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N° 345-Directive clinique de consensus sur la dysménorrhée primaire

      Résumé

      Objectif

      Analyser l’évaluation et le traitement de la dysménorrhée primaire.

      Utilisateurs cibles

      Fournisseurs de soins de santé.

      Population cible

      Les femmes et les adolescentes aux prises avec des douleurs menstruelles de cause inconnue.

      Données

      Essais cliniques publiés, études sur la population et articles de synthèse cités dans PubMed et dans la base de données Cochrane entre janvier 2005 et mars 2016.

      Méthodes de validation

      Les auteurs ont défini sept questions cliniques, qui ont été évaluées par le comité de pratique clinique – gynécologie de la SOGC. La littérature publiée a été étudiée. La directive clinique no 169 a été revue et retravaillée pour intégrer les données probantes actuelles. Les recommandations portant sur les sept questions cliniques ont été formulées et évaluées au moyen des critères décrits par le Groupe d’étude canadien sur les soins de santé préventifs.

      Avantages, désavantages et coûts

      La dysménorrhée primaire est un trouble fréquent, souvent insuffisamment traité. Des traitements efficaces sont largement accessibles et peu coûteux. Le traitement offre la possibilité d’améliorer la qualité de vie des patientes et de réduire la perte de temps de travail ou d’études.

      Mise à jour de directives cliniques

      La présente directive clinique est une révision et une mise à jour de la directive no 169, publiée en décembre 2005.

      Commanditaire

      SOGC.

      Déclarations sommaires

      • 1.
        La dysménorrhée a une prévalence élevée et est souvent insuffisamment traitée (III).
      • 2.
        Les anti-inflammatoires non stéroïdiens sont plus efficaces que les placebos, mais ils entraînent plus d’effets secondaires gastro-intestinaux. Les anti-inflammatoires non stéroïdiens actuellement en vente ont sensiblement tous le même profil d’innocuité et d’efficacité (I).
      • 3.
        L’inhibition de l’ovulation est associée à une diminution de la douleur menstruelle (II-1).
      • 4.
        L’aménorrhée, peu importe la façon dont elle est induite, est bénéfique dans le traitement de la dysménorrhée (II-2).
      • 5.
        L’hystérectomie est un traitement efficace (II-2).
      • 6.
        Des données probantes appuient la neurectomie par laparoscopie dans certains cas (II-1).
      • 7.
        L’ablation de l’endomètre peut atténuer les symptômes de dysménorrhée associés à la présence de ménorragie (I).

      Recommandations

      • 1.
        Les dysménorrhées primaire et secondaire peuvent toutes deux répondre au même traitement médical. Il n’est donc pas néces-saire d’établir un diagnostic précis avant d’entreprendre un traitement (II-1A).
      • 2.
        Les fournisseurs de soins de santé devraient poser des questions précises sur la douleur menstruelle au moment de la prise des antécédents médicaux de leurs patientes (III-B).
      • 3.
        L’examen pelvien n’est pas nécessaire avant d’entreprendre un traitement (III-D).
      • 4.
        L’examen pelvien est indiqué chez toutes les patientes qui ne répondent pas au traitement conventionnel de la dysménorrhée et chez celles où la présence d’une pathologie organique est soupçonnée (III-B).
      • 5.
        L’administration d’anti-inflammatoires non stéroïdiens de façon régulière devrait être envisagée comme traitement de première intention chez la plupart des femmes (I-A).
      • 6.
        À moins de contre-indications, l’hormonothérapie devrait être offerte aux femmes et aux adolescentes qui ne cherchent pas actuellement à tomber enceintes (I-A).
      • 7.
        L’administration continue ou prolongée de contraceptifs hormonaux combinés est recommandée (I-A).
      • 8.
        La pratique régulière d’exercices physiques peut atténuer les symptômes de dysménorrhée; c’est pourquoi elle devrait être recommandée (II-1A).
      • 9.
        L’application locale de chaleur par des timbres ou des coussins chauffants devrait être recommandée comme traitement complémentaire de la dysménorrhée (I-A).
      • 10.
        La neurostimulation transcutanée à haute fréquence devrait être envisagée comme traitement complémentaire chez les femmes qui ne tolèrent pas le traitement conventionnel ou qui ne désirent pas y avoir recours (II-1B).
      • 11.
        La stimulation de points d’acupuncture devrait être envisagée chez les femmes désirant avoir recours à des traitements complémentaires ou non conventionnels (II-1B).
      • 12.
        La consommation de gingembre est recommandée chez les femmes désirant avoir recours à des traitements complémentaires ou non conventionnels (I-A).
      • 13.
        Toute évaluation préopératoire devrait comprendre des antécédents médicaux détaillés, un examen physique approfondi, une échographie et possiblement une imagerie par résonance magnétique pour déterminer les causes secondaires de la dysménorrhée et orienter l’approche de traitement (III-A).
      • 14.
        La chirurgie ne devrait être envisagée que si la combinaison des autres thérapies n’a pas été fructueuse (III-A).

      Mots clés

      Sigles:

      AINS (anti-inflammatoire non stéroïdien), ALNU (ablation laparoscopique du nerf utéro-sacré), CANPAGO (Comité canadien d’obstétrique-gynécologie pédiatrique et de l’adolescence), CHC (contraception hormonale combinée), COC (contraceptif oral combiné), NPS (neurectomie présacrée), SIU-LNG (système intra-utérin au lévonorgestrel), TENS (Neurostimulation électrique transcutanée), TENS-hf (neurostimulation transcutanée à haute fréquence)
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