Dysmenorrhea( algosdismenorrhea) - Causes, symptoms and treatment. MF.

Dysmenorrhea( or algosdismenorrhea) is a pathological condition in which the main symptom is a sharp soreness during menstruation, mainly in the lower abdomen and in the lumbar region. Such a condition must be diagnosed from ordinary menstrual pain, which may not be the same in different cycles.

The frequency of treatment of women to a doctor with a complaint of painful periods is according to different data from 10 to 35% of cases among all reasons for contacting a gynecologist. Most often with such complaints to the doctor come young women of childbearing age. Due to the fact that this pathology sometimes causes unbearable pain, today it is viewed as an important social problem: a woman loses her ability to work, problems appear in her personal life.

Causes of algodismenosis

To date, there is no clear idea of ​​why young women experience dysmenorrhea. One version deserves attention, which states that pathological soreness is associated with an increased content( production) of prostaglandins( PG), especially P2 F2α.

Prostaglandins are biological active substances produced by cells of the body, which play an important role in metabolic processes in the body, especially in energy exchange, which increase the content of CAMP.Their role in the formation of the inflammatory process is great. Prostaglandin F2α plays an important role in the birth process, stimulating and enhancing contractions of the myometrium( the muscle of the uterus).

Therefore, if the concentration of P2 F2α in the blood is greatly increased, which occurs in some women in menstruation, then the force of myometrium contractions in such a patient will significantly exceed that in normal, causing severe soreness. In addition, such abnormal contractions can lead to ischemia( circulatory disorders) of certain parts of the myometrium, which can lead to tissue death.

Do not forget about the different susceptibility to pain - patients with a high threshold of pain sensitivity are less likely to consult a doctor than with a low one. This may be due to the increased work of opiates( endorphins), which to some extent block the pain in different ways and help to transfer it in different ways.

It is also believed that dysmenorrhea may be associated with a disruption of the normal functioning of the chain of hypothalamic-pituitary-ovarian regulation of the menstrual cycle. This, too, can increase the content of prostaglandins in the blood and increase their production in tissues.

Symptoms of algodismorrhoea

The main symptom of algodismenosis, of course, is painful menstruation, mainly in the early days of menstruation. However, there are other symptoms: headache, nausea, vomiting, sleep disorders, etc. Practical all authors agree that dysmenorrhea should be divided into primary and secondary.

1. Primary dysmenorrhea, as a rule, occurs at a young age, most often immediately with the establishment of a monthly or 1-1,5 after this. For this, the condition is characterized by:

• Pain in the lower abdomen - soreness, usually sharp, begins on the first day of the cycle. The pain is strong, sometimes unbearable, can give in the back, in the legs.
• Cerebral disorders - sleep disorders, headaches, fainting.
• Dyspeptic complaints - nausea, vomiting, diarrhea.

The last two complaints speak in favor of the prostaglandin theory of the onset of pain, since the increase in GHG can contribute to the described complaints and beyond the monthly ones.

When examined, the pathology of the organs is not detected. Often, patients begin "premenstrual syndrome" - waiting for the onset of painful periods. It can complicate the diagnosis and treatment.

2. Secondary dysmenorrhea: these pain data are associated with a disease. The list of gynecological diseases, in which the occurrence of algodismenosis is possible, is huge. We list only the main reasons:

• Endometriosis is a common cause of painful periods;except for pain during menstruation draws attention to the irregularity of the menstrual cycle, smearing the dark brown color of the discharge from the external genital tract to the menstrual period and immediately afterwards;when examined, formation in the small pelvis may be detected, possibly on the neck.
• Tumors of the ovaries.
• Varicose veins of the pelvis and pelvic organs are a common cause of undiagnosed pelvic pain.
• Uterine fibroids - possibly with submucous myoma.
• Inflammatory processes in the small pelvis.
• Infectious lesions( gonorrhea, etc.).
• Use of an IUD( progestogen-free IUD) - increases the level of prostaglandins, leading to pain.
• Adhesive process in the pelvis.
• Injuries.
• Developmental flaws - dysmenorrhea occurs more often in vices that hinder the outflow of blood from the uterine cavity( an additional closed horn of the uterus).Most often it occurs at a young age in patients with a primary form. Treatment operative.

The main symptoms of secondary dysmenorrhea are:

• Severe lower abdominal pains that drain the patient.
• Insomnia, headaches, fatigue, up to disability.
• Perversion of taste, dyspeptic complaints.
• Frequent urination.
• Swelling.

These symptoms occur in the early days of menstruation, can continue all the days and even go to the beginning of a new cycle.

Pain should also be divided according to the degree of their severity:

1. Light( grade I dysmenorrhea) - pains are poorly expressed, however, they occur with each cycle, the woman does not take an anesthetic.
2. Moderate( grade II) - pain always when menstruation;stronger, but withdrawn by taking medications;There may be other symptoms of dysmenorrhea or the symptoms of the underlying disease.
3. Severe( grade III) - severe pain, taking medications does not help the patient, other symptoms are pronounced.

Complications of dysmenorrhea

1. Psychosomatic - it is possible to develop psychoses against a background of long-lasting no-than-stop pains with menstruation.
2. In case of untimely diagnosis of the causes of pain in the secondary form, the risk of the transition of the underlying disease to an incurable form( for example, oncology) is great.
3. Permanent disability.
4. Infertility.

Diagnosis of algodismenorea

1. Examination of the patient. Attention is drawn to the patient's age, the age at which such complaints first appeared, the presence of concomitant symptoms;when examined, she looks at herself as a patient - exhausted, "exhausted".Palpatory in the primary form of dysmenorrhea, as a rule, nothing is determined, with the secondary can be determined: an increase in the uterus in size, the presence of formations in the small pelvis, the presence of infiltrates in the parameters, etc.

2. Laboratory methods of examination. As a rule, changes can occur in the secondary form of dysmenorrhea, corresponding to the nature of changes in the analyzes in this or that primary pathology.

3. Ultrasound. Ultrasound in the primary form is of little informative;at the secondary form can help or assist with diagnostics of the reason of pains, at detection of cysts, miom, tumors, etc.

4. MRI, CT is rarely used, with uninformative ultrasound and with suspicion of the presence of formations in the small pelvis.

5. Encephalography. A woman can( rarely) complain primarily about an intolerable headache. In this case, a diagnosis is necessary for the pathology of the central nervous system.

6. Hysteroscopy for diagnosing the adhesive process inside the uterine cavity( Ascherman's disease), for diagnosis of adenomyosis. It is rarely used.

7. Diagnostic laparoscopy. If it is impossible to determine the cause of the pain, this method is used, which allows us to assess in detail the condition of the abdominal cavity and small pelvis. Applicable in extreme cases.

8. Consultations of specialists may be needed: surgeon, urologist, neurologist, psychiatrist

Treatment of algodismenosis

Treatment is aimed at eliminating pain symptoms, as well as, if possible, ascertaining the cause that caused it. In the secondary form of dysmenorrhea, the main one is the elimination of the underlying pathology. Only a cure for the underlying disease will help relieve pain.

In the primary form of dysmenorrhea treatment it is advisable to start with the appointment of non-steroidal anti-inflammatory drugs that can suppress prostaglandins: ibuprofen, aspirin, nimesulide, diclofenac. Assign them for 48-72 hours, 1-3 times a day, depending on the intensity of pain. Perhaps preventive appointment, 1-3 days before menstruation( for 2-4 months).

In addition, it is possible to designate a highly selective progestin - gestodene, a combined estrogen-progestogen-containing contraceptive.

Methods of physiotherapy are actively used in the treatment of pain syndrome: electrophoresis, acupuncture, application of heat to the abdomen.

It is also possible to use sedatives: tincture of valerian, trioxazine at night before, during or after menstruation. Many women use the advice of a psychologist.

It is important to note the following - when sharp painful menstruation occurs within several cycles, you should consult a qualified obstetrician-gynecologist, as this may be the first symptom of a terrible illness.

Self-medication is possible with mild to moderate degrees of disease, but it is necessary to consult a gynecologist about this when examining. When severe it is necessary to consult a doctor immediately.

Doctor gynecologist-endocrinologist Kupatadze D.D.