasound (for follicle evaluation) at visit 1 (12-18th day of menstruation), the tests of first serum progesterone level at visit 2 (21-24th day of menstruation), second serum progesterone level at visit 3 (28-31st day of menstruation) was performed. Among the groups; anthropometric findings, menstrual history, and dysmenorrhea in the family were similar, while the NRS score was statistically significantly higher in the PD group (p<0,001). Anovulatory cycle rates according to 2 different serum progesterone threshold values (3 and 5 ng / ml) stated in the literature were; 31.7%, 44.4% in the PD group and 36.6%, 55.6% in the control group respectively, and there were no statistically significant differences between the groups. There were no significant differences between the NRS scores in the ovulatory and anovulatory cycles in the PD group. Anovulatory cycle rates in the first two years, first five years and after the fifth year of the menstrual cycles were determined 69.2%, 43.8%, 7.7% respectively, according to 3 ng / ml cut-off; and 76.9%, 51.6%, 15.4% according to 5 ng/ml cut-off. Additional symptoms that accompany menstrual pain were back pain, weakness, and irritability. In the group with threshold serum progesterone value ≥ 5 ng / ml, the NRS score was significantly higher in the group with ovulation than the non-ovulation group, and the NRS score was statistically significant in terms of diagnostic value. When the distribution percentages of serum progesterone levels were evaluated, the median value was 5.5 ng/mL. In conclusion; it has been shown that anovulatory cycles are seen with PD and the severity of pain is similar in these cycles as in ovulatory cycles. When presence of ovulation were evaluated with serum progesterone levels and follicle sizes on suprapubic ultrasound, it was found that serum progesterone level 5 ng/ml or above has the highest diagnostic value.