Algomenorrhea treatment drugs. Algodysmenorrhea (painful menstruation) - physiological norm or pathology

Algodysmenorrhea (algomenorrhea, dysmenorrhea) is a cyclically recurring pathological process, which is manifested by painful menstruation and is accompanied by a violation of the general condition of a woman.
According to various researchers, the frequency of dysmenorrhea ranges from 8 to 80%.

Classification of dysmenorrhea

I. Primary algomenorrhea- is functional.
II. Secondary algomenorrhea - develops against the background of organic lesions of the genital organs.

Etiopathogenesis of dysmenorrhea

The most common causes of primary algomenorrhea are:
1. Endocrine: the cause of spastic contractions of the uterine muscle, causing its ischemia, is an increase in the synthesis and a weakening of the processes of degradation of prostaglandins.
2. Neuropsychogenic: algodysmenorrhea is often observed with lability nervous system with a decrease in pain threshold.
3. Mechanical: lead to difficulty in the outflow of menstrual blood from the uterus. These reasons include incorrect positions of the uterus.
4. Constitutional: with infantilism, there is hypoplasia of the uterus, poor development of muscle elements that are difficult to stretch during menstrual plethora, resulting in irritation of the nerve endings and the occurrence of pain.

The causes of the development of secondary algomenorrhea are most often the following diseases:

1. Internal and external genital endometriosis. With endometriosis, painful menstruation is due to the fact that endometrioid heterotopias undergo cyclic changes similar to the endometrium. In this case, in the process of desquamation, irritation occurs
a large number of interoreceptors of the uterus, peritoneum and other organs affected by endometriosis, which leads to the release of prostaglandins and the appearance of a pronounced pain syndrome.

2. Uterine fibroids. With a submucosal location, the nodes can be a mechanical obstruction to outflow menstrual blood leading to an increase uterine contractions and hence pain.

3. Inflammatory diseases of the internal genital organs. Inflammatory processes, especially chronic ones, lead to the development of an adhesive process and a violation correct location uterus in the pelvis. The presence of infiltrates in the pelvis and parametric tissue is also common cause algomenorrhea.

4. The presence of the IUD contributes to increased synthesis of prostaglandins.

5. Allen-Masters syndrome. Rupture of the posterior leaf of the broad ligament and varicose veins pelvic veins at the base of the broad ligament of the uterus, arising from traumatic childbirth, rough induced abortion, lead to the development of algomenorrhea.
6. Anomalies in the development of the genital organs. Rudimentary uterine horn with active endometrium, doubling of the uterus with hypoplasia of one of them, atresia cervical canal cervix leads to difficulty in the outflow of menstrual blood.

Clinic of dysmenorrhea

Girls and women suffer from primary algomenorrhea asthenic physique, with reduced body weight, easily excitable and emotionally labile. Secondary dysmenorrhea is observed in women aged 30-40 years who have a history of childbirth, abortion, gynecological diseases and surgical interventions, in IUD carriers and patients suffering from long-term infertility. Clinical manifestations of algomenorrhea are divided into several groups:

1. Pain syndrome. Pain appears 1-1.5 years after the onset of menarche and coincides with the establishment of ovulatory cycles. In the first years of the disease, pain during menstruation is usually tolerable and does not affect performance. Over time, there may be an increase in pain, an increase in their duration, the appearance of new accompanying symptoms. Pain usually starts 12 hours before or on the first day menstrual cycle and continue for the first 2-42 hours or throughout the menstrual period. They have a cramping character, but can be aching, twitching, bursting, radiating to the rectum, the area of the appendages, bladder, lumbar region, inner thighs.

2. Emotional and mental disorders: irritability, anorexia, bulimia, depression, drowsiness, odor intolerance, taste perversion.

3. Vegetative disorders: nausea, belching, hiccups, chilling, feeling hot, sweating, hyperthermia, dry mouth, frequent urination, tenesmus, bloating.

4. Vegetative-vascular manifestations: fainting, headache, dizziness, tachycardia, bradycardia, extrasystole, pain in the heart, coldness and numbness of the upper and lower extremities, swelling of the eyelids, face.

5. Metabolic and endocrine disorders: vomiting, feeling of "cotton" legs, general severe weakness, itching of the skin, pain in the joints, swelling, polyuria.
With secondary algomenorrhea, the above symptoms develop against the background of clinical manifestations the underlying disease.
There are compensated and decompensated forms of algomenorrhea. With a compensated form, the severity and character pathological process on the days of menstruation, they do not change over time, with a decompensated bath, the intensity of pain and violations of the general condition increase every year.

Diagnosis of algomenorrhea

Diagnostic measures are aimed at eliminating the organic pathology of the genital organs, which can lead to the development of secondary algomenorrhea.

1. Anamnesis of life and illness
2. Objective examination
3. Gynecological examination
4. Ultrasound (to exclude adenomyosis, anomalies in the development of the uterus and vagina)
5. Hysteroscopy (with suspicion of internal endometriosis of the uterine body, submucosal myomatous nodes)
6. Laparoscopy before menstrual period(to exclude "small" forms of external endometriosis, pelvic varicose veins, rupture of broad ligaments)
7. Diagnostic curettage of the walls of the uterine cavity.

Treatment of algomenorrhea

I. Inhibition of prostaglandin synthesis during 3-4 menstrual cycles: rofecoxib (denebol, rofika) 12.5-25 mg 1 time / day, nimesulide (nimesil) 100 mg 2-3 times / day, naproxen 250 mg (1 tab.) 2-3 times / day, indomethacin 25 mg (1 tab.) 3 times / day, brufen 200 mg (1 tab.) 3 times / day, diclofenac one rectal suppository ( 0.01-0.05 g) at night, piroxicam 0.02 g orally or 1 rectal suppository (0.02 g) at night.

II. Analgesics and antispasmodics: analgin 2 ml of a 50% solution i / m, aspirin 200 mg 4-6 times / day, paracetamol 0.2-0.4 g 2-3 times / day, but-shpa 0 .04-0.08 g 3 times / day. or 2 ml of a 2% solution IM, baralgin 5 ml IM, spasmalgon 2 ml IM or 5 ml IV 2-3 times a day. Take 3-5 days before your period, during your period and 3-5 days after.

III. Beta-adrenergic agonists, for example, terbutaline 2.5-5 mg (table 1-2) 3 times / day.

IV. Vitamins: Unicap-T, Multitabs, Decamevit.

V. Tranquilizers: tazepam 0.01 g 1-3 times / day, frenol 2.5 mg 1-2 times / day.

VI. Hormone therapy:

1. Oral contraceptives: low-dose COCs (lo-gest, femoden, janine) according to the contraceptive regimen for 6-9 months.
2. "Pure" gestagens: dufaston 10 mg 2 times / day, morning-zhestan 100-200 mg 1-2 times / day. Appointed from the 5th to the 25th day of the cycle for 3-6 months.
3. Cyclic hormone therapy:

1st cycle: 4-6-8-10-12th days of the cycle - estrogens (folliculin 0.1% solution 1 ml, estradiol dipropionate 0.1% solution 1 ml, sinestrol 2% solution 1 ml, microfollin 0, 01 g, estriol 0.001 g) 1 time per day, intramuscularly or orally; 14-16-18th days of the cycle - estrogens (in the same doses) + gestagens (progesterone 1% solution 1 ml, utrozhestan 100 mg, dufaston 5 mg) 1 time per day, intramuscularly or orally; 20-25th days of the cycle - gestagens (in the same doses);
2-6th cycles: 10-12th days of the cycle - estrogens (in the same doses); 14-16-18th days of the cycle - estrogens (in the same doses) + gestagens (in the same doses); 21-22-23rd days of the cycle - gestagens (the dose is increased by 3 times);

VII. homeopathic remedies: remens 10-20 drops, diluted with water or in pure form 3 times/day 30 minutes before meals or 1 hour after meals, for a long time; klimadinon 30 cap. (1 tab.) 2 times / day, for a long time; femizol 1-2 tablets. 4-6 times a day in the premenstrual period.

VIII. Phytotherapy

IX. Physiotherapy:

Electrophoresis with novocaine on the area of the carotid plexus No. 8-10 every other day;
- ultrasound with hydrocortisone ointment on the area of the body of the uterus daily No. 3-5 in the premenstrual period.

X. Acupuncture

First, it is carried out throughout the entire cycle (1 course), then only in the second phase (2-3 courses).

Probably, there will not be a woman who has never in her life experienced painful sensations during menstruation. When everything hurts, the quality of life literally decreases: we cannot fully work, play sports, and relax. At such moments, nothing is needed, I want to curl up in a ball and quickly survive this period. But few people know that such an unpleasant symptom, which is considered a common occurrence, can serve as a certain signal in order to see a doctor and undergo a series of examinations. Often, algomenorrhea indicates a violation of the work reproductive system.

Description of the condition: do painful periods indicate ovulation has occurred

Algodysmenorrhea is a painful course of menstruation, mainly associated with an excessive accumulation of prostaglandins in the body, resulting in asynchronous uterine contractions that cause pain.

Under the diagnoses "algodysmenorrhea", "dysmenorrhea", "algomenorrhea" understand the same condition. So if in your medical card one of them is indicated, you should not be afraid of an incomprehensible word, all this means painful menstruation.

If we turn to medical statistics, we can see that more than half of women (about seventy-five percent) suffer from this condition. And this is only official data. Many do not tell the gynecologist about their problem or do not visit him at all.

Development mechanism

The mechanism of development of algomenorrhea depends on what caused it. If a woman has any gynecological diseases, then, most likely, it was they who led to the appearance of painful sensations during menstruation.

In about half of the fair sex, pain occurs due to the excessive accumulation of special biologically active substances in the body, in particular, in the uterus, which are called prostaglandins. As a result of hormonal fluctuations at the end of the cycle (three to four days before the start next menstruation) their enhanced synthesis begins. These substances are concentrated in uterine wall(V muscle layer organ). During menstruation, prostaglandins interfere with the normal contraction of the muscles of the uterus, causing its chaotic work. As a result of this, the normal processes of blood circulation and nervous innervation are disturbed, and pain.

During menstruation, the endometrial layer of the uterus is shed, accompanied by bloody discharge from the vagina. With algomenorrhea, the intrauterine system is disturbed enzymatic activity resulting in an increase in the amount of blood released with the formation of clots

In addition, prostaglandins reduce the production of special enzymes that thin menstrual blood, thereby provoking the appearance of abundant blood secretions with clots.

Some people have the misconception that pain during menstruation indicates that ovulation has occurred. Needless to say, this is just a myth.

There is no connection between the occurrence of ovulation and the subsequent onset of painful menstruation.

Classification: primary and secondary algomenorrhea

Allocate algomenorrhea primary and secondary.

Primary is formed most often from the establishment (from the very beginning) of the menstrual function of girls. Basically, it is not a sign of any diseases of the genital area. Most often it is associated with hormonal disorders in adolescence, constitutional features and psychogenic factors.

Secondary algomenorrhea is always formed against the background gynecological diseases or anomalies in development or position reproductive organs. An important difference from the primary algomenorrhea is that the secondary appears after a long period of painless menstruation and is always accompanied by symptoms of the pathology that caused it.

In addition, algomenorrhea is classified according to the degree of development:

The first degree of algomenorrhea. It is distinguished by the presence of mild pain in the lower abdomen, which sometimes go unnoticed or are considered a manifestation of mild discomfort during menstruation.
The second degree of algomenorrhea. It is distinguished by moderate pulling and aching pain in the lower abdomen and other not very pronounced systemic disorders, which slightly worsen the general well-being of a woman.
The third degree of algomenorrhea. It is considered severe and is expressed in excruciating pain during menstruation, which disrupts the usual way of life, forcing a woman to spend the entire period of menstruation in a horizontal position.

Causes: pelvic tilt, hormonal imbalance, removal of polyps or ovarian cysts, taking Duphaston, Qlaira, Regulon cancellation, premenopause, IVF and others

The causes of algomenorrhea can be:

hormonal imbalance in a woman's body;
luteal insufficiency of the second phase of the menstrual cycle;
abnormal development of the genital organs (their underdevelopment or incorrect position in the small pelvis);
asthenic constitution of the body;
frequent IVF trials;
pelvic tilt;
irregular sex life or its complete absence;
gynecological pathologies (, endometriosis, varicose veins of the pelvic organs, adhesions, infectious and inflammatory diseases, and others);
taking contraceptives, hormonal drugs(Duphaston, Midiana, Postinor, Radon, Qlaira) or Regulon cancellation;
blood clotting disorder;
surgical interventions (for example, removal, polyp, diagnostic curettage);
oncology;
premenopause.

Characteristic symptoms: fever, dizziness, swelling, scanty or copious discharge of blood with clots

The main symptom that distinguishes algomenorrhea is a constant monthly pain syndrome of varying intensity. If a woman experiences discomfort far from every menstruation, then most likely this diagnosis will be incorrect.

In addition, pain may be accompanied by:

But you need to remember that all organisms are different: someone is limited to pain in the lower abdomen, and someone "gathers the whole bouquet" unpleasant symptoms straightaway. In the presence of gynecological problems a woman, in addition to the main signs of algomenorrhea, experiences an additional number of signs of concomitant pathology.

Diagnosis and differential diagnosis: ultrasound, hysteroscopy and other methods

Diagnostics and differential diagnosis algomenorrhea do not have any clear and consistent actions. The doctor always begins the study by collecting complaints and a detailed history, followed by examination of the woman on the gynecological chair.

Sometimes an examination by a gynecologist becomes enough to find out the causes of regular pain during menstruation.

Sometimes this becomes enough to identify the cause of the monthly pain syndrome. If this is not enough, then the gynecologist sends a series of additional examinations:

swab sampling (necessary to detect inflammatory and infectious diseases);
hormonal screening (allows you to identify possible hormonal disorders that contribute to the development of algomenorrhea);
ultrasound diagnostics (reveals gynecological diseases, pathologies of the development and location of the reproductive organs, adhesions, and so on);
computed tomography (reveals anomalies in the position, development of the reproductive organs, the presence of tumor formations, etc.);
laparoscopy (used in severe cases, allows you to detect diseases and improper arrangement of organs in the small pelvis);
hysteroscopy (allows you to assess the condition of the inner uterine layer).

Depending on the results of the research, the patient is referred for a consultation with other specialists (therapist, endocrinologist, neurologist, psychotherapist).

Treatment of painful periods in girls and women

Treatment of algomenorrhea is usually complex. It directly depends on the cause of its occurrence. In the primary form of pathology, therapy is mainly aimed at suppressing unpleasant symptoms and lowering the level of prostaglandins in the blood, and in the secondary form, it is aimed at treating the disease that caused discomfort during menstruation. I must say that there is no need to go to the hospital. Therapy of algomenorrhea is carried out on an outpatient basis, that is, it is enough to visit a gynecologist in a antenatal clinic and follow all his recommendations.

General recommendations: proper nutrition, avoidance of stress, yoga classes

nutritious and regular meals enough fruits and vegetables in the daily diet, the exclusion of products containing caffeine in their composition (black tea, coffee);
physical activity ( fast walk, jogging, various gymnastic exercises);
giving up bad habits (smoking, drinking alcohol);
avoidance of stress and emotional tension;
at overweight weight loss;
compliance with the rules of personal hygiene;
yoga (it contains special exercises that directly affect the state of the reproductive system).

Many with pain during menstruation apply a hot heating pad to the lower abdomen. It should be noted that in no case should this be done, as this can aggravate the condition.

Exercises to improve the condition during menstruation: video

Drug therapy: taking hormonal, homeopathic, non-steroidal anti-inflammatory drugs, antispasmodics and other drugs

Basically, with the syndrome of painful menstruation, two types of drugs are prescribed:

non-steroidal anti-inflammatory drugs that interfere with the synthesis of prostaglandins, as a result of which a woman ceases to experience pain or may notice a significant decrease in their intensity. Such drugs include Paracetamol, Ibuprofen, Diclofenac, Nise, Aspirin, Meloxicam, Cefecon (candles) and others. The beginning of the reception should be carried out approximately three to four days before the expected date of the start of the next menstruation (just at this time the accumulation of prostaglandins in the body occurs) and end on the third day of menstruation (during this period, the action of prostaglandins noticeably weakens);
combined preparations, which are based on two active ingredients: antispasmodic and analgesic. They relieve excessive spasm of the uterine muscles and eliminate pain. Quite often, drugs such as Baralgin, Sedalgin, Tempalgin and others are used.

But in some cases, the doctor may additionally prescribe:

sedatives(Persen, Novopassit and others);
vitamin complexes (Complivit, Alphabet, Magne B6 and others);
homeopathic preparations that normalize the menstrual cycle and facilitate the general condition during menstruation (Tazalok, Mastodinon, Remens, Menalgin and others);
metabolic agents, in particular those that compensate for the lack of magnesium and potassium in the body, which directly affect the contractility of the uterus during the menstrual period (tablets Asparkam, Panangin and others);
antispasmodics that relieve spasm of the muscles of the uterus (Sirdalud, Tizanidin, No-shpa, Papaverine and others);
hormonal drugs.

With algomenorrhea, which is caused by the presence of gynecological diseases, drugs are prescribed to treat the cause of painful menstruation. Therapy is selected by the doctor individually for each patient.

Papaverine, Sirdalud, Asparkam, Aspirin, Cefekon suppositories, vitamin complexes and other drugs that will help relieve unpleasant symptoms - photo gallery

Asparkam affects the contractility of the uterus during the menstrual period Aspirin reduces pain intensity Magne B6 is useful for female body Mastodinone normalizes the menstrual cycle Persen - sedative Sirdalud relieves uterine muscle spasm Tempalgin eliminates pain Cefecon has an analgesic and antipyretic effect

Physiotherapeutic methods: massage, electrophoresis, acupuncture and others

Physiotherapy procedures are prescribed to a woman in combination with the use of drugs. Apply them in the second phase of the cycle, when the body begins to prepare for the next menstruation. Finish on the last “menstrual-free” day. Widely used:

general strengthening, relaxing or gynecological massage (the doctor will advise you on the desired type);
electrophoresis;
phonophoresis;
ultrasound therapy;
diadynamic therapy (treatment with electric current impulses);
diathermy with short-wave currents;
acupuncture.

Folk remedies for pain relief

Although the effectiveness of treatment with folk remedies has not been proven, they are successfully used by women during menstruation to alleviate the condition. Widely applied:

Infusions and decoctions medicinal herbs have a beneficial effect on the body as a whole, have a calming, anti-inflammatory and analgesic effect.

Prognosis of treatment and possible complications, consequences

Forecasts for algomenorrhea are positive. The primary form of pathology is perfectly stopped by taking medications and normalizing lifestyle. The course and elimination of the secondary form directly depends on the treatment of the underlying disease. Therefore, if unpleasant symptoms appear, it is not worth delaying the trip to your gynecologist, as this may affect the further possibility of becoming pregnant on your own, carrying out and giving birth to a child normally.

Prevention: how often to see a doctor

Prevention of algomenorrhea comes down to:

elimination of factors leading to its development;
immediate visit to the gynecologist in case of pain during menstruation for two or more cycles;
timely diagnosis and treatment of gynecological diseases;
general medical recommendations(physical activity, exclusion of bad habits, rational nutrition, etc.);
compliance with all the advice of the attending physician;
preventive visits to the gynecologist at least twice a year.

At first glance, pain during menstruation is normal. But, having understood why they arise, we can say the opposite. Algodysmenorrhea is a pathology that requires special attention, since serious gynecological diseases that require specific treatment can be hidden behind it. Therefore, when pain occurs, it is necessary to consult a specialist.

Good afternoon My name is Ekaterina. By education - a paramedic, plus I have an unfinished higher medical education. education (in the process of learning). Previously, I had to write medical topics quite a lot, as she constantly took part in medical conferences.

Algodismenorrhea (in some sources, the pathology is called dysmenorrhea) is a disease that manifests itself with a whole range of symptoms - pain, impaired well-being, and nervous discomfort. More than half of the women different ages consult a doctor with similar complaints.

In some cases, the cause of this disease is anatomical features, and sometimes algomenorrhea itself is a sign of damage to the reproductive system.

According to the international classification of ICD pathology, the code N94.4 - N94.6 was assigned (primary, secondary and dysmenorrhea of unspecified origin).

What is it in simple words?

Algodysmenorrhea is a regularly recurring painful menstruation accompanied by metabolic, hormonal, neurological and psycho-emotional disorders. Menstrual pain is in the lead (8 - 80%) among the complaints of young women who turned to a specialist, but their presence is not always associated with gynecological pathology.

Reasons for the development of algomenorrhea

The menstrual cycle is formed with the participation of all the most important systems of the body, so the cause of algomenorrhea can be located both in the uterus and appendages, and far beyond the genital organs.

Secondary algomenorrhea appears after a period of normal menstruation and is always associated with gynecological pathology. It occurs among the symptoms of external or internal endometriosis, infectious and inflammatory processes of the pelvic region (endometritis, salpingo-oophoritis), submucosal (submucosal), endometrial polyps, adhesions and other ailments. They are the cause of menstrual pain. Known cases of algomenorrhea on the background intrauterine device.

Algodysmenorrhea in adolescents is of a primary nature, appears with the first menstruation with a “healthy” uterus and appendages. Its causes are conditionally classified into groups:

Hormonal: algodysmenorrhea often appears against the background of hormonal dysfunction with insufficiency of the second (luteal) phase. The appearance of pain is due to the excessive influence of estrogens with an insufficient concentration of progesterone.
Endocrine: excessive contractions of the uterine muscles, eventually leading to its ischemia, are associated with a violation of the synthesis of prostaglandins - biologically active compounds that control the contractility of smooth muscles.
Neuropsychogenic: painful menstruation more often occurs in girls with a labile psyche and a low pain threshold.
Constitutional: with sexual infantilism, the uterus is hypoplastic, and its muscles are underdeveloped and poorly stretched due to the accumulation of menstrual blood.
Mechanical: menstrual pain may be associated with malformations of the genitals: partial or complete infection (atresia) of the cervical canal, incorrect position of the uterus or its underdevelopment. The presence of anomalies in the development of the genitals leads to difficulty in the free flow of menstrual blood, it accumulates in the uterine cavity, stretches it and provokes pain.

It should be noted that the concept of pain during menstruation in different patients is not the same. It is determined by the individual pain threshold. If the examination of a patient with algomenorrhea does not reveal organic pathology, there are no concomitant systemic symptoms and progression of pain intensity, we can talk about the physiological characteristics of pain perception.

Symptoms and first signs

Symptoms of such a disorder as primary algomenorrhea are not as pronounced as in secondary pathology. Therefore, the diagnosis of the disease in this case is difficult.

The main symptoms of secondary algomenorrhea depend on the cause of the development of the disorder in the patient. So, the most obvious symptoms with this violation are:

, which occurs a few hours before the onset of menstruation and can last several days, and sometimes until the end of menstruation;
copious menstrual flow;
disorders of general well-being (headache, weakness, fatigue, sleep disturbance and lack of appetite).

In some cases, the symptoms are supplemented fever body, which can be increased slightly (subfebrile condition) or to febrile indicators. Also, the symptoms of algomenorrhea can be supplemented by symptoms of inflammatory or dystrophic processes in the pelvic organs:

copious discharge from the vagina;
pain during sexual contact;
swelling of the labia and other symptoms.

Therefore, before prescribing treatment, the doctor must carefully examine the patient in order to exclude the possibility of her having other diseases that cause pain.

Diagnostics

The diagnosis is made on the basis of complaints, anamnesis and data from additional studies. The gynecologist finds out when the patient with algomenorrhea first experienced pain during menstruation, what is the duration of the pain, whether the pain is accompanied by a violation of the general condition, whether the patient with algodysmenorrhea suffers from gynecological diseases, whether there was a history of childbirth, abortion and operations on the female genital organs. During the survey, the doctor determines at what age menstruation began, what is the duration of the cycle, how often there are violations of the cycle and how heavy menstruation is.

After collecting complaints and clarifying the anamnesis, the specialist conducts a gynecological examination, takes a swab from the cervical canal, vagina and urethra. Then a woman with algomenorrhea is sent for an examination, which includes an ultrasound of the pelvic organs, general blood and urine tests, an analysis for sexually transmitted diseases and a study of hormone levels. To clarify the ultrasound data, CT and MRI of the pelvis are used. With algomenorrhea, presumably caused by polyposis and endometriosis, hysteroscopy and separate diagnostic curettage are prescribed. In some cases, laparoscopy is performed. If necessary, a patient with algomenorrhea is referred to a urologist, psychologist, psychotherapist and other specialists.

Treatment of algomenorrhea

At home, the approach to the treatment of primary and secondary algomenorrhea is unequal. To eliminate secondary algomenorrhea, it is necessary to cure the underlying disease, for the period of treatment, menstrual pain is relieved by painkillers.

Therapy of primary algomenorrhea implies the correction of all existing systemic disorders, therefore it is a lengthy process. There is no universal treatment regimen for all; for each patient, it is compiled individually according to the severity of pain and the nature of concomitant systemic manifestations.

For the treatment of primary algomenorrhea use:

Vitamins Unicap, Multitabs, Decamevit.
Antioxidants: Vitamin E in continuous mode for a long time.
Tranquilizers and sedatives: Tazepam, valerian tincture and others.
Analgesics and antispasmodics for direct action on the uterine muscles: No-shpa, Baralgin, Spazmalgon and analogues.
Preparations based on magnesium salts: Magne-B6 and analogues. It has been established that magnesium takes part in the transmission of a nerve impulse and the formation of the mechanism of muscle contractions, and in primary algomenorrhea there is a deficiency of it.
Hormonal preparations. They are prescribed for girls with signs of hormonal dysfunction and insufficiency of the luteal phase of the cycle. A hormonal examination is preliminarily performed, and the menstrual cycle is adjusted according to its conclusion.
Non-steroidal anti-inflammatory drugs: Nimesil, Naproxen, Indomethacin, Ibuprofen, Aspirin and the like. They block the excessive synthesis of prostaglandins, thereby reducing the intensity of pain. With intense pain, it is advisable to prescribe these funds two days before the onset of menstruation in order to prevent severe pain.

If the amount of estrogen remains within the normal range, the lack of the luteal phase is compensated by gestagens. A severe degree of algomenorrhea against the background of an excess of estrogen requires the appointment of monophasic hormonal agents: Logest, Lindinet, Janine and the like. The popularity of homeopathic therapy for primary dysmenorrhea is growing. In combination with drug treatment physiotherapy is also used.

Prevention

After making a diagnosis, the doctor explains to the patient what algomenorrhea is and gives recommendations to alleviate the symptoms of the disease. So, you should stop smoking, excessive consumption of sweets, carbonated drinks. When obese, you need to get rid of excess weight with the help of sports and the right diet. A few days before and during menstruation, it is advised to limit coffee. In the second phase of the cycle, preference should be given to vegetables, fruits, cereals, bran bread.

To normalize the psychological state, preparations containing magnesium and B vitamins (Neurovitan, Magnikum, Magne-B6) are needed. Doctors advise decoctions of lemon balm, motherwort, calamus root, yarrow herb for dysmenorrhea. Relieves pain mixture of royal jelly with honey. It must be kept in the mouth until completely dissolved.

For the treatment of secondary algomenorrhea, the fight against its cause is of great importance. And to eliminate pain during menstruation, anti-inflammatory and analgesic drugs are used. The prognosis depends on the accompanying pathology. If it is treatable, then the symptoms of dysmenorrhea will also disappear over time.

Treatment prognosis

If the patient is diagnosed with a disease that belongs to the primary form of pathology, the prognosis of algomenorrhea is quite favorable. You just need to slightly adjust your lifestyle, nutrition and, if necessary, undergo a little therapy.

The situation with the treatment of secondary pathology is somewhat more complicated. If the patient turned to the local obstetrician-gynecologist in time, fully passed the examination and adequate treatment, then we can expect a complete cure or at least a decrease in the intensity of pain manifestations. The end result in this case depends significantly on the severity of the disease that causes such symptoms.

The main omen of a woman is the birth of a child. And if the symptoms described above begin to bother her, she should not be delayed with going to the doctor. Pain may indicate the development of a rather serious illness in the patient's body. There is only one conclusion. If a woman carefully fulfills all the requirements of her attending physician, then there are high chances of getting rid of such a disease as algomenorrhea once and for all, as well as fulfilling the mission given to her by nature - the birth of a new person.

The main thing is to contact a specialist in time and in any case do not give up, your health, first of all, is in your hands.

Quite a lot of women and girls are faced with such a diagnosis as algomenorrhea. This disease is manifested by the appearance of spasmodic or monotonous, pulling pains during the passage of menstruation.

Algodysmenorrhea - the appearance during menstruation of sharp cramping or aching pain in the lower abdomen, in the lumbar and sacral regions of the spine, accompanied by general malaise and decreased ability to work. They are caused various reasons. Timely determination of the root cause of the pathology and conducting high-quality therapy will allow a woman to avoid even more serious problems with health.

Primary dysmenorrhea is associated with the accumulation of prostaglandins in the uterus, leading to the development of ischemia and pain. It is often noted with sexual infantilism or pathological bending of the body of the uterus. The cause of secondary algomenorrhea is inflammatory diseases of the genital organs, tumors of the uterus, endometriosis, partial infection of the cervical canal, etc.

ICD-10 code

N94.6 Dysmenorrhea, unspecified

Causes of algomenorrhea

If a woman has painful periods, you should not dismiss such a problem. Pain is a signal from the body that a malfunction has occurred in its functioning, which must be immediately eliminated. Otherwise, further progression of the disease can lead to a complex pathology with the impossibility of regression.

The causes of algomenorrhea can be quite diverse:

Endometriosis is a disease that mainly affects women. reproductive age. With this pathology, the cells of the inner layer of the walls of the uterus grow outside their layer.
Myoma - the formation of a benign neoplasm in the muscle layer of the female organ.
Adenomyosis is a rather complex inflammatory process, as a result of which there is a focal fusion of two layers of tissues of the uterine walls: myometrium ( muscle tissue walls of the uterus) and endometrium (the inner lining of the uterus).
Hyperretroflexia is the growth of segmental reflexes, which become more frequent due to a decrease in the inhibitory effect of the cerebral cortex on the segmental reflex apparatus.
Hypoplasia of the uterus is a condition in which the size of the female organ is much smaller than the norm, due to its underdevelopment.
The uterus is incorrectly located in the pelvic cavity, which entails a failure in the mechanism for the withdrawal of menstrual blood from the uterine region.
Violation of the integrity of the inner layer caused by trauma, abortion, difficult childbirth, surgery.
The cause of algomenorrhea may also lie in an infectious and inflammatory disease that affects one or more organs of the reproductive system. These include, for example, salpingoophoritis (inflammation of the uterine appendages, fallopian tubes and ovaries), both acute and chronic forms.
Physical inactivity, lack of physical activity can also cause pain symptoms.
Psychological diseases caused by increased excitability of the patient's central nervous system can provoke the development of pathology: a tendency to tantrums and hypochondria.

Symptoms of algomenorrhea

This pathology is predominantly observed in women. childbearing age quite often in infertility. The disease can be either congenital or acquired. Symptoms vary depending on the type of disease.

In the case of congenital pathology, pain symptoms begin to appear even during the puberty of a girl, while acquired is a consequence of an operation, an infectious-inflammatory disease and other factors.

The symptoms of algomenorrhea are as follows:

Sleep disturbance.
Often, the pain begins to pester a woman a few days before the onset of menstruation and stops after the start or complete completion bleeding. Pains are pulling or cramping. Their appearance can be expected in the lower abdomen, in the region of the lower back and sacrum. Gradually, irradiation of pain can develop. The woman begins to feel that the pain begins to “radiate” to the intestines, in the perineum, to affect the inner thighs.
Failures in metabolic processes.
Dry mouth.
Flatulence.
Headaches, sometimes quite severe.
Temporary disability.
Maybe increased secretion fluids produced by sweat glands.
Nausea, sometimes turning into a vomiting reflex.
Very low vitality.
Symptoms of diarrhea may appear.
Dizziness, possible fainting.
Rarely enough, but bulimia and anorexia can be observed.
An increase in body temperature to a figure of 37ºС.
Exhaustion of the nervous system, which can be observed against the background of severe pain.

Primary algomenorrhea

Doctors distinguish between primary and secondary forms of the disease. Primary algomenorrhea - it is still diagnosed as a functional pathology, does not affect the violation of the anatomical structure female organs. It begins to appear even in young girls during puberty or a year and a half after the onset of menarche (menstrual cycle).

Whereas secondary algomenorrhea develops on the basis of anatomical changes caused by trauma or one of the diseases of the internal genital organs. With this pathology, the body temperature of a woman can be significant and be accompanied by pathological secretions from the vagina, which have a characteristic unpleasant odor. In this case, the menstrual cycle can be knocked down, and the time of blood discharge will lengthen.

The considered pathology is divided into three types according to functionality:

Spasmodic algomenorrhea, accompanied by spasms of a sufficiently high intensity (there is an intense contraction of the smooth muscles of the uterus).
Essential algomenorrhea. Mostly this congenital pathology associated with a very low sensitivity threshold in women.
Psychogenic algodismenorrhea is diagnosed in most cases in an adult of the fair sex, if she suffers from any mental illness, or in a girl during puberty - this may be due to the fear of the first menstruation.

Symptoms of primary algodismenoria are similar to those listed above. Their complex is individual for each woman suffering from this pathology. To the already existing list, you can add:

Hiccups.
Drowsiness.
Syndrome of "cotton legs".
Possible swelling.
Dislike of certain odors.
Aversion to certain foodstuffs.
Numbness of the lower and / or upper limbs.
Skin itching.

Pain in primary algomenorrhea has a cramping character. The predominant localization is down the abdomen and the lumbar region, much less often it can be felt in the groin and in the area of the external genital organs.

If a woman - a girl is concerned about these symptoms, accompanied by pain in the designated places, you should not postpone going to the doctor - gynecologist. It is he who is able to establish a diagnosis, attributing it to a primary or secondary pathology. But only by making the correct diagnosis, you can count on a positive outcome of treatment.

Can contribute to the development of algodismenoria early term the beginning of the menstrual cycle, failures in its course (a long period of blood discharge). Not the last place in the appearance of this pathology is the presence of bad habits in a woman: smoking, alcohol, physical inactivity. No matter how sad it sounds, but today the majority of women who have not yet given birth suffer, to one degree or another, from primary algomenorrhea. This fact is very frightening for physicians, because subsequently, if appropriate therapeutic measures are not taken in a timely manner, the progression of this pathology can become an obstacle to the desire of a young woman to become a mother.

Diagnosis of algomenorrhea

Making the correct diagnosis is perhaps one of the key points in treatment. After all, how correctly the cause of the disease is established, the prescribed therapy also depends. An incorrect diagnosis, therefore, an incorrect approach to treatment, and as a result, the patient, at best, is not waiting for a solution to his problem, and at worst, getting a complication from incorrectly prescribed medications.

Diagnosis of algomenorrhea includes the following studies:

Questioning the patient about her complaints, and how long they bother her, and what symptoms accompany the pain during the passage of menstruation. Already at this stage, a qualified specialist is able to make an assumption about the presence of a pathology of a certain direction.
Examination by a gynecologist.
Identification of a gynecological history: the presence of specific diseases, hereditary predisposition. The doctor is trying to get information about whether the mother, grandmother of the patient suffered from this disease. How early the first menstruation passed, the presence of surgical interventions affecting the genitals and other organs of the small pelvis. Knowledge of the abundance of discharge during menstruation and the nature of pain symptoms are also essential.
Ultrasound examination of the pelvic organs.
Calposcopy or hysteroscopy is a diagnostic procedure that allows you to visually examine the condition of the entrance to the vagina, the mucous membrane of its walls and the cervix close to the vagina. The study takes place using a colposcope or, accordingly, a hysteroscope - a special medical device consisting of a binocular and an illuminating lamp.
Polymerase chain reaction (PCR) is a high-precision information method for molecular genetic research. It makes it possible to identify various infectious and hereditary diseases in the examined patient (both in the acute and chronic stages).
Taking a smear from the vagina, cervical canal and urethra. Microbiological examination of its flora.
Establishing the level of hormones in a woman's blood during the first and second phases of a woman's physiological cycle.
Laparoscopy is a method of endoscopic surgery that allows you to examine the organs of the abdominal cavity.
A consultation with a psychotherapist or psychologist is required.

Primarily, specialist studies are aimed at identifying secondary pathology, and only if the diagnosis of algomenorrhea made it possible to exclude it, the patient is diagnosed with primary algomenorrhea, which is essential for determining treatment methods.

It is unlikely that anyone will argue that timely and professional diagnosis is a guarantee effective therapy, and the basis of any treatment course.

Treatment of algomenorrhea

The treatment of secondary algomenorrhea is aimed, at the first stage, at eliminating the identified organic changes in the uterine cavity and small pelvis by hysteroscopy and laparoscopy methods (separation of adhesions, removal of endometriosis foci, correction of the incorrect position of the uterus, etc.), which can significantly reduce pain. At the second stage, if necessary, the use of conservative therapy methods used in the treatment of primary algomenorrhea (inhibitors of prostaglandin synthesis, progestin or combined estrogen-progestin drugs, antispasmodics, analgesics) is shown.

The diagnosis is made, and treatment can begin. If the disease is defined as a primary pathology, then the treatment of algomenorrhea begins with the attending physician - a gynecologist, usually with antispasmodics and hormonal drugs. For example, it can be buskopan, flexen, no-shpa, oki and many others.

An anesthetic drug that effectively relieves muscle spasms - Buscopan is prescribed for oral administration (orally). The recommended dosage for adult patients and children who are already six years old is three doses throughout the day, one to three tablets.

If the gynecologist has prescribed another method of drug administration - rectal, in this case, this drug is used in the form of suppositories, which are used in the same age category three times a day. Before use, the rectal suppository is removed from the sealed shell and brought in with a beveled edge. The duration of the course of treatment is controlled by the attending physician and, if necessary, can extend it.

Refusal to use this drug can be: angle-closure glaucoma diagnosed in a patient, pulmonary edema, myasthenia gravis (an autoimmune disease manifested by weakness and pathological fatigue of skeletal muscles). These are atherosclerosis that affected the capillaries of the brain, megacolon (a malformation described as an anatomical increase in the size of the colon), as well as individual intolerance to hyoscine-N-butyl bromides or other components in the composition of the drug.

No-shpa is attributed to the patient in the form of tablets or a solution for subcutaneous or intramuscular injections.

In the form of tablets, the medicine is used by the patient two to three times a day, 40 to 80 mg after the main meal. And in the form of injections of 2%, the drug is administered rather slowly two to three times throughout the day in an amount of 2 to 4 ml (for one injection).

Medicine has its contraindications. This:

Arterial hypertension.
Stable increase in blood pressure immediately before the onset of menstruation.
Bronchial asthma.
Pylorospasm is a spastic contraction of the muscles of the pyloric part of the stomach, causing difficulty in emptying it.
Angina.
Ulcerative manifestations on the mucous membrane of the digestive tract.
Colitis, including spastic nature.
Cholelithiasis.

If a young girl does not have a regular sexual life, NSAIDs (non-steroidal anti-inflammatory drugs), mainly selective COX-2 inhibitors, are usually prescribed. These include: celebrex, celecoxib.

A highly selective cyclooxygenase-2 inhibitor, Celebrex is prescribed for use by a doctor twice a day at a dosage of 0.2 g.

It is recommended to take Celebrex twice a day, 0.2 g of the drug. If there is enough activity muscle spasms, the attending physician may prescribe to the patient a single dose in an amount of 0.4 to 0.6 g of the drug. After removal acute pain, it is desirable to return to the recommended dosage of 0.2 g.

If a woman has a history of a problem with kidney function, daily amount the drug taken should be halved. At liver failure the recommended dosage of the drug should not be adjusted.

Celebrex contraindications include a tendency to allergic manifestations, hypersensitivity or complete intolerance to the components of this drug or sulfonamides. And also if a woman or a girl underwent surgery to install a coronary bypass graft or the fair sex is in the third trimester of pregnancy.

Non-selective NSAID drugs used in the treatment of algomenorrhea include faspic, ibuprofen, buran, nurofen, which show pronounced anti-inflammatory and analgesic characteristics.

The dosage of Ibuprofen is prescribed purely individually and depends on the level of manifestation of pain symptoms. Mostly for adult patients and girls who are already 12 years old, the doctor prescribes one or two tablets, administered three to four times a day, immediately after meals. In acute pain or a complex course of the disease, the attending physician may decide to increase the dosage: three tablets taken three to four times a day, which corresponds to the daily intake of ibuprofen ( active substance drug) in the amount of 1.8 - 2.4 g. Maximum daily dosage should not be higher than 2.4 g.

You should not take this drug if a woman is ill with one of the following pathologies:

Ulcerative and erosive lesion mucosa of the digestive tract.
Bronchial asthma.
Ulcerative colitis of a nonspecific form of manifestation.
Leukopenia - a reduced number of leukocytes contained in the blood of a woman (less than 4000 in 1 μl of peripheral blood).
thrombocytopenia.
Dysfunction of the kidneys and / or liver in severe form.
Hypertension.
Dysfunction of the heart muscle.
A disease that affects the optic nerve.
Pregnancy and lactation.
Hypersensitivity to non-steroidal anti-inflammatory drugs or other components of the drug.

Hormonal drugs are prescribed by a gynecologist depending on the age of the patient and whether she has a permanent sexual partner. If a woman regularly lives sexually, then she is mainly prescribed hormonal drugs that have the status of contraceptives. The modern pharmacological market is represented by a wide range products of this category, but in the treatment of algomenorrhea, the advantage of prescribing belongs to low-dose oral contraceptives.

To those used in such a situation medicines, belonging to the medicine of the third generation, can be attributed mersilon, femoden, zhanin and others.

Method and schedule for taking microdosed ethinyl estradiol in combination with a progestogen chemical element can be found in any instructions attached to a hormonal contraceptive prescribed by a gynecologist.

For example, Jeanine is administered orally, washing down the dragee with a sufficient volume of water. Reception is carried out once a day at a certain time, which must be strictly adhered to. The duration of the treatment course is 21 days, after which it is kept for seven days without injection. Do not skip doses - this significantly reduces the effectiveness of treatment.

Jeanine is not prescribed for women with severe liver pathology, with hypersensitivity to any of the components of the drug, if the patient has thrombophlebitis or a tendency to thrombosis, diabetes, arterial hypertension, pancreatitis, malignant neoplasm affecting the liver, bleeding affecting the female reproductive system. Jeanine is also not taken during pregnancy or when a young mother is feeding her newborn baby.

In addition to the therapy described above, a woman suffering from algomenorrhea receives general strengthening therapy. Under these terms, the intake of vitamins is hidden (this especially applies to their B6 and E group affiliation), as well as minerals and trace elements. In this situation, the presence of magnesium ions is especially necessary.

If a secondary algomenorrhea is diagnosed, then, depending on the primary source, it may be necessary to include in the therapy a surgical intervention performed on the organs of the woman's reproductive system. The operation makes it possible to eliminate the anomaly in structural structure one of the reproductive organs. If the operation is performed, then immediately after its completion, the obstetrician-gynecologist prescribes antibiotics, and then other medications described above.

To get the fastest effect, in the protocol complex therapy connect and a number of physiotherapy. In this situation, electrophoresis performed on a woman in the second half of the menstrual cycle works great.

Drugs for algomenorrhea

The essence of any therapy is the elimination of the cause of the pathology or, in extreme cases, its symptomatic manifestation. To stop or reduce the intensity of pain, drugs for algomenorrhea are prescribed from the group of analgesics. For example, it can be sedal-M, pentalgin, ketonal, spasmol, efferalgan, baralgin M, analgin, panadol. With severe pain symptoms, complex medicines are suitable, for example, baralgetas, took, spazgan or pazmalgon.

If the cause of pathological pain in a woman is one of the diseases affecting the psychological area of \u200b\u200bthe woman's health, which is caused by increased excitability of the central nervous system (a tendency to tantrums and hypochondria), tranquilizers are prescribed to such a patient. This category of drugs is designed to stabilize the mental state of a woman. These drugs include: valium, chlordiazepoxide, xanax, hydroxyzine, diazepam, clobazam, triazolam, lorazepam, alprazolam, librium, frisium, elenium, phenazepam, bromazepam, seduxen, atarax, relium, oxylidine.

The dosage of Diazepam (Diazepamum) is prescribed to patients individually and based on the severity of the diagnosed disease. The drug is taken twice a day. A single amount of the administered drug can be administered in the range of 4 to 15 mg. At the same time, the maximum allowable daily volume of the administered drug should not exceed 60 mg (and this dose is prescribed by the attending doctor only if the woman is in a hospital, so that it is possible to constantly monitor her condition).

If necessary, intramuscular or intravenous administration, the doctor prescribes injections or invasion with a volume of 10 - 20 mg of the drug.

It is strictly forbidden to introduce this drug into the treatment protocol if a woman is diagnosed with myasthenia gravis, liver and / or kidney dysfunction, angle-closure glaucoma, and also if the body shows increased intolerance to the constituent components of diazepam or the patient is pregnant.

If an adult woman who seeks advice has regular sexual intercourse, then in order to stop the spasmodic pain that bothers her and the accompanying symptoms, hormonal drugs classified as low-dose contraceptives are prescribed. It can be microgynon, yarina, novinet, logest, marvelon, belara, miranova, regulon, silest, triregol.

Yarin is administered orally in the form of a dragee, which is washed down with a sufficient volume of water. Reception is carried out once a day at a certain time, which must be strictly adhered to. The duration of the treatment course is 21 days, after which it is kept for seven days without injection. Do not skip doses - this significantly reduces the effectiveness of treatment.

This contraceptive is not prescribed for women with severe liver pathology, with hypersensitivity to any of the components of the drug, in case of arterial hypertension, diabetes mellitus, the patient has thrombophlebitis or a tendency to thrombosis, pancreatitis, a malignant neoplasm affecting the liver, bleeding affecting the female reproductive system . Yarina is not accepted during pregnancy or when a young mother is feeding her newborn baby.

But still, the preferred method of therapy is taking two to three days before the expected monthly inhibitors of the production of prostaglandin synthetase, which in medicine are combined into a group of non-steroidal anti-inflammatory drugs. This group includes: nifluril, kaksulindak, orthofen, ketazon, indomethacin, voltaren, ketoprofen, donalgin, revodin, mefenamic acid, metindol, butadione, surgam, reopyrin, pirabutol, piroxicam.

Mostly adult patients and girls who are already 14 years old, the doctor ascribes a single dosage that falls in the range from 0.25 to 0.5 g, taken three to four times throughout the day. The maximum daily dosage should not exceed 3.0 g. If the expected effect is achieved, then to maintain it at the required therapeutic level, it is enough to reduce daily intake, bringing up to 1.0 g.

If premenstrual pains torment a girl under 14 years old who has already had her period, then mefenamic acid is taken at 0.25 g three to four times throughout the day. The recommended duration of treatment is from 20 to 45 days, and with medical indications and longer.

This drug should not be taken by women with a history of peptic ulcer of the stomach and duodenum, renal pathology, problems with hematopoiesis, diseases caused by inflammation in one of the organs of the digestive tract, as well as in case of individual intolerance to the components of the drug in question.

The main principle of such therapy is the prevention of the occurrence of pain symptoms. And if pain is still felt during the onset of menstruation, then, while taking inhibitors of prostaglandin reproduction, its intensity is significantly lower than without the introduction of such drugs.

With severe pain, drugs of the same group will be more effective, but combined action. These include veralgin, baralgin, spazgin, trigan, spazmalgin, maxigan, spazmalgon, minalgan.

Baralgin does not depend on the time of eating and is prescribed one - two tablets two - three times during the day. With very strong spasmodic pains, baralgin in the form of injections or invasions is administered slowly in an amount of 2–5 ml intravenously or intramuscularly. The treatment course is usually three to four menstrual cycles.

Monogestagens also showed high efficiency of administration: norkolut, acetomepregenol, dydrogesterone, norethisterone, turinal, orgametril and dufaston. Preparations of this group are usually prescribed for admission, starting from the 14-16th day of the menstrual cycle to the 25th day. In this case, the drug is administered once a day, at the same time, with a dosage of 5 to 15 mg.

Remove from the diet foods that include stabilizers, dyes, preservatives and other chemicals.

Refusal of bad habits and eating at fast food outlets.

Compliance with the rules of personal hygiene.

Moderate physical exercise, which are interspersed with a good rest.

Minimize the amount of strong coffee and tea consumed.

For pleasure, do morning exercises, light jogging.

It is advisable to visit the pool and / or fitness.

If you experience unpleasant symptoms, do not postpone going to a specialist. Timely diagnosis and careful implementation of the doctor's recommendations in the course of treatment.

Prevent infectious and inflammatory diseases that affect the pelvic organs.

Monitor your weight.

Preferably twice a year preventive examination at the gynecologist.

Inattention to one's health is simply a crime against nature. After all, it would seem that such a harmless algomenorrhea, if ignored, can ultimately lead to infertility and deprive a woman of the chance to become a mother.

Forecast of algodismenorrhea

The situation with the treatment of secondary pathology is somewhat more complicated. If the patient turned to the local obstetrician-gynecologist in time, underwent a complete examination and adequate treatment, then we can expect a complete cure or at least a decrease in the intensity of pain manifestations. The end result in this case depends significantly on the severity of the disease that causes such symptoms.

The main thing is to contact a specialist in time and in any case do not give up, your health, first of all, is in your hands.

It is important to know!

Hypermenstrual syndrome - an increase in the volume and duration of menstruation up to constant bleeding. The development of hypermenstrual syndrome can be associated with both delayed rejection of the thickened uterine mucosa against the background of a relative or absolute excess of estrogens, and delayed regeneration at the end of the next menstruation.

- painful menstruation, accompanied by a violation of the general condition. Occurs with anomalies in the development of the uterus, hormonal disorders, increased excitability of the central nervous system, organic lesions of the uterus due to certain inflammatory and non-inflammatory diseases, abortions and complicated births. Algodismenorea is characterized by aching or cramping pains in the lower abdomen in the first days of menstruation. Weakness, nausea, edema, headaches, dizziness, sweating, stool disorders and decreased performance are possible. The diagnosis is established on the basis of anamnesis, complaints and data objective research. Treatment tactics depend on the cause of the disease.

General information

Algodysmenorrhea - cramping or aching pain in the first days of menstruation, arising against a background of general malaise. It is a widespread disease, detected in 30-50% of women of reproductive age. In every tenth case, it is accompanied pronounced violation working capacity. It can be primary (essential) or secondary (symptomatic). Primary algomenorrhea manifests itself in adolescence. As a rule, it is not associated with diseases of the female genital organs. Secondary algomenorrhea usually develops after 30 years on the background of inflammatory or non-inflammatory gynecological diseases, after complicated childbirth, rough abortions, etc. Treatment is carried out by specialists in the field of gynecology.

Causes of algomenorrhea

The reasons for the development of primary algomenorrhea can be mechanical, endocrine, neuropsychogenic and constitutional. Among the mechanical causes include abnormalities in the development of the uterus, violations of the position of the uterus (hyperanteflexia), cervical atresia and others. pathological conditions, creating an obstacle to the normal outflow of menstrual blood. endocrine cause algodysmenorrhea is an excessively active synthesis and a slow process of disintegration of prostaglandins.

Prostaglandins increase the contractility of the muscular layer of the uterus, cause spasm of the arterioles, which leads to a deterioration in the blood supply to the myometrium, and act on the nerve fibers in the wall of the uterus, increasing their sensitivity to pain. Prolonged vasospasm, increased uterine contractions and increased pain sensitivity provoke pain. Other symptoms of algomenorrhea are also associated with an increase in the level of prostaglandins: nausea, diarrhea, palpitations, chills, hyperhidrosis, dizziness, etc.

Among the neuropsychogenic causes of the development of algomenorrhea, experts call an individual decrease in the threshold of pain sensitivity, a hidden rejection of one's own female essence, the denial of the sexual aspects of life and of herself as a woman and mother. constitutional cause the occurrence of algomenorrhea is infantilism. Hypoplasia of the uterus 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 onset of pain.

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

Cell separation is accompanied by irritation of a large number of nerve fibers in the wall of the uterus, peritoneum, other organs and tissues containing heterotopic endometrial cells, and causes a sharp increase in the level of prostaglandins. The release of prostaglandins provokes intense pain and general malaise. In many patients, secondary algomenorrhea develops against the background of submucosal uterine fibroids. Myoma prevents the outflow of menstrual blood, the uterus begins to contract more intensively, the pressure in its wall rises, the nerve fibers are irritated, prostaglandins are released, and pain appears.

Algomenorrhea also often appears in inflammatory diseases, especially chronic, long-term ones. 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 tissue swelling and compression of nerve fibers and in itself causes pain, aggravated by uterine contractions.

In some cases, algomenorrhea develops after the installation of an intrauterine device that stimulates the production of prostaglandins. In some patients, the symptoms of algomenorrhea appear after a rough curettage during an abortion or after a complicated birth. The cause of algomenorrhea in such cases is a rupture of the posterior leaf of the broad ligament of the uterus or varicose veins of the small pelvis. Sometimes, with secondary algomenorrhea, there is a separation of the “cast of the uterus” - a condition in which the functional layer of the endometrium does not undergo melting in the uterine cavity, but leaves it in the form of a whole film. The release of such a film is accompanied by very intense cramping pains.

Symptoms of algomenorrhea

Primary algomenorrhea is usually detected in sensitive, emotionally unstable girls of asthenic physique with a tendency to underweight. Secondary algomenorrhea is more often diagnosed in women over the age of 30 years. In the anamnesis, the patients revealed abortions, intrauterine device installation, 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 worsening of the general condition. Pain syndrome with algomenorrhea occurs simultaneously with the onset of menstruation or a few hours before it begins. The pains are often cramping, less often - pulling, aching or arching. Possible irradiation to the lumbar region, groin, perineum, rectum, or upper part inner surface hips. The intensity of the pain syndrome in algomenorrhea may vary. Both moderate pains are possible, which do not have a significant effect on working capacity, are well eliminated by conventional analgesics or antispasmodics, and extremely intense, requiring professional medical care.

Violation of the general condition with algomenorrhea is manifested by vegetative-vascular, metabolic and emotional-psychological disorders. Shortly before the onset of menstruation and in the first days of menstruation, a woman suffering from algomenorrhea becomes touchy and irritable, overly worried 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 in algomenorrhea are manifested 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-syncope, pain and discomfort in the region of the heart, an increase or decrease in heart rate, extrasystoles, numbness and coldness of the extremities. Metabolic disorders in algomenorrhea indicate pruritus, increased urine output, general weakness, feeling of weakness in the legs and flying pains in the joints.

In diseases of the female genital organs, the clinical picture of algomenorrhea may become somewhat more complicated or modified due to the overlapping symptoms of the underlying disease. Depending on the characteristics of the course, two forms of algomenorrhea are distinguished - compensated and decompensated. In patients with a compensated form of the disease, the symptoms remain stable for many years. In patients with a decompensated form, increased pain and aggravation of general condition disorders over time are detected.

Diagnosis of algomenorrhea

After collecting complaints and clarifying the anamnesis, the specialist conducts a gynecological examination, takes a swab from the cervical canal, vagina and urethra. Then a woman with algomenorrhea is sent for an examination, which includes an ultrasound of the pelvic organs, general blood and urine tests, an analysis for sexually transmitted diseases, and a study of hormone levels. To clarify the ultrasound data, CT and MRI of the pelvis are used. With algomenorrhea, presumably caused by polyposis and endometriosis, hysteroscopy and separate diagnostic curettage are prescribed. In some cases, laparoscopy is performed. If necessary, a patient with algomenorrhea is referred to a urologist, psychologist, psychotherapist and other specialists.

Treatment of algomenorrhea

Treatment of algomenorrhea is carried out in outpatient settings. The classic method of treatment is pharmacotherapy in combination with physiotherapy. In the presence of gynecological diseases, tactics are determined depending on the underlying pathology. Patients with algomenorrhea are prescribed non-steroidal anti-inflammatory drugs that inhibit the synthesis of prostaglandin synthetase. It is recommended to start taking drugs for algomenorrhea 2-4 days before the onset of menstruation and stop 2-4 days after it starts. Aspirin, paracetamol, ibuprofen, naproxen, diclofenac and their analogues are used.

With algomenorrhea, combined agents are also widely used, which include an analgesic and an antispasmodic. If algomenorrhea 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. In the absence of the effect of analgesics and antispasmodics, patients with algomenorrhea are prescribed oral contraceptives containing ethinylestradiol and levonorgestrel.

In the second phase of the cycle or shortly before the onset of menstruation, patients with algomenorrhea are referred for phonophoresis and electrophoresis with sodium bromide, magnesium sulfate, trimecaine or novocaine. Patients with algomenorrhea are prescribed short-wave diathermy, diadynamic currents and ultrasound. Some specialists use reflexology. In the presence of psychoemotional disorders, treatment by a psychologist or psychotherapist is indicated. Patients with algomenorrhea are provided with psychological support, sedatives are prescribed, relaxation techniques are taught, explanatory conversations are held about the nature of algomenorrhea and its safety for life.

Women suffering from algomenorrhea are advised to give up bad habits, avoid drinking strong caffeinated drinks, normalize the daily routine, eliminate stress factors if possible, reduce weight (in case of excess body weight), observe balanced diet, keep moderate physical activity. Primary dysmenorrhea usually responds well to treatment. The prognosis for secondary algomenorrhea depends on the type and characteristics of the course of the underlying disease.