Dysmenorrhea

Primary form

The causes of primary dysmenorrhea can be mechanical, endocrine, neuropsychogenic and constitutional:

• Mechanical. They include abnormalities of uterine development, violations of the position of the uterus (hyperanteflexia), cervical atresia and other pathological conditions that create an obstacle to the normal outflow of menstrual blood.
• Endocrine. They are associated with an overly active synthesis and a slow process of prostaglandin breakdown.
• Neuropsychogenic. Among them, experts call an individual decrease in the threshold of pain sensitivity, a hidden rejection of one's feminine essence, denial of the sexual aspects of life and oneself as a woman and mother.
• Constitutional (infantilism). Uterine hypoplasia and insufficient development of the myometrium reduce the ability of the organ to stretch during menstruation. The pressure on the walls of the uterus increases, this causes irritation of sensitive nerve fibers and the appearance of pain syndrome.

Secondary form

Secondary (symptomatic) Dysmenorrhea occurs as a result of inflammatory and non-inflammatory diseases of the female genital organs, surgical interventions, adhesions in the pelvis, complicated labor and damage to the cervix during curettage. The most common causes of secondary dysmenorrhea are adenomyosis and external endometriosis. Pain during menstruation in these diseases is caused by desquamation of heterotopic areas of the endometrium.

In many patients, secondary dysmenorrhea develops against the background of submucosal uterine fibroids. Fibroids prevent the outflow of menstrual blood, the uterus begins to contract more intensively, the pressure in its wall increases, nerve fibers become irritated, prostaglandins are released, pain appears.

In some cases, Dysmenorrhea develops after the installation of an intrauterine device. In some patients, symptoms of dysmenorrhea appear after rough curettage during abortion or after complicated childbirth. The cause of dysmenorrhea in such cases is the rupture of the posterior leaf of the broad ligament of the uterus or varicose veins of the pelvis.

The separation of endometrial cells is accompanied by irritation of a large number of nerve fibers in the uterine wall, peritoneum, other organs and tissues and causes a sharp increase in prostaglandin levels. Prostaglandins increase the contractility of the muscular layer of the uterus, cause spasm of arterioles, which leads to a deterioration of the blood supply to the myometrium, and affect nerve fibers in the uterine wall, increasing their sensitivity to pain. Prolonged vasospasm, increased uterine contractions and increased pain sensitivity provoke pain syndrome. Other symptoms of Dysmenorrhea are also associated with an increase in prostaglandin levels: nausea, diarrhea, palpitations, chills, hyperhidrosis, dizziness, etc.

Dysmenorrhea also often appears in inflammatory diseases, especially chronic, long-term. This is due to the fact that inflammation provokes the formation of adhesions, and the adhesive process entails a violation of the location of the uterus and the appearance of mechanical obstacles to the normal outflow of menstrual blood. In addition, inflammation is accompanied by swelling of tissues and compression of nerve fibers and in itself causes pain, aggravated by contractions of the uterus.

Sometimes, with secondary Dysmenorrhea, there is a separation of the "impression of the uterus" - a condition in which the functional layer of the endometrium is not subjected to melting in the uterine cavity, but comes out of it in the form of a whole film. The release of such a film is accompanied by very intense cramping pains.

Classification

Dysmenorrhea can be primary (essential) or secondary (symptomatic). In diseases of the female genital organs, the clinical picture of Dysmenorrhea may become somewhat complicated or modified due to the overlap of symptoms of the underlying disease. Depending on the characteristics of the course , two forms of dysmenorrhea are distinguished:

• compensated - symptoms remain stable for many years.
• decompensated - an increase in pain and an aggravation of disorders of the general condition are detected over time.

Primary Dysmenorrhea is usually detected in sensitive, emotionally unstable asthenic girls with a tendency to body weight deficiency. Secondary dysmenorrhea is more often diagnosed in women over the age of 30. The patients have a history of abortions, the installation of an intrauterine device, childbirth, operations on the pelvic organs, infertility, inflammatory (endometritis, cervicitis, adnexitis, salpingitis, oophoritis) and non-inflammatory (adenomyosis, interstitial uterine fibroma, endometriosis, polycystic ovaries) diseases of the female genital organs.

Patients complain of pain and deterioration of the general condition. Pain syndrome with Dysmenorrhea occurs simultaneously with the onset of menstruation or a few hours before it begins. Pain is more often cramping, less often – pulling, aching or bursting. Possible irradiation to the lumbar region, groin area, perineum, rectum or the upper part of the inner surface of the thighs. The intensity of the pain syndrome in Dysmenorrhea may vary. Moderate pains that do not significantly affect the ability to work, well eliminated by conventional analgesics or antispasmodics, and extremely intense, requiring professional medical care are possible.

Violation of the general condition in Dysmenorrhea is manifested by vegetative-vascular, metabolic and emotional psychological disorders. Shortly before the start of menstruation and in the first days of menstruation, a woman suffering from Dysmenorrhea becomes touchy and irritable, unnecessarily worries about minor reasons. There may be a steady decrease in mood, drowsiness, an increase or decrease in appetite, a perversion of taste and intolerance to odors.

Vegetative and vascular disorders manifest themselves in the form of hiccups, belching, nausea, vomiting, dry mouth, diarrhea, bloating, fever, chills, fever to subfebrile numbers, increased urination, dizziness, headache, fainting and pre-fainting states, pain and discomfort in the heart, increased or decreased heart rate, extrasystole, numbness and cold extremities. Metabolic disorders in Dysmenorrhea are indicated by skin itching, an increase in the amount of urine excreted, general weakness, a feeling of weakness in the legs and volatile joint pain.

The diagnosis is made on the basis of complaints, anamnesis and additional research data. An obstetrician-gynecologist finds out when a Dysmenorrhea patient first experienced pain during menstruation, what is the duration of pain, whether the pain is accompanied by a violation of the general condition, whether a patient with Dysmenorrhea suffers from gynecological diseases, whether there was a history of childbirth, abortions and operations on female genital organs. During the survey, the doctor determines at what age menstruation began, what is the duration of the cycle, whether cycle disorders often occur and how abundant menstruation is.

After collecting complaints and finding out the anamnesis, the specialist conducts a gynecological examination, takes a smear from the cervical canal, vagina and urethra. Then a woman with Dysmenorrhea is sent for examination, which includes ultrasound of the pelvic organs, general blood and urine tests, analysis for sexually transmitted diseases and hormone levels. To clarify the ultrasound data, CT and MRI of the pelvis are used.

With Dysmenorrhea, presumably caused by polyposis and endometriosis, hysteroscopy and separate diagnostic curettage are prescribed. In some cases, laparoscopy is performed. If necessary, a Dysmenorrhea patient is referred to a urologist, psychologist, psychotherapist and other specialists.

Dysmenorrhea is treated on an outpatient basis. The classical method of treatment is pharmacotherapy in combination with physiotherapy. In the presence of gynecological diseases, the tactics are determined depending on the underlying pathology. Patients with Dysmenorrhea are prescribed:

• NSAIDs. Nonsteroidal anti-inflammatory drugs inhibit the synthesis of prostaglandin synthetase. Taking medications for Dysmenorrhea is recommended to start 2-4 days before the onset of menstruation and stop 2-4 days after its onset.
• Combined analgesics. With Dysmenorrhea, combined agents are also widely used, which include an analgesic and antispasmodic. If Dysmenorrhea is accompanied by a very intense pain syndrome, drugs are administered intravenously or intramuscularly for 3 or 4 cycles, sometimes in combination with sedatives and antihistamines.
• Hormonal drugs. In the absence of the effect of analgesics and antispasmodics, patients with dysmenorrhea are prescribed oral contraceptives containing ethinyl estradiol and levonorgestrel.
• Physiotherapy. In the second phase of the cycle or shortly before the onset of menstruation, Dysmenorrhea patients are referred for phonophoresis and electrophoresis with sodium bromide, magnesium sulfate, trimecaine or novocaine. Patients with dysmenorrhea are prescribed short-wave diathermy, diadynamic currents and ultrasound. Some specialists use reflexology.
• Psychotherapy. In the presence of psychoemotional disorders, treatment with a psychologist or psychotherapist is indicated. Patients with Dysmenorrhea are provided with psychological support, sedatives are prescribed, relaxation techniques are taught, explanatory conversations are held about the nature of Dysmenorrhea and its safety for life.

Primary Dysmenorrhea, as a rule, responds well to treatment. The prognosis for secondary Dysmenorrhea depends on the type and characteristics of the course of the underlying disease. Women suffering from Dysmenorrhea are recommended to give up bad habits, avoid the use of strong caffeinated beverages, normalize the daily routine, eliminate stress factors if possible, reduce weight (in case of excess body weight), follow a balanced diet, maintain moderate physical activity.