The bulk of women, and this is more than 70% of the total, experiences some discomfort or pain during menstruation and for several days before their onset. In addition, there may be concomitant manifestations, which are expressed in increased irritability, sweating, sleep disorders. All these signs are associated with certain processes occurring in the body of a woman cyclically. They are directly interrelated with the course of the menstrual cycle and are called dysmenorrhea.
What is this pathology and how to deal with it? Answers to all questions related to dysmenorrhea, you can find in this article. It will help you cope with the unpleasant sensations that are associated with a complex and such a beautiful female organism, intended for the continuation of the genus.
The concept. Definition.
Dysmenorrhea is not a disease, but a state of the female body that develops on days that coincide with a woman’s menstrual cycle. Sometimes under this name other disorders of the menstrual cycle are combined (too abundant, irregular menstruation, etc.). Most often these conditions are experienced by young women and girls. In some cases there is even a loss of ability to work. That is, this condition has a significant impact on the quality of life during menstruation. Previously, to determine this condition, there was another term – algodismenorea. Since it reflected only one of the signs of this pathological condition – morbidity, and in fact is a consequence of deeper changes, later this term was replaced by the present one.
According to the modern point of view, dysmenorrhea is considered as a phenomenon of psychophysiological orientation, which develops in response to painful irritations.
The mechanism of dysmenorrhea development.
The mechanism of the emergence of dysmenorrhea is complex and not fully understood. To date, there are several different opinions that explain this phenomenon. The most common is the point of view that explains the development of dysmenorrhea by the connection with the secretion of prostaglandins. Scientists believe that the clinical picture of the syndrome develops due to the fact that in the premenstrual days the secretion of prostaglandins increases and accordingly their release into the uterus cavity, which continues during menstruation, increases. This leads to a rise in uterine activity, and its spastic contractions increase. As a result, ischemia of uterine tissues develops. As a consequence, the nerve endings are irritated, their sensitivity is increased. The end result of the chain of these changes is the increased perception of pain.
The main clinical symptom of dysmenorrhea is pain syndrome. The pain is characterized by the following criteria. it develops in the lower abdomen, often has an irradiation (spread) into the inguinal and sacral region, accompanied by aching sensations in the lumbar region. Most often this kind of pain is characteristic of secondary dysmenorrhea. With primary dysmenorrhea, the pain is paroxysmal, maximally expressed in the lower abdomen, almost always radiating to the lumbar region. With primary dysmenorrhea, pain occurs 1-2 days before the onset of menstruation, continues for another 1-2 days of menstruation, and the intensity of pain is unstable.
Common symptoms with dysmenorrhea are disorders of a psycho-emotional nature. Vegetative manifestations lead to a general disturbance of the patients’ well-being. Women experience mood lability, increased anxiety, can feel depressed and depressed. Some women with dysmenorrhea have motivational disorders: bulimia. anorexia. increased or decreased libido.
According to the frequency of manifestations of symptoms, the following pattern is revealed.
Vertigo develops in 85% of patients.
Diarrhea can occur in 60% of cases.
Pain in the back is noted by 60% of women.
Headache (sometimes as a migraine) is observed in 45% of women.
Epidemiology. Statistical data.
Dysmenorrhea according to various data is observed in approximately 31-52% of women. Approximately 1/3 of the patients are girls and women, from 1 to 3 years old, from the beginning of the first menstruation. Depending on the causes leading to the development of dysmenorrhea, the diseases that most often cause this pathology are isolated. Endometriosis in this case is taken up to 12% in the age group of 11-13 years and up to 54% in the group of patients 20-21 years.
Relatively recently, when studying dysmenorrhea, absolutely unexpected facts were revealed. As it turned out, there is a relationship between the working conditions of women and their social situation. An interesting feature was revealed – the more active life (including exercise, sport, etc.) the woman leads, the more often she becomes a patient belonging to the group suffering from dysmenorrhea. The role of the hereditary factor is traced in 30% of cases. Some scientists have established and another relationship – with frequent stresses and other adverse environmental factors, the percentage of women suffering from dysmenorrhea increases.
If we talk about the causes leading to the development of the syndrome, it is important to note that we should separately consider primary and secondary dysmenorrhea, since they are associated with various provoking factors.
This kind of dysmenorrhea is also called functional spasmodic. Among the causes that can cause primary dysmenorrhea, identify the main groups.
Mechanical. Associated with the difficulty of outflow of menstrual blood from the uterine cavity due to: cervical atresia, anomaly of the development of the uterus, an incorrect position of the uterus.
Endocrine. Associated with a violation of the synthesis of prostaglandins, which leads to spastic contractions of the uterus.
Constitutional. The pain syndrome develops on the background of infantilism, that is, it becomes a consequence of irritation of the nerve endings due to uterine hypoplasia, weak development of the muscular elements, which do not lend themselves to sufficient stretching with the accumulation of menstrual blood in the uterine cavity.
Neuropsychogenic. They are explained by the lability of the nervous system and the consequent decrease in threshold sensitivity.
This group is directly related to gynecological diseases: endometriosis, uterine myoma. malformations of genital organs and pelvic inflammatory disease. In some cases, secondary dysmenorrhea may be a consequence of the use of intrauterine forms of contraception. In these situations, usually during the removal of the intrauterine device, the course of menstruation becomes normal and the soreness is reduced or eliminated completely.
This syndrome is classified according to several criteria. Because of the onset of this pathology is divided into.
Primary – not associated with pathology or diseases of internal genital organs. In this case, it is considered as a violation of neurohumoral regulation at various levels.
Secondary – associated with malformations of internal genital organs, a violation of the function of the hormonal system or inflammatory diseases of the sexual sphere. In this case, dysmenorrhea is only one of many symptoms of the underlying disease.
Primary dysmenorrhea, in turn, is classified as follows.
Essential. The causes of this species are either unknown, or scientists are reduced to the view that they are in the low threshold of pain sensitivity. Another part of the scientists holds the view that essential dysmenorrhea is an individual feature of the female body.
Psychogenic. This kind of dysmenorrhea is directly related to the features of the functioning of the nervous system. The explanation of its occurrence consists in a feeling of fear and anxiety that precede the onset of menstruation. This form is more typical for girls in the puberty period, for which subconsciously the onset of menstruation is associated with the mandatory presence of pain. Psychogenic dysmenorrhoea is characteristic of individuals who develop on an hysteroid or sensitive type. It can also be observed in women with all kinds of psychopathological conditions or astheno-vegetative syndrome.
Spasmogenic. This type of dysmenorrhea is directly related to spasms of the smooth muscles of the uterus.
In addition, the speed of progression dysmenorrhea is divided into.
Compensated. Characterized by the fact that throughout all menstrual days from year to year the severity and nature of violations remain unchanged.
Decompensated. For this form of dysmenorrhea is characterized by the progression of symptoms (intensity and nature of pain) every year.
The severity of the course of dysmenorrhea is classified as follows.
I degree – painfulness of menstruation is moderate, systemic syndromes are not observed, the working capacity of patients is not violated.
II degree – painfulness of menstruation has a pronounced character, accompanied by some neurovegetative and metabolic-endocrine, working capacity is negligible.
III degree – pain during menstruation is very strong, sometimes unbearable, accompanied by a complex of neurovegetative and metabolic-endocrine symptoms, working capacity is completely lost.
Complications of dysmenorrhea can be of two kinds.
Relating to the genital area. Infertility refers to this species. the transition of the main gynecological disease into a more severe form. In single cases, development of oncological pathology is possible.
Relating to the general state of health. This category includes disorders of a psychosomatic nature. Perhaps the development of depression. psychosis. loss of ability to work on menstruation days.
Diagnosis of dysmenorrhea.
Diagnosis of dysmenorrhea is not very difficult due to very characteristic manifestations and the presence of a direct link between the development of pain syndrome and menstrual days. A more difficult task for the doctor is to identify possible causes when it comes to the secondary form of dysmenorrhea.
Given that primary dysmenorrhea may not be accompanied by any deviations, a gynecological and general clinical examination of the patient (ultrasound, laboratory diagnostics) is important for the doctor. If a suspected secondary dysmenorrhea is suspected, the woman should be fully examined.
To establish the diagnosis of dysmenorrhea, the following examinations are carried out.
General examination. Allows to determine the general condition of the patient. In some cases, these women look exhausted, exhausted or irritated. At a palpation nothing is defined at primary dysmenorrhea. With secondary dysmenorrhea, the uterus, enlarged in size, the presence of infiltrates in the nearby area or formations in the small pelvis may be determined.
Laboratory diagnostics. With secondary dysmenorrhea, changes in laboratory parameters are detected that are characteristic of the main gynecological disease or changes in the endocrine function.
Ultrasound. With primary dysmenorrhea, this study is considered uninformative. With secondary dysmenorrhoea, ultrasound helps in diagnosing the causes that could lead to the development of this pathology (cysts, fibroids, tumors, etc. are determined).
Magnetic resonance imaging . It allows to reveal neoplasms in a small pelvis. With primary dysmenorrhea, it is not informative.
Hysteroscopy. This method is currently used rarely. It is carried out in those cases when there is a need to identify intracavitary adhesions.
Laparoscopy (diagnostic). In cases where it is not possible to identify the cause of pain in the pelvic area and the treatment does not bring relief, laparoscopy can help. This method allows you to determine the condition of the small pelvis and abdominal cavity. It is used when suspicion of secondary dysmenorrhea is rare.
Encephalography. In those cases where dysmenorrhea is accompanied by an intolerable headache, this study is mandatory. It allows differential diagnosis of headache and to identify other possible causes of it, as well as pathologies of the central nervous system.
In some cases, women are assigned additional specialist advice. urologist. the surgeon. psychiatrist, neuropathologist.
Achieve success in the treatment of dysmenorrhea is possible only with a comprehensive approach, which provides for a careful selection of drug and non-pharmacological methods of exposure. When selecting adequate therapy, it is important to consider not only the form of dysmenorrhea (primary, secondary), but also the nature of pain, individual personality characteristics. The tactics of managing patients with dysmenorrhea is selected individually.
Surgical treatment is indicated only in those cases when secondary dysmenorrhea is associated with a reproductive disease requiring surgical treatment. At the initial stage of selection of adequate therapy, patients are recommended general measures, which provide.
Normalization of the regime of work and rest.
Exclusion of irritating factors: smoking. alcohol, coffee. strong tea.
Minimizing stressful situations, normalizing sleep.
Dietary measures. restriction of fatty foods and difficult to digest.
It has been established that women with overweight are more likely to suffer from a primary form of dysmenorrhea.
Normalization of the physical activity, active sports. Physical culture and water procedures help to improve muscle tone, and this leads to a decrease in the intensity of pain.
Non-medicamentous therapy The use of non-pharmacological methods has two objectives. They allow.
Reduce the intensity of pain, affecting the various links of pathogenesis.
Reduce the need for medicines.
Drug therapy In the treatment of dysmenorrhea, several main groups of medicines are effectively used, which differ in the mechanism of action: oral contraceptives, gestagens, non-steroidal anti-inflammatory drugs.
Gestagens In this group, progesterone has been used in the treatment of dysmenorrhea. as well as its derivatives and testosterone derivatives. Their role is determined by the fact that they do not affect ovulation, but at the same time they influence the secretory transformation of the endometrium.
Preparations from the group of gestagens reduce the production of prostaglandins and, as a consequence, reduces the contractile activity of the uterus. These medicines also reduce the threshold of excitability of nerve fibers located in the wall of the uterus.
Oral contraceptives These drugs normalize the hormonal component of the menstrual cycle. They help reduce the volume of menstrual flow, which is due to the suppression of ovulation. Also contraceptive drugs reduce the threshold of excitability and contractile activity of the uterus. The pain syndrome is significantly reduced.
Nonsteroidal anti-inflammatory drugs Drugs of this group are most often prescribed to women at a young age who refuse to use contraceptives. Their effectiveness is explained by analgesic properties, which are associated with a decrease in the secretion of prostaglandins. Their shortcoming is the short duration of the exposure, which is 2-6 hours on average. The advantage of this group of drugs is the lack of the need to take medications constantly, since they are sufficient to use only in premenstrual days and the first 1-2 days from the onset of menstruation. Among the medicines of this group the most popular are: ketoprofen. piroxicam. MIG, nimesil. diclofenac.
In addition to the above groups of drugs, antioxidants are also used. vitamin complexes, tranquilizers (with psychogenic form of dysmenorrhea) and antispasmodics, homeopathic remedies and phytopreparations.
Folk ways of treating dysmenorrhea.
The application of traditional medicine recipes is effective in primary dysmenorrhea. Most often, the effectiveness of this group of drugs is not high enough, and therefore, it is recommended to use them in conjunction with traditional therapy.
The prognosis for dysmenorrhea is considered favorable. In most cases, it is possible to normalize the condition of patients and significantly reduce or eliminate the pain syndrome completely. In those cases where the patient suffers from a secondary form of dysmenorrhea, the prognosis is determined by the underlying disease.
Preventive measures, as well as what women should know about pain during menstruation.
If a woman suffers from a form of dysmenorrhea, then before the next menstrual cycle can take preventive measures that will help reduce menstrual pain.
You can start taking pain medication 2-3 days before the expected onset of menstruation. A woman should also know that increased stress (including psycho-emotional) and abuse of strong tea and coffee before the onset of menstruation, increase the intensity of bleeding and pain.
To all women who suffer from pain during menstruation, I want to give the most important advice. Do not suffer the pain and for a few days a month to deprive yourself of the joy of life. Medicine is developing rapidly and in the arsenal of doctors there is enough money to help you. Qualified care is the only thing that should be used in cases where your health causes anxiety or fear. Stay healthy.
Before use, consult a specialist.
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