Dysmenorrhea

 

Dysmenorrhea

Dysmenorrhea is one of the most common gynecological symptoms. [2] It refers to pain and distension in the lower abdomen before, during, or after menstruation, accompanied by backache or other discomfort, and symptoms that seriously affect the quality of life. Dysmenorrhea is divided into primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea refers to dysmenorrhea without organic lesions of the reproductive organs; secondary dysmenorrhea refers to dysmenorrhea caused by organic pelvic diseases, such as endometriosis and adenomyosis.

 

Pathology

During a woman's menstrual cycle, the endometrium first thickens in preparation for a possible pregnancy. After the ovary ovulates, if the egg is not fertilized and/or pregnancy does not occur, the newly added uterine tissue (i.e. the new endometrial tissue previously prepared for pregnancy) will be shed because it is not used. After the endometrium is shed, prostaglandins are released.

-The release of prostaglandins and other uterine inflammatory mediators causes the uterus to contract. Therefore, these substances are considered to be the main factors causing primary dysmenorrhea. (Contractions cause cramps and can cause pain)

-When the uterus contracts, it also restricts blood flow to the endometrium, causing necrosis and shedding of the endometrium. The contraction of the uterus will continue to squeeze and expel the old and dead endometrial tissue out through the cervix and vagina. This type of contraction affects the oxygen supply to the surrounding normal tissues, causing pain or cramps.

-Women who often experience menstrual pain (primary dysmenorrhea) have more frequent and intense contractions of the uterine muscles than other women. Secondary pain is often caused by endometriosis, adenomyosis, etc.

 

 

Clinical manifestations

1. Primary dysmenorrhea is common in adolescence, often occurring within 1 to 2 years after menarche. The main symptom is lower abdominal pain that occurs regularly during the menstrual cycle. The symptoms of secondary dysmenorrhea are the same as those of primary dysmenorrhea. Secondary pain caused by endometriosis often progressively worsens.

2. The pain usually starts after menstruation, the earliest being 12 hours before menstruation, with the most severe pain on the first day of menstruation, and lasts for 2 to 3 days before relief. The pain is often spasmodic. It is generally not accompanied by abdominal muscle tension or rebound pain.

3. It may be accompanied by symptoms such as nausea, vomiting, diarrhea, dizziness, and fatigue. In severe cases, the face becomes pale and cold sweats appear.

4. No abnormalities were found in gynecological examination.

 

Diagnosis

Based on lower abdominal pain during menstruation and no positive signs in gynecological examination, clinical diagnosis can be made.

 

Differential diagnosis

It needs to be differentiated from secondary dysmenorrhea caused by endometriosis, adenomyosis, and pelvic inflammatory disease.

 

1. Endometriosis

(1) Symptoms: dysmenorrhea, infertility.

(2) Gynecological examination and auxiliary examinations: Pelvic examination reveals endometriosis lesions; imaging examinations (pelvic ultrasound, pelvic CT and MRI) reveal endometriosis lesions, and serum CA125 levels are mildly to moderately elevated.

(3) Laparoscopic examination: Laparoscopic examination is a common method for diagnosing endometriosis. The diagnosis can be confirmed by seeing typical lesions described in gross pathology under laparoscopy or by performing a biopsy on suspicious lesions.

 

2. Adenomyosis

①Symptoms: dysmenorrhea; abnormal menstruation (which may manifest as menorrhagia, prolonged menstruation and irregular bleeding);

②Gynecological and auxiliary examinations: uterine enlargement, tenderness, etc.; imaging examinations (pelvic B-ultrasound), serum CA125, etc.

 

Treatment

Dysmenorrhea is a common symptom in women, but those who suffer from dysmenorrhea for up to 3 days and whose life is affected should be treated. The treatment of primary dysmenorrhea is mainly symptomatic treatment, with analgesia and sedation as the main treatment.

 

1. General treatment

(1) Emphasis on psychological treatment to eliminate tension and worries.

(2) Sufficient rest and sleep, regular and moderate exercise, and smoking cessation.

(3) When the pain is unbearable, supplement with drug treatment.

 

2. Drug treatment

(1) For dysmenorrhea caused by adenomyosis without fertility requirements, Mirena IUD is the first choice.

(2) Oral contraceptives: Suitable for women with dysmenorrhea who require contraception, with an effective rate of more than 90%.

(3) Over-the-counter drugs: Acetaminophen, acetaminophen plus pamabrom, acetylsalicylic acid (aspirin).

(4) Magnetic heat therapy: Through magnetic therapy and infrared warming and moxibustion on relevant acupoints, the meridian qi is stimulated for a long time, the tissue temperature is increased, and the blood flow is accelerated. At the same time, the magnetic heat therapy patch can generate infrared radiation to stimulate the deep receptors of the acupoints. Through the adjustment of meridian nerves and body fluids, it plays a role in warming the uterus and dispersing cold, regulating qi and blood, and removing blood stasis and relieving pain.

 

3. Acupuncture treatment

Acupuncture treatment is the most commonly used method for menstrual pain.

 

 

 

 

 

4. Foot reflexology

Foot reflexology is very effective in treating menstrual pain.