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Dysmenorrhea

In some cases, it is necessary to observe women who, outside of the menstruation period, are healthy, and their menstruation is so painful that they are forced to seek medical help.

By the nature of these pains are very diverse. Sometimes patients characterize them as dull, aching, colicky, or they have the nature of contractions, and sometimes they are so strong that they deprive a woman of working capacity and even chain her to bed. The pain is localized in the lower abdomen, in the lower back, in the sacrum. Such painful periods are called dysmenorrhea (dysmenorrhoea).

Pain with dysmenorrhea can occur at different times. Sometimes they appear several days before menstruation and with the onset of menstruation cease, sometimes they appear during menstruation or, finally, by the end of menstruation . The pain continues sometimes for several hours and then subsides, and sometimes continues throughout the menstrual period.

Although dysmenorrhea has been studied in a comprehensive manner, much of this disease is still unexplained.

First of all, it was erroneous that the pain in dysmenorrhea was considered as a result of only local changes in the organs (uterus), as a result of purely mechanical causes, for example due to obstacles to the release of menstrual blood from the uterus (incorrect position of the uterus, narrowing of the internal orifice) polyps, submucous myomas, etc.). Similarly, in inflammatory processes accompanied by menstrual disorder (dysmenorrhea), pain was seen as a result of increased blood flow to the genitals, as a result of the formation of adhesions due to inflammation, etc. However, it is impossible to recognize as a reasonable explanation of all cases of dysmenorrhea by purely mechanical causes, about which it was just said, if only because many women who also have the listed changes in the genitals (incorrect position of the uterus, peritoneal junction and transferred as a result of inflammatory diseases, particularly gonorrhea , and m. n.) do not suffer from dysmenorrhea. A confirmation of this is also the fact that the elimination of the listed “causes”, for example, correction of incorrect uterine positions, removal of polyps, does not always lead to the cessation of dysmenorrhea. Apparently, in this symptom complex, the underestimated and unrecognized neuropsychiatric disorders of patients are much more important.

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This is especially pronounced in cases where no pathological changes on the part of the genital organs can be detected, and there is dysmenorrhea. Often in such cases any nervous disease is detected, and there is no need for the presence of sharply expressed and severe nervous suffering; sometimes mild nervous system disorders cause severe dysmenorrhea.

Especially often dysmenorrhea is observed in anemic, weak and poorly nourished women, as well as in persons who are in a state of depression under the influence of some kind of nervous experiences. Dysmenorrhea occurs in various forms in women suffering from infantilism, as well as neurasthenia, hysteria.

Finally, the pain in dysmenorrhea can be instilled. If, for example, a girl hears from her relatives in a family that for some of them menstruation is painful, sometimes it is enough that she herself also begins to experience pain when menstruation occurs. Sometimes, impressionable persons have an even more or less pronounced fear of menstruation.

These facts indicate the enormous role of the nervous system in the origin of menstrual disorders and, in particular, such disorders as dysmenorrhea.

Treatment of dysmenorrhea should first of all be directed towards eliminating the causes of the pain reflex, which is not always easy to recognize. Interventions of a local nature (correction of abnormal uterus positions, dilation of the cervix, etc.), as said, do not always give an effect. Much more important are measures aimed at treating disorders of the neuropsychiatric state of women suffering from dysmenorrhea. With appropriate indications applied hormone therapy and physiotherapy. For young women you need to recommend gymnastics and sports. In cases where dysmenorrhea occurs due to inflammatory processes, treatment should be directed primarily to the underlying disease.

Along with causal treatment, sometimes it is necessary to resort to symptomatic treatment, especially in cases when it is not possible to detect any pathological abnormalities in the genitals or when the cause of dysmenorrhea is not immediately able to be identified. Symptomatic remedies include the use of heat in the form of a bubble with hot water or warming compresses on the stomach, hot baths.

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Of the drugs used, antipyrine is 0.3, pyramidone 0.3, bromine 0.5-1.0 per reception, and finally, with severe pain, narcotic drugs: Tinctura Opii simplex, Tinctura Belladonnae no 8-10 drops at the reception, codeine at 0.01-0.02.

In those cases when the cause of dysmenorrhea are nervous diseases or it turns out that it has a conditioned-reflex nature, it is necessary to refer the patient to a neuropathologist.

Dysmenorrhea is a painful condition in which a woman during menstruation feels unwell and painful in the absence of other pathological phenomena or changes in the genital area. The condition is mainly characterized by headaches and general malaise the day before menstruation, increased nervous excitability, sometimes associated with mental depression. Later, colicky pains in the lumbosacral region and lower abdomen, which usually continue on the first day of menstruation, join. Sometimes they do not disappear during the whole period of menstruation and even after it.

The etiology of dysmenorrhea is not fully elucidated. The spasmodic nature of the pain leads to the idea that the cause of dysmenorrhea can be a narrowing of the cervix and, therefore, an obstacle to the outflow of blood. Such an obstacle the uterus seeks to overcome with the help of convulsive cuts, which the patient feels in the form of pain. It is also known that these ailments appear more often in women after increased mental stress, with prolonged sedentary work, fatigue after exercise, etc. Nerve impulses play a major role in the occurrence of dysmenorrhea. A further cause may also be spastic muscle spasm of the internal pharynx of the uterus or narrowing of the cervix. A certain place in the occurrence of dysmenorrhea may take an increased sensitivity of the vaginal part of the uterus and the mucous membrane of the cervix and body of the uterus, as is often observed in the study of patients with dysmenorrhea. A prominent place in the pathogenesis of dysmenorrhea takes and hormonal imbalance.

Treatment. 7-8 days before the onset of menstruation, progesterone injections of 5 mg daily or presginine under the tongue of 20-30 mg daily for 5-6 days are prescribed. Such courses are repeated 2-3 times. Menzilan is also recommended.

If dysmenorrhea is associated with underdevelopment of the sexual apparatus, treatment begins with the use of estrogen in the proliferation phase.

Dysmenorrhea (more correctly algomenorrhea) - pain in the lower abdomen and in the lumbosacral region before or during menstruation . Dysmenorrhea can be of a different etiology and is not a disease, but a symptom that accompanies or complicates sex and non-sex diseases. Distinguish between primary and secondary dysmenorrhea. Primary dysmenorrhea is more often observed in healthy girls and women in the absence of any disorders on the part of the genital organs; pains during menstruation often begin at the age of 17-18 years, usually increasing in the future; at the same time, the state of the neuroendocrine system, moments of a psychogenic nature, also plays a big role. Secondary dysmenorrhea (acquired) can be observed with chronic perimetritis and adnexitis (see) or other diseases of the internal genital organs (inflammatory process, abnormal development of the uterus, tumor). Dysmenorrhea is the main symptom of endometriosis of the ovaries, tubes and cervico-rectal space; dysmenorrhea can also be observed with submucous myomas.

Many women have painful sensations during menstruation; with dysmenorrhea, the pain is so intense that it forces a woman to seek medical help, many are forced to bed rest. Pain usually occurs before the onset of menstruation, continues for the first day, and then decreases. Pain localized in the lower abdomen, less frequently in the sacrum; often accompanied by nausea , migraine attacks, dyspeptic symptoms, palpitations , sleep disorders, etc.

Treatment of dysmenorrhea depends on the cause of it. Each patient should be referred to a gynecologist for examination, diagnosis and treatment prescription. In case of primary dysmenorrhea, a thorough examination of the menstrual function (according to hormonal tests) is necessary. Treatment with hormones is carried out strictly according to indications. Estrogens are prescribed in the first phase of the menstrual cycle ( proliferation phase), hormones of the corpus luteum ( progesterone ) in the secretion phase (second phase of the menstrual cycle). The dosage of hormonal drugs varies individually, depending on the degree of hormonal deficiency.

From painkillers can not prescribe drugs that cause addiction to them (codeine and morphine); during the pain should be limited to non-narcotic agents: analgesic (acetylsalicylic acid, amidopirin ), anticholinergic (belladonna) and antispasmodic drugs ( papaverine ). It is better to use them in the form of candles (for example, papaverine hydrochloric acid, 0.03 g, belladonna extract 0.02 g, antipyrine 0.25 g). Great attention in the treatment of dysmenorrhea should be paid to physical therapy , physiotherapy and balneological methods of treatment.

See also menstrual cycle , disorders.