Dysmenorrhea is characterized by the appearance of such accompanying symptoms. Dysmenorrhea: types, signs, diagnosis and treatment

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The majority of women, more than 70% of the total, experience some discomfort or pain during menstruation and for several days before their onset. In addition, there may be accompanying manifestations, which are expressed in increased irritability, sweating, and sleep disturbances. All these signs are associated with certain processes that occur cyclically in a woman’s body. They are directly related to the course of the menstrual cycle and are called dysmenorrhea.

What kind of pathology is this and how to deal with it? You can find answers to all questions related to dysmenorrhea in this article. It will help you cope with the unpleasant sensations that are associated with the complex and beautiful female body, designed for procreation.

Concept. Definition

Dysmenorrhea is not a disease, but a condition of the female body that develops on days coinciding with a woman’s menstrual cycle. Sometimes other menstrual cycle disorders (too heavy, irregular menstruation, etc.) are also combined under this name. Most often, young women and girls experience such conditions. In some cases, even loss of ability to work is observed. That is, this condition has a significant impact on the quality of life during menstruation. Previously, another term existed to define this condition – algodismenorrhea. Since it reflected only one of the signs of this pathological condition - pain, and in fact is a consequence of deeper changes, this term was subsequently replaced by the current one.

According to the modern point of view, dysmenorrhea is considered as a psychophysiological phenomenon that develops in response to painful stimuli.

Mechanism of development of dysmenorrhea

The mechanism of dysmenorrhea is complex and not fully understood. Today, there are several different opinions that explain this phenomenon. The most generally accepted point of view is that the development of dysmenorrhea is related to 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 uterine cavity increases, which continues during menstruation. This leads to increased uterine activity and increased spastic contractions. As a result, ischemia of the uterine tissue develops. As a result, the nerve endings become irritated and their sensitivity increases. The end result of the chain of these changes is an increased perception of pain.

Clinical symptoms

The main clinical symptom of dysmenorrhea is pain. The following criteria are typical for pain:: it develops in the lower abdomen, often radiates (spreads) to the groin and sacral region, and is accompanied by aching sensations in the lumbar region. Most often, this type of pain is characteristic of secondary dysmenorrhea. With primary dysmenorrhea, the pain is paroxysmal in nature, most pronounced in the lower abdomen, and almost always radiates to the lumbar region. With primary dysmenorrhea, pain occurs 1-2 days before the start of menstruation, continues for another 1-2 days of menstruation, the intensity of the pain is variable.

Common symptoms of dysmenorrhea are psycho-emotional disorders. Vegetative manifestations lead to a general disturbance in the well-being of patients. Women experience mood lability, increased anxiety, and may feel depressed and depressed. Some women suffering from dysmenorrhea have motivational disorders: bulimia, anorexia, increased or decreased libido.

The following pattern was revealed in terms of the frequency of symptoms::

• Dizziness develops in 85% of patients;


• Diarrhea may occur in 60% of cases;


• Back pain is reported by 60% of women;


• Headache (sometimes migraine-type) is observed in 45% of women.

Epidemiology. Statistical data

Dysmenorrhea, according to various sources, is observed in approximately 31-52% of women. Approximately 1/3 of the patients are girls and women for whom 1 to 3 years have passed since the onset of their first menstruation. Depending on the causes leading to the development of dysmenorrhea, diseases are identified that most often cause this pathology. In this case, endometriosis accounts for up to 12% in the age group of 11-13 years and up to 54% in the group of patients 20-21 years old.

Relatively recently, completely unexpected facts were revealed during the study of dysmenorrhea. As it turns out, there is a relationship between a woman’s working conditions and her social status. An interesting feature was identified - the more active a woman’s life (including physical activity, sports, etc.), the more often she becomes a patient belonging to the group of those suffering from dysmenorrhea. The role of the hereditary factor can be traced in 30% of cases. Some scientists have also established another relationship - with frequent stress and exposure to other unfavorable environmental factors, the percentage of women suffering from dysmenorrhea increases.

Causes

If we talk about the reasons leading to the development of the syndrome, it is important to note that we should consider primary and secondary dysmenorrhea separately, since they are associated with various provoking factors.

Primary dysmenorrhea

This type of dysmenorrhea is also called functional spastic. Among the causes that can cause primary dysmenorrhea, there are main groups:

1. Mechanical. Associated with difficulty in the outflow of menstrual blood from the uterine cavity due to: cervical atresia, abnormal development of the uterus, abnormal position of the uterus.


2. Endocrine. Associated with impaired prostaglandin synthesis, which leads to spastic contractions of the uterus.


3. Constitutional. Pain syndrome develops against the background of infantilism, that is, it becomes a consequence of irritation of nerve endings due to uterine hypoplasia, poor development of muscle elements that cannot be stretched sufficiently due to the accumulation of menstrual blood in the uterine cavity.


4. Neuropsychogenic. They are explained by the lability of the nervous system and the resulting decrease in threshold sensitivity.

Secondary dysmenorrhea

This group is directly related to gynecological diseases: endometriosis, uterine fibroids, malformations of the genital organs and inflammatory pelvic diseases. In some cases, secondary dysmenorrhea may be a consequence of the use of intrauterine forms of contraception. In these situations, usually when the intrauterine device is removed, the course of menstruation becomes normal and the pain decreases or is completely eliminated.

Classification

This syndrome is classified according to several criteria. Due to its occurrence, this pathology is divided into:

1. Primary – not associated with pathology or diseases of the internal genital organs. In this case, it is considered as a violation of neurohumoral regulation at various levels.


2. Secondary – associated with malformations of the internal genital organs, dysfunction of the hormonal system or inflammatory diseases of the genital area. In this case, dysmenorrhea is only one of many symptoms of the underlying disease.

Primary dysmenorrhea, in turn, is classified as follows:

• Essential. The reasons for this type are either unknown, or scientists are reduced to the opinion that they lie in a low threshold of pain sensitivity. Another part of scientists is of the opinion that essential dysmenorrhea is an individual feature of the female body.


• Psychogenic. This type of dysmenorrhea is directly related to the functioning of the nervous system. The explanation for its occurrence lies in the feeling of fear and anxiety that precedes the onset of menstruation. This form is more typical for girls in puberty, for whom the onset of menstruation is subconsciously associated with the obligatory presence of pain. Psychogenic dysmenorrhea is characteristic of individuals who develop the 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, according to the rate of progression, dysmenorrhea is divided into:

• Compensated. It is characterized by the fact that throughout all menstrual days from year to year the severity and nature of the disorders remain unchanged.


• Decompensated. This form of dysmenorrhea is characterized by progression of symptoms (intensity and nature of pain) every year.

According to the severity of dysmenorrhea, it is classified as follows::

• I degree – the pain of menstruation is moderate, systemic syndromes are not observed, and the patient’s performance is not impaired.


• II degree – the pain of menstruation is pronounced, accompanied by some neurovegetative and metabolic-endocrine symptoms, performance is slightly impaired.


• III degree – pain during menstruation is very severe, sometimes unbearable, accompanied by a complex of neurovegetative and metabolic-endocrine symptoms, working capacity is completely lost.

Complications

Complications of dysmenorrhea can be of two types:

• Relating to the sexual sphere. This type includes infertility, the transition of the main gynecological disease to a more severe form. In isolated cases, the development of oncological pathology is possible.


• Related to general health. This category includes disorders of a psychosomatic nature. It is possible to develop depression, psychosis, and loss of ability to work during menstruation.

Diagnosis of dysmenorrhea

Diagnosis of dysmenorrhea is not very difficult due to very characteristic manifestations and the presence of a direct connection between the development of pain and menstrual days. A more difficult task for the doctor is to identify possible causes when it comes to the secondary form of dysmenorrhea.

Considering that primary dysmenorrhea may not be accompanied by any abnormalities, a gynecological and general clinical examination of the patient (ultrasound, laboratory diagnostics) is important for the doctor. If secondary dysmenorrhea is suspected, the woman should be fully examined.

To establish a diagnosis of dysmenorrhea, the following examinations are carried out::

• General inspection. Allows you to determine the general condition of the patient. In some cases, such women look exhausted, exhausted or irritated. On palpation, nothing is determined with primary dysmenorrhea. With secondary dysmenorrhea, an enlarged uterus may be detected, the presence of infiltrates in the nearby area or formations in the pelvis.
• Laboratory diagnostics. With secondary dysmenorrhea, changes in laboratory parameters characteristic of the underlying gynecological disease or changes in indicators of the function of the endocrine system are determined.


• Ultrasound. In case of primary dysmenorrhea, this study is considered uninformative. In case of secondary dysmenorrhea, ultrasound helps in diagnosing the causes that could lead to the development of this pathology (cysts, fibroids, tumors, etc. are determined).


• Magnetic resonance imaging. Allows you to identify neoplasms in the pelvis. In case of primary dysmenorrhea, it is not informative.


• Hysteroscopy. This method is rarely used nowadays. It is carried out in cases where there is a need to identify intracavitary adhesive processes.


• Laparoscopy(diagnostic). In cases where the cause of pain in the pelvic area cannot be identified and treatment does not bring relief, laparoscopy can help. This method allows you to determine the condition of the pelvis and abdominal cavity. Rarely used for suspected secondary dysmenorrhea.


• Encephalography. In cases where dysmenorrhea is accompanied by an unbearable headache, this study is mandatory. It allows for differential diagnosis of headaches and identification of other possible causes, as well as pathologies of the central nervous system.


• In some cases, a woman is prescribed additional consultations with specialists: a urologist, a surgeon, a psychiatrist, a neurologist.

Treatment

It is possible to achieve success in the treatment of dysmenorrhea only with an integrated approach, which involves a careful selection of medicinal and non-medicinal methods of influence. When selecting adequate therapy, it is important to take into account not only the type of dysmenorrhea (primary, secondary), but also the nature of the pain and individual personality characteristics. The management tactics for patients with dysmenorrhea are selected individually.

Surgical treatment is indicated only in cases where dysmenorrhea is secondary and associated with a reproductive disease requiring surgical treatment.
At the initial stage of selecting adequate therapy, patients are recommended to take general measures, which include:

• Normalization of work and rest schedules;


• Elimination of irritating factors: smoking, alcohol, coffee, strong tea;


• Minimizing stressful situations, normalizing sleep;


• Dietary measures: limiting foods that are fatty and difficult to digest.

It has been established that overweight women are more likely to suffer from the primary form of dysmenorrhea.

• Normalization of the physical activity regime, active sports. Physical education and water procedures help improve muscle tone, and this leads to a decrease in pain intensity.

Non-drug therapy
The use of non-drug methods has two goals. They allow:

• Reduce the intensity of pain by influencing various stages of pathogenesis;


• Reduce the need for medications.

Non-drug methods include:

• 
  Drugs from the group of gestagens reduce the production of prostaglandins and, as a result, the contractile activity of the uterus decreases. These medications 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 achieved by suppressing 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 in this group are most often prescribed to young women who refuse to use contraceptives. Their effectiveness is explained by their analgesic properties, which are associated with a decrease in the secretion of prostaglandins. Their disadvantage is the short duration of exposure, which is 2-6 hours on average. The advantage of this group of drugs is that there is no need to take medications constantly, since it is enough to use them only in the premenstrual days and the first 1-2 days from the start of menstruation. Among the medications in this group, the most popular are: ketoprofen, piroxicam, MIG, nimesil, diclofenac.

  In addition to the groups of drugs listed above, antioxidants, vitamin complexes, tranquilizers (for the psychogenic form of dysmenorrhea) and antispasmodics, homeopathic remedies and herbal remedies are additionally used.

  Traditional methods of treating dysmenorrhea

  The use of traditional medicine recipes is effective for primary dysmenorrhea. Most often, the effectiveness of this group of drugs is not high enough, and therefore it is recommended to use them in combination with traditional therapy.

  Forecast

  The prognosis for dysmenorrhea is considered favorable. In most cases, it is possible to normalize the patient’s condition and significantly reduce or completely eliminate pain. In cases where the patient suffers from a secondary form of dysmenorrhea, the prognosis is determined by the underlying disease.

  Preventative measures and what women should know about pain during menstruation

  If a woman suffers from one of the forms of dysmenorrhea, then before the onset of the next menstrual cycle, preventive measures can be taken to help reduce menstrual pain.

  You can start taking painkillers 2-3 days before the expected start of menstruation. A woman should also know that increased stress (including psycho-emotional) and the 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: You shouldn’t endure pain and deprive yourself of the joy of life for a few days a month. Medicine is developing rapidly and doctors have enough tools in their arsenal to help you. Qualified help is the only thing you should resort to in cases where your health causes concern or concern.
  Stay healthy!
  

Many women experience pain during menstruation, but only a few pay attention to it and try to find out the cause. The opinion that severe pain during menstruation is normal is erroneous. Severe symptoms of PMS and menstruation may indicate a serious condition called dysmenorrhea. Any deviations from the usual state should be studied and examined by an experienced doctor.

Dysmenorrhea is a condition in which a woman experiences severe pain during menstruation. Dysmenorrhea affects more than 45% of women of childbearing age. May develop during the first cycle with ovulation. Severe pain reduces performance and activity.

A similar condition is often diagnosed in women with an asthenic physique (thinness, high or short stature, flat chest and shoulders, long arms and legs). Dysmenorrhea consists of mild excitability and a tendency to lose consciousness. Among the physiological factors, vegetative-vascular dystonia and astheno-neurotic syndrome predominate.

Depending on the severity of pain, dysmenorrhea is divided into three degrees:

• First degree. Moderate pain in the absence of disturbances in other systems. Performance is maintained. Even with mild pain you should consult a doctor. Dysmenorrhea may worsen over the years.
• Second degree. Pronounced nature of pain in endocrine and neurovegetative disorders. Performance is reduced. The pain is combined with insomnia, vomiting, anxiety, and depression. This degree of dysmenorrhea requires treatment with special medications.
• Third degree. Pronounced nature of pain in serious endocrine and neurovegetative disorders. There is no performance. Severe dysmenorrhea is rare. Severe pain in the abdomen and lower back is associated with fainting, tachycardia and pain in the heart. Painkillers are not able to improve a woman’s condition.

The disease predominates in women who move little at work and at home. Obese women are at risk. The role of heredity is important. Other factors: infections, hypothermia.

Primary dysmenorrhea

Not associated with pathologies of the pelvic organs. Often, primary dysmenorrhea is observed already in adolescence, but can also appear 1-3 years after the first menstruation. Initially, the pain is minor, but can intensify as the girl gets older.

Primary dysmenorrhea can be essential (with a low pain threshold) and psychogenic (with a strong fear of menstrual pain).

Medicine distinguishes two forms of primary dysmenorrhea:

• compensated (constant pain);
• uncompensated (pain worsens with age).

Uncompensated dysmenorrhea becomes so intense that at some point women can no longer cope without the help of specialists.

Usually the pain begins 1-2 days before menstruation and disappears only a few days after the start of the discharge. Pain during dysmenorrhea can be aching, like contractions, or bursting, radiating to the rectum or bladder.

Secondary form

It occurs against the background of pathologies of the pelvic organs, due to urogenital diseases and inflammatory processes. Secondary dysmenorrhea is more often observed in women over 30 years of age, accounting for up to 33% of all cases. The secondary form is more complicated.

The condition is so critical that the woman is unable to work. The day before menstruation, severe pain begins. With secondary dysmenorrhea, the discharge is abundant and clots are observed. The pain is localized in the lower back.

Causes of dysmenorrhea

Primary dysmenorrhea has not been fully studied, but medicine has proven that the condition can be a consequence of physiological and psychological disorders. Often this is the production of prostaglandins E2 and E2-alpha. These lipids provoke contractions of muscle tissue, which increases pain.

When uterine contractions increase, blood flow decreases and vascular spasms occur. These processes cause cramping pain during menstruation. Also, excessive production of prostaglandins provokes headaches, nausea and even vomiting. The primary form often develops in thin girls with an underdeveloped uterus.

Hormonal imbalance may also be the cause. A woman’s fear of pain can aggravate painful sensations during menstruation. Often, the primary form is observed in teenage girls who are afraid of PMS and pain during menstruation. Primary dysmenorrhea worries women with emotional lability (instability of insistence) and a low pain threshold.

Secondary dysmenorrhea is observed in women with pathologies of the reproductive organs. It can be argued that the secondary type will only be a symptom of another disease. Dysmenorrhea is often a sign of endometriosis.

The secondary form of dysmenorrhea may be a sign of:

• abnormal development of the genital organs;
• inflammatory process in the pelvic organs
• tumor process in the pelvic organs
• hormonal imbalance (predominance of estrogens);
• dilation of the pelvic veins;
• STI;
• dysplasia;
• intrauterine device;
• ovarian cysts;
• uterine fibroids.

Symptoms of primary and secondary dysmenorrhea

A clear symptom of dysmenorrhea is pain in the lower abdomen, which appears before menstruation and lasts for several days.

Dysmenorrhea causes severe abdominal pain (dull, cramping, aching). Pain provokes disorders at the mental level. A woman, suffering from pain, becomes irritable, cannot sleep, and becomes depressed. This condition can cause a decrease in appetite, which will affect the digestive system. As a result, bloating, nausea, and taste distortion appear. Against the background of such disorders, fainting, headaches, swelling, problems with urination, and excessive sweating occur.

In the primary form, pain accompanies menstruation immediately after menarche (first discharge). Sometimes unpleasant sensations arise only 1-1.5 years (sometimes even 3) after the first menstruation. With primary dysmenorrhea, the pain resembles contractions and manifests itself differently in each woman (only pain or in combination with other symptoms). Often women complain that the pain extends to the lower back and lower extremities. It happens that cerebral disorders (related to the brain) develop against the background of dysmenorrhea. This could be a severe headache, insomnia, or regular fainting.

Symptoms of primary dysmenorrhea

• pain during menstruation;
• nausea (possible vomiting);
• dizziness;
• weakness and fatigue;
• heat;
• red spots on the face, neck and arms;
• constipation;
• disturbances in heart rhythm;
• sleep problems.

Such symptoms occur when there is excessive production of hormones (adrenaline, norepinephrine, dopamine). Manifestations indicate an adrenergic type of dysmenorrhea. When serotonin levels increase, the manifestations will be:

• diarrhea;
• vomit;
• low temperature.

These symptoms characterize the parasympathetic type of dysmenorrhea. Sometimes women report pain during sexual intercourse.

A gynecological examination (when diagnosing primary dysmenorrhea) does not give any results. PMS is sometimes detected, although this syndrome is diagnosed in many women who do not suffer from dysmenorrhea.

Possible manifestations of primary dysmenorrhea:

1. Skin changes: networks of blood vessels in the chest and back, bleeding, varicose veins, stretch marks.
2. Abnormal bone development: thinness and length of the limbs, deformation of the chest, pathological curvature of the spine, excessive mobility of the joints, length of the fingers, flat feet.
3. Pathologies of internal organs.
4. Manifestations of magnesium deficiency.

Symptoms of secondary dysmenorrhea

With secondary dysmenorrhea, symptoms are complemented by manifestations of the disease. With endometriosis, pain worries a woman not only during menstruation, but also on other days of the cycle. Aching nature of the pain, predominantly localized in the lower back.

When the appendages become inflamed, the temperature rises and symptoms of intoxication of the body appear (pain in the limbs, weakness, lack of appetite).

Other possible symptoms of secondary dysmenorrhea:

• headache;
• insomnia;
• swelling;
• frequent urge to urinate;
• digestive problems;
• severe fatigue.

During a gynecological bimanual examination, the doctor diagnoses uterine enlargement and sensitivity (, ovarian cyst), a feeling of heaviness in the appendages (inflammation, adhesions that put pressure on the uterus).

Spasmodic dysmenorrhea manifests itself in the form of spasms and stabbing pains. The condition worsens in the first two days of menstruation. The pain is combined with nausea and fainting. PMS symptoms get worse. Malaise forces a woman to lie in bed.

Oligomenorrhea is directly related to infertility. It provokes a reduction in menstruation. Oligomenorrhea can be recognized by acne and excess hair on the face, chest and back. Women with oligomenorrhea are often diagnosed with obesity and a male type of skeleton and muscles. Red spots appear on the body. Sexual desire decreases.

Diagnosis of dysmenorrhea

The diagnosis is based on anamnesis, clinical picture and complaints. The doctor must immediately exclude acute abdominal syndrome using differential diagnosis (comparing symptoms with all possible diseases, excluding those that are not at all suitable).

Similar pain is caused by the following diseases:

1. Appendicitis. Pain from appendicitis can occur on any day of the menstrual cycle. The increase does not occur immediately. The first focus of pain is the epigastric region (between the chest and abdomen). Signs of intoxication and inflammation are noticeable.
2. Torsion of the pedicle of the cyst on the ovary, apoplexy. There are symptoms of abdominal irritation.
3. Inflammation of the appendages. The pain appears before menstruation and lasts for three days from the start of the discharge. Has an increasing character. When analyzing a smear, pathogenic microorganisms (gonoccocci, chlamydia) are identified.
4. Tuberculosis of the genital organs. Disruptions of the menstrual cycle, high fatigue, weakness, fever to subfebrile levels, chaotic pain. When the uterine horn is closed and the pleura is intact, pain appears with the first menstruation and constantly intensifies.

Diagnosis of dysmenorrhea begins with clinical minimum tests:

• a general blood test can confirm inflammation (increase in ESR, leukocytes), anemia (reduction in hemoglobin, red blood cells), which indicates endometriosis or bleeding in the peritoneum due to rupture of a cyst or ovary;
• A general urine test allows you to exclude disorders in the genitourinary system;
• bacteriological analysis (extended blood test) makes it possible to identify extragenital pathologies that may indicate primary dysmenorrhea.

Instrumental methods for diagnosing dysmenorrhea:

• vulvoscopy (assessment of the condition of the vaginal and vulvar mucosa using a colcoscope);
• colposcopy (examination of the vagina and part of the cervix) allows you to notice inflammation, pathologies of the cervix and vagina;
• Ultrasound of the pelvic organs (transbdominal and transvaginal) makes it possible to diagnose tumor, inflammation, adhesions and proliferation of the endometrium of the uterus;
• An ultrasound of internal organs is needed to exclude or confirm other diseases that are accompanied by similar symptoms.

Additional examinations (to exclude possible causes) include a smear examination and determination of hormonal status. First of all, the concentration of such hormones is determined:

• , progesterone (in the second phase of the menstrual cycle);
• prolactin;
• testosterone.

Makes it possible to assess the condition of the uterine walls in case of secondary dysmenorrhea. During hysteroscopy, the doctor can detect intrauterine abnormalities.

Another method for diagnosing secondary dysmenoria is laparoscopy. This procedure is more complicated than hysteroscopy. Laparoscopy is a minimally invasive surgical procedure that allows you to examine the abdominal organs.

Treatment of dysmenorrhea

The woman is seen by a gynecologist-endocrinologist, with consultations from a surgeon, physiotherapist and psychologist. General recommendations for dysmenorrhea: normalization of the daily routine, moderate exercise, good rest, diet. Women with dysmenorrhea should avoid eating chocolate, coffee and dairy products.

First of all, women are advised to use non-drug methods. For dysmenorrhea, physical therapy, physiotherapy, massage, acupuncture and taking herbal teas will be effective. Only if there is no effect, the patient is prescribed medications.

The main goal of treating dysmenorrhea is to eliminate gynecological pathology. They use medications, physiotherapy, and psychological influence. It is necessary to remove the fear of menstrual pain. For this, doctors prescribe antidepressants and even tranquilizers. Among the effective physiotherapy procedures are balneotherapy, sinusoidal currents, acupuncture, and galvanization of the collar zone.

Three types of conservative treatment:

1. The use of gestagens. Hormones that renew the uterine mucosa, promote muscle relaxation, and keep estrogen levels under control.
2. Use of hormonal contraceptives. Often these are combined oral contraceptives that prevent ovulation and reduce the production of prostaglandins. Contraceptives reduce pressure in the uterus, which leads to slower contractions and less pain. For dysmenorrhea, low-dose contraceptives (Lindinet, Logest) will be effective. COCs should be taken from the fifth day of the cycle, one tablet (21 days with weekly breaks) or 28 days in a row.
3. Use of non-steroidal anti-inflammatory drugs. Prescribed for contraindications to gestagens and hormones. Anti-inflammatory drugs inhibit the production of prostaglandins. The recommended drugs are nurofen, ketoprofen and indomethacin. You need to take non-steroidal anti-inflammatory drugs one tablet three times a day.

Hormonal medications are prescribed for six months. They significantly reduce the volume of menstrual flow, which reduces the number of uterine contractions. Sometimes the patient is prescribed antispasmodics (papaverine), which inhibit spasms of the muscles of organs and blood vessels. For magnesium deficiency, Magne-B6 is recommended. Additionally, you can take antioxidants in a six-month course (vitamin E).

In case of psycho-emotional disorders, it is necessary to take sedatives (valerian, trioxazine). The course of treatment ranges from 3 to 6 months.

Surgical treatment of dysmenorrhea is effective for endometriosis, acute inflammation, and abnormalities in the structure of the genital organs. Hospitalization is carried out for abnormalities with critical symptoms.

Possible complications

The most severe complication of dysmenorrhea is infertility. Sometimes patients subsequently suffer from psychosis, depression, and disability. With timely and correct treatment, the prognosis is favorable.

Dysmenorrhea causes severe menstrual pain that needs to be relieved within a short time. We'll then explain what dysmenorrhea is and its symptoms, when it occurs, and what you should do to reduce or eliminate it.

Severe dysmenorrhea is one that often causes severe pain in the abdominal area. In gynecology, this is something very similar to menstrual cramps. This is premenstrual pain syndrome that occurs before the arrival of menstruation, and in most cases usually lasts two or three days. Code according to the international classification of diseases ICD-10.

It is important to know that while it is normal for menstrual pain to be present during this period, there are times when women experience so much pain from menstruation that they do not feel able to carry out their activities normally on those days. These are what are known as dysmenorrhea symptoms.

How to Relieve Natural Dysmenorrhea Treatment

Among the best folk remedies for treating dysmenorrhea are the following:

1. Peppermint with thyme

The combination of these two ingredients is essential for relieving menstrual cramps. This is because the combination acts as a wonderful anti-inflammatory that can combat fluid retention and at the same time promote blood circulation in the pelvic area to minimize it.

To cope with severe pain, you only need to mix a spoonful of mint with two thymes and a cup of water. Boil over low heat for 5 minutes. Finally, drink it on an empty stomach two days before the start of your menstrual cycle.

2. Raspberry leaf tea

Severe menstrual pain can be easily relieved with this wonderful tea, which has analgesic and antispasmodic properties, ideal for reducing very severe pain.

You just need to wait until the water boils to add the raspberry leaves. Wait until the infusion cools down and enjoy the pleasant and healthy taste of tea. You can take it whenever you have unbearable menstrual pain.

For any dysmenorrhea, suppositories based on cocoa butter and propolis are indicated.

3. Anise infusion

Another one of the best treatments for dysmenorrhea is star anise. Due to its anti-inflammatory and analgesic properties, it can quickly relieve menstrual pain.

To do this, pour a spoonful of anise in a cup with boiling water. Let it cool for a while and then drink everything. Take this treatment for dysmenorrhea 2 or 3 times a day.

Causes of dysmenorrhea

Among the main causes of menstrual pain are the following:

Chemical imbalance in the body

In most cases, girls who have pain during menstruation are those who have a certain chemical imbalance in the body. Basically, what is an imbalance between the values ​​of arachidonic acid and prostaglandins. These two substances are responsible for controlling uterine contractions.

Endometriosis

This occurs when period pain contains tissue that usually implants outside the uterus, causing uncomfortable, very severe menstrual pain. It is one of the few common causes of dysmenorrhea, but it has a big impact on it.

Other reasons for defining dysmenorrhea are:
Primary and secondary dysmenorrhea can be caused by abnormal pregnancy.
Another reason is due to uterine fibroids in polyps in the uterine cavity, ovarian cysts, and infection are also responsible for menstruation symptoms.

Primary dysmenorrhea

Primary dysmenorrhea is one in which menstrual pain occurs in the lower abdomen. In most cases, since they give menstrual pain, they begin between 24 and 48 hours before the start of the menstrual cycle. However, these severe pains usually disappear gradually on the first day of menstruation.

On the other hand, the prevalence of dysmenorrhea in adolescents was 79.67%. Most of them, 37.96%, regularly suffered from the severity of dysmenorrhea.

The three most common symptoms present on both days, that is, the day before and on the first day of menstruation, were lethargy and fatigue (first), depression (second) and inability to concentrate on work (third), while the classification of these symptoms into the day after the cessation of menstruation showed depression as the first general symptom.

Menstrual pain has been found to occur with this type of dysmenorrhea, as a negative correlation between dysmenorrhea and general health, as measured by body surface area, is typically observed in women between 17 and 25 years of age. For those women who are older in age or who have been mothers, this type of dysmenorrhea usually does not affect them.

It is important to note that in the process of preventing menstrual pain, these discomforts begin 6 or 12 months after the arrival of the first period. In these cases, menstrual cramps can be very helpful in relieving severe menstrual cramps.

Secondary dysmenorrhea

Secondary dysmenorrhea is one in which there is constant and more acute pain. This irritation usually appears a week before your period arrives and remains as long as it lasts. In some cases, the pain also goes away on its own, as with primary dysmenorrhea. Usually occurs in women over 30 years of age and those who have children.

However, we want to mention that for menstrual pain relief, secondary dysmenorrhea may be due to other causes such as fibroids or endometriosis. This is why, in this case, the treatment we recommend for dysmenorrhea is to visit a doctor so that he can give you an accurate diagnosis of what is causing these pains.

For quotation: Prilepskaya V.N., Mezhevitinova E.A. Dysmenorrhea // Breast cancer. 1999. No. 3. P. 6

Painful menstruation is commonly called dysmenorrhea. This disease is a relatively common menstrual dysfunction. Dysmenorrhea is a Greek word that literally means “difficult menstrual flow.” Hippocrates also believed that the most important cause of dysmenorrhea is a mechanical obstacle to the release of blood from the uterine cavity. Subsequently, the view on the cause of dysmenorrhea progressively changed.

B Painful menstruation is commonly called dysmenorrhea. This disease is a relatively common menstrual dysfunction. Dysmenorrhea is a Greek word that literally means “difficult menstrual flow.” Hippocrates also believed that the most important cause of dysmenorrhea is a mechanical obstacle to the release of blood from the uterine cavity. Subsequently, the view on the cause of dysmenorrhea progressively changed.
It is very interesting to note that, according to various researchers, the frequency of dysmenorrhea ranges from 8 to 80%, and often only those cases of dysmenorrhea that reduce a woman’s normal level of activity or require medical intervention are statistically taken into account.
About 1/3 of women suffering from dysmenorrhea are unable to work for 1-5 days every month. Among all the reasons for the absence of girls from school, dysmenorrhea takes 1st place.A connection was revealed between social status, nature and working conditions and the severity of dysmenorrhea. Moreover, among women engaged in physical labor and athletes, the frequency and intensity of dysmenorrhea is higher than in the general population. Heredity plays an important role - 30% of patients' mothers suffered from dysmenorrhea. Some researchers have found that the occurrence of dysmenorrhea is preceded by various adverse effects of the external environment on a woman’s body (hypothermia, overheating, infectious diseases) and stressful situations (physical and mental trauma, mental and physical overload, etc.).

Secondary dysmenorrhea is a symptom of a number of diseases, most often endometriosis, inflammatory diseases of the pelvic organs, anomalies in the development of the internal genital organs, ruptures of the posterior leaf of the broad ligament (Allen-Masters syndrome), varicose veins of the pelvic veins of the parietal or in the area of ​​the ovarian ligament, etc.
Primary dysmenorrhea, as defined by most authors, is a cyclical pathological process, expressed in the fact that on the days of menstruation, severe pain in the lower abdomen appears, which can be accompanied by severe general weakness, nausea, vomiting, headache, dizziness, lack of appetite, increased body temperature up to 37 - 38 0 With chills, dry mouth or drooling, bloating, a feeling of “wobbly” legs, fainting and other emotional and autonomic disorders. Sometimes the leading symptom may be one of the listed complaints, which bothers the patient more than pain. Severe pain depletes the nervous system, contributes to the development of an asthenic state, reduces memory and performance.
All symptoms of dysmenorrhea can be divided into emotional-mental, vegetative, vegetative-vascular and metabolic-endocrine.
Emotional-mental: irritability, anorexia, depression, drowsiness, insomnia, bulimia, odor intolerance, taste perversion, etc.
Vegetative: nausea, belching, hiccups, chills, feeling hot, sweating, hyperthermia, dry mouth, frequent urination, tenesmus, bloating, etc.
Vegetative-vascular: fainting, headache, dizziness, tachycardia, bradycardia, extrasystole, heart pain, cold snap, numbness in the arms and legs, swelling of the eyelids, face, etc.
Exchange-endocrine: vomiting, feeling of “woolly” legs, general severe weakness, itchy skin, joint pain, swelling, polyuria, etc.

Primary dysmenorrhea

Primary dysmenorrhea usually appears in women during adolescence, 1-3 years after menarche, with the onset of ovulation.
In the first years of the disease, pain during menstruation is usually tolerable, short-lived and does not affect performance. Over time, there may be an increase in pain, an increase in its duration, and the appearance of new symptoms accompanying the pain. Pain usually begins 12 hours before or on the first day of the menstrual cycle and continues during the first 2-42 hours or the entire menstruation. The pain is often cramping in nature, but can be aching, tugging, bursting, and radiate to the rectum, appendage area, and bladder. In the clinical picture of dysmenorrhea, compensated and uncompensated forms are distinguished. In the compensated form of the disease, the severity and nature of the pathological process on the days of menstruation do not change over time. In the uncompensated form, the intensity of pain in patients increases every year.

Table 1 System for rating dysmenorrhea by severity

Severity	Performance	Systemic symptoms	Efficiency prescribing analgesics
0 - menstruation is painless, does not affectfor daily activities	Doesn't decrease	None	Prescription of analgesics
I - menstrual bleedingaccompanied weaklysevere painand only rarely leads to a decreasenormal everydaywoman activity	Rarely decreases	None	Analgesics required rarely
II - daily activity is reduced,missing school or absenteeismrarely reports to work becauseanalgesics have a good effect	Moderately reduced	Single	Analgesics are givengood effect, thoughtaking them is necessary
III - daily activity is sharply reduced, analgesics are ineffective,the presence of vegetative symptoms (headache, fatigue,nausea, vomiting, diarrhea, etc.)	Sharply reduced	Occur frequently	Ineffective

Greek scientists Efthimios Deligeoroglou and D.I. Arvantinos in 1996 developed a system for assessing dysmenorrhea by severity ( ).
Etiology of dysmenorrhea not clear. There are several theories of its development; at different times, the origin of dysmenorrhea was explained by different factors (both physiological and psychological).
Currently, most researchers associate the occurrence of primary dysmenorrhea with a high level of prostaglandins (PG) F 2 a and E 2 in the menstrual endometrium. PGs are actually found in all tissues of animals and humans. They belong to the class of unsaturated fatty acids.
PGF 2 a and PGE 2 are the most likely causative factors causing dysmenorrhea. PGs are not hormones. Hormones are substances secreted by the endocrine glands, which, spreading through the bloodstream, have a biologically active effect on various systems of the body. PGs are produced by various tissues and exert their effect where they are synthesized. The obligate precursor of PG is arachidonic acid. This fatty acid is usually present among tissue phospholipids. Arachidonic acid is released by enzymes called phospholipases. Free arachidonic acid can be converted into various compounds. Enzymes,Catalyzing this reaction are called cyclooxygenases.
With the help of cyclooxygenase, arachidonic acid is converted into the following 3 compounds: prostacyclin (PGI 2), thromboxane (A 2) and PG D 2, E 2 F 2 a PGE 2 and PGF 2 a are powerful stimulators of myometrial contractile activity. Increasing the concentration of F 2 a and increasing the value of the PGF 2 a / PGE 2 ratio cause dysmenorrhea.
table 2 Doses of non-steroidal anti-inflammatory drugs for the treatment of dysmenorrhea

A drug
Ibuprofen	300 mg 3 or 4 times daily 400 mg 3 or 4 times daily 600 mg 3 or 4 times daily
Indomethacin	25 mg 3 or 4 times daily
Mefenamic acid	250 mg 3 or 4 times daily 500 mg 3 or 4 times daily
Naproxen	250 mg 2 times a day 275 mg 2 times a day 550 mg 2 times a day
Ketoprofen	Capsules: 1 capsule (50 mg) in the morning with meals, 1 in the afternoon, 2 capsules in the evening (or 1-2 candles per day). 1 capsule morning and afternoon and 1 suppository (100 mg) in the evening. Tablets: 1 tablet forte (100 mg) 3 times a day or 1 retard tablet (150 mg) 2 times a day with an interval of 12 hours. The daily dose of the drug should not exceed 300 mg
Diclofenac	25-50 mg 2-3 times a day. Maximum daily dose 150 mg

The formation and release of PG from the endometrium is provoked by many irritants - stimulation of nerves and a decrease in oxygen delivery to the organ, exposure to hormones and simple mechanical stretching of the organ, etc. In some cases, in response to these irritations, the organ releases PGs in quantities that are tens of times greater than their concentration in this organ at rest. An excess of PGs is associated with both an increase in their synthesis and a decrease in their catabolism. Their level in menstrual blood in women with dysmenorrhea is significantly higher than in healthy women, and decreases with appropriate treatment. Drugs commonly used to treat dysmenorrhea act by blocking the activity of cyclooxygenase, and therefore inhibiting the production of prostacyclin, thromboxane and PG. A cyclic fluctuation in the concentration of PG/F 2 a in the blood of women with a peak during menstruation has been described (similar cyclic fluctuations for PGE 2 not described).
An increase in PG levels in the secretory endometrium occurs long before menstruation. There is no doubt that during the luteal phase the endometrium secretes PG. An increase in PGF content was noted 2 a of uterine origin, coinciding with the regression of the corpus luteum. The role of PG in regression of the corpus luteum in women remains unclear. The presence of hormonal regulation of PG synthesis is evidenced by a positive correlation between high levels of PGF 2 a in the middle and late period of the secretory phase and the level of estradiol. The stimulating effect of estrogens on the synthesis of PG and progesterone has been proven.
The decrease in progesterone levels at the end of the menstrual cycle causes the release of phospholipase A 2 from endometrial cells. This enzyme, acting on cell membrane lipids, leads to the release of arachidonic acid and, with the participation of prostaglandin synthetase, to the formation of PG F 2 a, I 2 and E 2 .
PGs are involved in the contraction of spiral arterioles, which causes the menstrual reaction. Tissue rejection leads to an increase in their content, which explains their high concentration in menstrual blood. A high level of PG leads to increased contractile activity of the uterus, vasospasm and local ischemia, which in turn causes pain, since it is the disturbance of pelvic hemodynamics in the form of hypertension and vasospasm or prolonged vasodilation and venous stagnation that contributes to cell hypoxia, accumulation of halogenic substances, irritation of nerve endings and pain. At the same time, there is an increase in intrauterine pressure and amplitude, as well as the frequency of uterine contractions by 2 - 2.5 times, compared with women whose menstruation is painless. Increased pain is facilitated by the accumulation of potassium salts in tissues and the release of free active calcium. In addition, under the influence of an increased concentration of PG, ischemia of other organs and tissues may occur, which leads to extragenital disorders in the form of headache, vomiting, diarrhea, etc. The introduction of antiprostaglandin drugs leads to a marked decrease in pain intensity in almost 80% of women with dysmenorrhea.
The etiological role is also widely discussed in the literature. vasopressin . Studies have shown that in women with dysmenorrhea, the concentration of vasopressin in the blood plasma during menstruation is increased. The administration of vasporessin increases the contractile activity of the uterus, reduces uterine blood flow and causes dysmenorrhea. Vasopressin infusion leads to increased PGF concentrations 2 a in blood plasma. The action of vasopressin is not blocked by antiprostaglandin drugs. Perhaps this is what explains the ineffectiveness of treatment for dysmenorrhea in some cases. However, it has been proven that combined oral contraceptives lead to a decrease in the content of this substance, confirming the validity of simultaneous treatment with oral contraceptives and antiprostaglandin drugs.
The same modulator of PG release is bradykinin and oxytocin, which change the supply of oxidation substrate (free fatty acids), apparently through a calcium current. A positive feedback relationship was noted between the PG content and the effect of oxytocin.
Publications devoted to the etiology of primary dysmenorrhea also constantly emphasize the significant role mental factors .
Sensitivity to pain plays an important role in a woman's response to increased spasmodic contractions of the uterus during menstruation.
Pain - this is a unique psychophysiological state of a person that arises as a result of exposure to super-strong or destructive actions that cause an organic or functional disorder in the body. Pain is an integrative function that mobilizes a wide variety of body functions to protect it from the effects of a harmful factor and includes such components as consciousness, sensation, memory, motivation, autonomic, somatic and behavioral reactions, emotions. Reactions that occur in animals and humans to the action of a stimulus that can cause damage to the body or carries the danger of such are called nociceptive reactions (from the Latin nocere - to harm).
The question of whether there are specific pain receptors or whether pain arises as a result of irritation of various receptors when a certain intensity of stimulation is reached is still a subject of debate. According to the most common opinion, one of the components of pain - painful sensation - occurs when non-encapsulated nerve endings are excited.
For the sensation of pain to occur, it is necessary to irritate the nerve endings with biologically active substances, mainly from the group of kinins, PGs, as well as some ions (K, Ca), which are normally found inside cells. Under the influence of damaging factors that disrupt the permeability of membranes, these substances enter the intercellular spaces and irritate the nerve endings located here. It is currently believed that, due to their physiological properties, these free nerve endings are chemoreceptors. It has been established that the receptors that perceive nociceptive stimuli have a high threshold of excitability. The level of excitability is regulated by special fibers of the sympathetic division of the autonomic nervous system.
Excitation caused by nociceptive stimulation is carried out through both thin myelinated and non-myelinated fibers.
The concepts of “pain receptors” and “pain conductors” should be considered conditional, since the pain sensation itself is formed in the central nervous system. The process of transmission and processing of excitations that form pain is ensured by structures located at different levels of the central nervous system.
The most important structure that processes information entering the brain is the reticular formation, where the reaction to painful stimulation appears earlier than in the cerebral cortex. This electroencephalographic reaction is expressed in the appearance of a slow regular rhythm with a frequency of 4-6 vibrations per 1 s, which is called the tension rhythm, as it accompanies a state of stress.
Based on many experimental data a position was formulated according to which the activation reaction of the cerebral cortex, which occurs during nociceptive stimulation, is formed with the participation of the adrenergic substrate of the reticular formation. It has been established that narcotic substances and analgesics exert their effect primarily on this area of ​​the brain.
The possibility of obtaining an analgesic effect without turning off consciousness indicates that the state of wakefulness and the conscious sensation of pain are provided by various brain mechanisms.
It has long been believed that the leading role in the formation of sensations belongs to the thalamus. This is confirmed by modern data obtained in experiments and clinics. The limbic system of the brain, which is directly related to memory, motivation and emotions, is also involved in the formation of pain integration.
Medicinal substances from the group of tranquilizers, which have a predominant effect on the limbic structures of the brain, have little effect on the threshold of excitation, but clearly modify pain integration as a whole, affecting mainly emotional manifestations.
The criteria for assessing pain include different indicators (measurement of cardiac activity, respiration, blood pressure level, pupil size, galvanic skin reflex,scream, reaction of avoidance and aggression, electrophysiological indicators, biochemical changes in the blood, endocrine changes, etc.)
The intensity of pain depends on a number of factors: the type of autonomic nervous activity, psychological mood, emotional background, the environment in which the patient is located. It is known that strong motivations, efforts of the will of the patient himself, switching attention to some kind of intellectual activity, etc. can reduce or even completely suppress the sensation of pain.
In case of mental disorders (some forms of schizophrenia, extensive lesions of the frontal lobes of the brain, alcohol intoxication), pain sensitivity may be impaired and even a painless course of severe pathological conditions.

Secondary dysmenorrhea

Secondary dysmenorrhea is caused by organic changes in the pelvic organs. It usually occurs several years after the start of menstruation, and pain may appear or intensify 1-2 days before the start of menstruation. Secondary dysmenorrhea, unlike primary dysmenorrhea, occurs most often in women after 30 years of age.
One of the most common causes of secondary dysmenorrhea is the inflammatory process in the pelvic organs and endometriosis. Dysmenorrhea can also be caused by the use of an intrauterine device. Dysmenorrhea in diseases of the internal genital organs occurs as a result of impaired blood flow, spasm of smooth muscles, stretching of the walls of hollow organs, excessive irritation of the nervous elements during contractions of the uterus, inflammatory changes in organs and tissues, endometriosis, developmental abnormalities, etc.
In chronic inflammatory processes, the tension of the adhesions formed between the abdominal covering of the uterus and neighboring organs is important. A vaginal examination of the pelvic organs may reveal signs of pathology such as pain, enlargement of the uterine appendages, and limited mobility. With endometriosis, there may be a similar clinical picture, however, with this pathology, pain can be observed throughout the entire cycle and intensify 2 - 3 days before menstruation. Most often, they are not cramping, but aching in nature, with irradiation to the rectum, appendages, lumbar region, etc. (depending on the location of endometrioid heterotopias) and are most pronounced on days when menstrual flow is especially intense. During a gynecological examination of the pelvic cavity, roughness and thickening of the uterosacral ligaments, pain when the uterus is displaced, soreness, enlargement, immobility of the appendages, changes in the size of the uterus and ovaries before and during menstruation and their reduction after its end, the uterus becomes spherical with heterogeneous consistency shape, most often deviated posteriorly and limited in mobility.
When internal organs are damaged, it is diagnostically important to identify the corresponding neurological symptoms, in particular, the identification of pain points, sensory disturbances, and symptoms of tension in the nerve trunks. However, the latter does not exclude the presence of combined processes (diseases of the nervous system and secondary involvement in the process of receptors and pain sensitivity pathways in somatic diseases).
Dysmenorrhea may occur in women who use intrauterine contraception. It has been proven that when using an IUD, the concentration of PG in the endometrium during the adaptation period increases and causes increased contractile activity of the uterus, which in women with an increased threshold of excitability leads to dysmenorrhea.
Dysmenorrhea can also develop in women with uterine malformations that impede the outflow of menstrual blood and myomatous nodes that are born when the node reaches the internal os and is pushed out through the cervical canal by contractions of the uterus.
Methods for diagnosing secondary dysmenorrhea include culture of material taken from the cervix and vagina, pelvic ultrasound, hysterosalpingography, hysteroscopy, laparoscopy, etc.
One of the important diagnostic points in recognizing the nature of the pathological process is the effectiveness of medications that affect various levels of pain integration.

Treatment of dysmenorrhea

The main treatments for primary dysmenorrhea are oral contraceptives and non-steroidal anti-inflammatory drugs.
Oral contraceptives reduce the volume of menstrual flow by inhibiting endometrial proliferation and suppressing ovulation. Under conditions of anovulation, PG secretion by the endometrium decreases. Oral contraceptives cause a decrease in the threshold of excitability of the smooth muscle cell and reduce its contractile activity, thereby helping to reduce intrauterine pressure, frequency and amplitude of contractions of the uterine muscle. Increased uterine contractility may be the result of an increase in estrogen concentrations in the luteal phase of the cycle. Estrogen can stimulate the release of PGF 2a and vasopressin. The use of combined estrogen-progestogen-containing monophasic contraceptives (rigevidon, microgynon, miniziston, marvelon, femoden, mersilon, etc.) and contraceptives containing only progestogen (continuin, microlut, excluton, depo-provera, norplant, intrauterine hormonal system "Mirena" etc.), leads to a decrease in the concentration of estrogen, and therefore PG, and the disappearance or reduction in the severity of symptoms of dysmenorrhea.
Combined estrogen-gestagen-containing contraceptives for the treatment of primary dysmenorrhea are taken according to the usual regimen: 1 tablet daily at the same time of day, starting from the 5th day of the menstrual cycle, until the end of the package, 7 days break, then the next package. Mini-pills are used daily, 1 tablet at the same time of day, continuously. Injectable contraceptives, for example Depo-Provera, are used once every 3 months, intramuscularly. The first injection is given on the 1st - 5th day of the menstrual cycle.
Norplant is injected under the skin of the forearm on days 1–5 of the cycle. The intrauterine hormonal system is introduced on the 4-8th day of the menstrual cycle.
If contraceptives do not provide the desired effect, PG synthetase inhibitors are additionally prescribed.
PG synthetase inhibitors are considered the drugs of choice for young women who do not want to use oral contraceptives for the treatment of primary dysmenorrhea, and in cases where these drugs are contraindicated. The most widely used PG synthetase inhibitors are non-steroidal anti-inflammatory drugs: aspirin, indomethacin, ibuprofen, mefenamic acid, naproxen, etc.
Typically, a non-steroidal anti-inflammatory drug is prescribed orally from the 1st day of the menstrual cycle until the pain completely subsides. The prescription regimen is as follows: when pain appears - 1 tablet, every subsequent 3 - 6 hours - 1 tablet until the pain completely disappears or from the moment the pain begins - a double dose (2 tablets), then 1 tablet 3 - 4 times a day until complete pain relief.
PG synthetase inhibitors reduce the PG content in menstrual blood and relieve dysmenorrhea. These drugs themselves have an analgesic effect, and the advisability of their use during the first 48–72 hours after the onset of menstruation is determined by the fact that, as researchers have shown, PGs are released into the menstrual fluid in maximum quantities in the first 48 hours of menstruation. Antiprostaglandin drugs are rapidly absorbed and act within 2 to 6 hours. Most need to be taken 1 to 4 times daily during the first few days of menstruation ( ).
Aspirin, being a mild cyclooxygenase inhibitor, helps only some patients. Paracetamol is also not effective enough in most cases.
In the treatment of primary algodismenorrhea, zomepirac, fentiazac, flubiprofen, diclofenac, ketoprofen, piroxicam, etc. are also used.
However, all of these drugs can have a number of side effects, both extragenital and antifertility, which may limit their use in gynecological patients. Although serious complications and significant side effects are usually rare and most women tolerate them well. The use of antiprostaglandin drugs is contraindicated for gastric or duodenal ulcers, gastritis and other diseases of the gastrointestinal tract, as they can cause an exacerbation of the process.
There is also prophylactic use of drugs: 1-3 days before the expected menstruation, 1 tablet 2-3 times a day. The course of treatment usually lasts 3 menstrual cycles. The effect of nonsteroidal anti-inflammatory drugs persists for 2 to 3 months after their discontinuation, then the pain resumes, but is less intense.
Given that in a controlled study using placebo, some patients felt better after receiving a placebo, it appears to make sense to prescribe a multidrug treatment that includes vitamins, amphetamines, and tranquilizers. The effectiveness of placebo is 21 - 41%, which indicates the importance of cortical regulation in this pathological condition.
Considering dysmenorrhea as emotional-painful stress, it is pathogenetically justified to use antioxidants . In particular, a natural antioxidant - a-tocopherol acetate (vitamin E) 150-200 mg/day orally 3-4 days before the start of menstruation (preventive option) or 200-300 mg/day starting from the 1st day of menstruation (therapeutic option).
For the treatment of primary dysmenorrhea, antispasmodics, calcium channel blockers, nonspecific analgesics, progestogens, gonadotropin-releasing hormone analogues, magnesium are also used, dilation of the cervical canal and its curettage are performed, methods of neurectomy in the presacral region, transcutaneous electrical nerve stimulation and acupuncture are used. Psychotherapeutic assistance that affects the reactive component of pain can also have a good effect.
In case of ineffectiveness of non-steroidal anti-inflammatory drugs for dysmenorrhea, prescribe calcium and serotonin antagonists, b -stimulants, antispasmodics. The activity of the uterine muscles is characterized by high active and residual pressure and largely depends on the concentration of free calcium in the cytoplasm. Dysfunction of the uterine muscles is explained by changes in the content of free active calcium. An increase in the level of free calcium in the uterus stimulates the formation of PGF 2 a, and this process is hormone dependent. It is interesting that the relationship between free calcium content and PG levels is unidirectional, i.e. It was noted that prostaglandins E 2 and F 2 a do not change the calcium current into the cell. Thus, calcium antagonists indirectly reduce the content of prostaglandins, thereby reducing the frequency of uterine contractions, intrauterine pressure and, accordingly, the severity of dysmenorrhea. Uterine contractions are often painless, and pain may be due to irritation of the endocervix. Under the influence of nimesulide and nifedipine, intrauterine pressure, frequency and amplitude of uterine contractions decrease, and the pain stops after approximately 30 minutes. The selective b-stimulant terbutaline relieves muscle activity, reduces intrauterine pressure, and relieves pain.
Partusisten and orciprenaline reduce the frequency and amplitude of uterine contractions, the latter inhibiting contractions caused by potassium, oxytocin, and vasopressin, effectively reducing the content of prostaglandins E 2 and F 2 a.
Treatment of secondary dysmenorrhea. As for secondary dysmenorrhea, most researchers consider it to be a consequence of organic disorders in the female reproductive system - developmental anomalies, inflammatory diseases of the pelvic organs, endometriosis, submucous uterine fibroids, etc. Accordingly, the choice of therapeutic agents is determined by the nature of the main pathological process.
If organic pathology of the pelvic organs is detected, treatment of secondary dysmenorrhea should be aimed at eliminating the identified lesions.
Studies by many authors have found an increase in the synthesis of endogenous PGs in salpingoophoritis and endometriosis, which indicates the pathogenetic significance of PG hyperproduction and justifies the use of antiprostaglandin drugs for secondary dysmenorrhea. For chronic inflammatory diseases of the pelvic organs, endometriosis, malformations, and uterine fibroids, therapeutic hysteroscopy and laparoscopy are used.
Among surgical interventions for secondary algodismenorrhea, presacral sympathectomy is most often of historical interest. Quite often bougienage of the cervical canal is performed, A hysterectomy is undoubtedly a measure of desperation, especially since the pain often remains after it.
When curing a somatic disease, persistent pain syndrome is possible: residual effects of damage to the nerve trunks, ischemic changes, adhesive processes, changes in the functional state of the nodes of preganglionic autonomic innervation, in which persistent morphological changes are observed, as well as psychogenic fixation of the pain syndrome. Therefore, when treating secondary dysmenorrhea, it is necessary to eliminate pain. Therefore, when treating secondary dysmenorrhea, it is necessary to eliminate pain. In the search for an effective remedy for pain, one should not forget about the central regulation of the pathological symptom complex by both the hypothalamic-pituitary system and the cerebral cortex. In this sense, the effectiveness of psychotherapy, tranquilizers, auto-training and acupuncture is known.
It must also be remembered that if the nature of the disease is unspecified, accompanied by pain, long-term use of analgesics and tranquilizers is contraindicated, since this erases not only pain sensitivity, but also the clinical picture, for example, in acute processes in the abdominal cavity.
Thus, menstrual pain, the cause of which is not organic lesions, is considered as primary dysmenorrhea, and those associated with lesions or diseases of an organic nature - as secondary dysmenorrhea.
Due to the fact that non-steroidal anti-inflammatory analgesics sometimes reduce the severity of some symptoms associated with organic pathology, it may be difficult to make a diagnosis. If the doctor believes that the pain is caused only by menstruation, a thorough history should be taken to identify diseases of the gastrointestinal tract, urological and other diseases. Treatment should be primarily aimed at identifying endometriosis, uterine fibroids, adenomyosis and salpingitis. If the prescribed treatment leads to complete disappearance of symptoms, no further studies are required. If it does not give positive results, laparoscopy should be performed. Many women have minimal symptoms and do not need such testing. However, if an organic pathology is suspected or severe symptoms (the patient is forced to remain in bed and not go to work for several days every month), the only way to make a correct diagnosis is to perform laparoscopy. If laparoscopic examination reveals the initial symptoms of endometriosis, then heterotopias can be subjected to coagulation directly during this operation. The diagnosis of submucous uterine fibroids can be made by hysteroscopy or