A 17-year-old sexually active female with moderate to severe dull lower abdominal pain associated with periods but also occurring at other times; pregnancy test negative. Which course of action is most important?

A 17-year-old sexually active female with moderate to severe dull lower abdominal pain associated with periods but also occurring at other times; pregnancy test negative. Which course of action is most important?

• A. Perform a full diagnostic workup to evaluate potential causes.
• B. Prescribe a prostaglandin synthetase inhibitor.
• C. Start a 3- to 6-month trial of oral contraceptive pills.
• D. Suggest using transcutaneous electrical nerve stimulation.

Answer: (A)

Pelvic or lower abdominal pain in a sexually active adolescent that occurs beyond menses demands a full diagnostic evaluation to identify potential organic causes. A negative pregnancy test reduces the likelihood of ectopic pregnancy but does not rule out conditions such as pelvic inflammatory disease, endometriosis, ovarian cysts or torsion, appendicitis, urinary or gastrointestinal issues. The most important step is to take a careful history and perform a thorough physical exam, including a pelvic examination when appropriate, along with targeted testing (urinalysis, STI screening, CBC or inflammatory markers) and imaging such as a transvaginal ultrasound to assess the uterus, ovaries, and surrounding structures. Only after this evaluation can therapy be tailored; while NSAIDs or hormonal therapy can help with symptoms, they do not substitute for diagnosing underlying causes and could delay appropriate care.

Pelvic or lower abdominal pain in a sexually active adolescent that occurs beyond menses demands a full diagnostic evaluation to identify potential organic causes. A negative pregnancy test reduces the likelihood of ectopic pregnancy but does not rule out conditions such as pelvic inflammatory disease, endometriosis, ovarian cysts or torsion, appendicitis, urinary or gastrointestinal issues. The most important step is to take a careful history and perform a thorough physical exam, including a pelvic examination when appropriate, along with targeted testing (urinalysis, STI screening, CBC or inflammatory markers) and imaging such as a transvaginal ultrasound to assess the uterus, ovaries, and surrounding structures. Only after this evaluation can therapy be tailored; while NSAIDs or hormonal therapy can help with symptoms, they do not substitute for diagnosing underlying causes and could delay appropriate care.