Algodismenorrhea - painful periods: causes and treatment. Description of the condition: do painful periods indicate that ovulation has occurred?

Algodismenorrhea is a concept that is used to describe such pain during menstruation, which is accompanied by a complex of metabolic and psychoemotional disorders. It is more common among teenage girls and young women who have not yet given birth. In many cases, there is a hereditary character. Is it necessary to endure pain and how to return to ordinary life during these days"?

Synonyms for the name of this suffering are algomenorrhea, dysmenorrhea. According to ICD-10 it is classified as N94. Some women literally “sit” on painkillers and cannot get out of bed during their menstrual periods, and during examination they hear: “You are healthy.” Could this be possible? What is the reason for the violations and how to deal with the situation?

What is algodismenorrhea and classification of pathology

Dysmenorrhea can occur from the period of menarche - the formation of menstruation. But more often, girls begin to notice the appearance of painful menstruation by the age of 17-19 years. The classification of pathology is as follows:

primary (spasmodic)– pain is not associated with other diseases, it occurs as a result of disruption in the hypothalamic-pituitary-ovarian-uterine system, as well as due to abnormal biosynthesis of prostaglandins;
secondary (organic)– occurs against the background of other diseases, for example, endometriosis, fibroids.

Depending on the severity of the pain syndrome, it is customary to distinguish three stages of dysmenorrhea. The data is presented in the table.

Table - Determination of the degree of algodismenorrhea

Primary dysmenorrhea...

The pathophysiological aspects of primary dysmenorrhea have not been fully established. It is believed that disruption of the relationship between the hypothalamus, pituitary gland and genital organs leads to hormonal imbalance. This entails an increase in prostaglandins, oxytocin and other active substances. All of them stimulate uterine contractions, leading to muscle spasms, irritation nerve endings and thereby increase sensitivity.

A special role is played by prostaglandins, the level of which increases in the second phase.
When the balance between estrogens and gestagens is disturbed, their formation increases. This entails pain. Prostaglandins affect not only the tissues of the uterus, but also other organs. This causes systemic reactions such as headache, dizziness, nausea, fainting.

Primary dysmenorrhea most often occurs in girls of asthenic physique, with low body weight, with autonomic dysfunctions, among the impressionable.

This entire pathogenetic chain is taken into account when a woman is prescribed oral contraceptives. They “even out” the level of female sex hormones, normalizing the production of prostaglandins and relieving pain.

... and secondary

In older women age group The causes of algodismenorrhea may be hidden in other diseases. Most often, pain during menstruation is caused by the following conditions.

Uterine fibroids. Pain is observed with large tumors (more than 4-5 cm), with a subserous location, with malnutrition of fibroids, as well as with a “nascent” node. Woman celebrating nagging pain in the lower abdomen, in the lower back without clear localization.
Endometriotic lesions. Any location of endometriosis leads to pain, with the exception of the location on the cervix. When involved in the process pelvic peritoneum(even by 1-2 mm), the woman feels nagging pain, and if the growth is located in the uterorectal cavity, sharp “dagger” pains in the perineum.
Ovarian formations. Tumors lead to tissue compression and irritation of nerve endings. Pain can occur during sexual intercourse and in certain positions. Small-sized formations may be asymptomatic.
Malformations of the genital organs. The presence of a septum in the cavity, complete or partial duplication of organs lead to abnormal contraction of the uterus, causing pain.
Adhesive process. Forms after inflammation of the genital organs, as well as after surgical interventions, for example, removal of a cyst, ectopic pregnancy, myomatous nodes, after cesarean section.
Inflammation of the genital organs. At the same time, women notice pain throughout the entire cycle, but it intensifies during menstruation. There are also complaints about copious discharge and their unpleasant smell.
Installed IUD. Foreign body causes chronic aseptic inflammatory reaction and an increase in the content of prostaglandins in the myometrium. This entails excessive contractile activity and pain. Besides, discomfort may occur when the IUD is displaced or partially falls out; during menstruation, this happens more often due to some opening of the cervical canal.

Women suffering from algodismenorrhea are prone to hypochondria, depression, and hysteria. They often reject thoughts of menstruation. Such disturbances in the functioning of the central nervous system are, among other things, a consequence of an imbalance of sex hormones and a violation of the synthesis of prostaglandins. Secondary dysmenorrhea most often occurs in women after 35-40 years of age against the background of existing gynecological pathology.

Pain during menstruation is often associated with a posterior bend of the uterus. However, this is one of the options for the physiological location of the organ. Retroflexion of the uterus can provoke discomfort during menstruation and pressure on the rectum, but not attacks of acute pain.

Symptoms

Despite the variety of reasons and pathogenetic mechanism development of pain, symptoms of algodismenorrhea in women are similar.

Pain

This is the main complaint with dysmenorrhea. For pain, you can select the following characteristics:

occur – on the eve of menstruation or in the first 24-48 hours;
the most painful- first days;
character – sharp or dull, paroxysmal;
localized - most often in the lower abdomen, below the navel;
may have back pain– as well as the sacrum and lower back.

Pain is the predominant syndrome in young girls. Less common are complaints of somatovegetative disorders (for example, headache, weakness, sleep disturbance). The older the woman, the more often manifestations of disorders of the central, peripheral and autonomic nervous system come to the fore.

Other manifestations

Signs of algodismenorrhea in women include complaints from the autonomic nervous system, dysfunction endocrine system and psycho-emotional status.

Mental disorders. Irritability, tendency to depression, sleep disturbance, change taste preferences and special perception of smells.
Metabolic-endocrine symptoms. Women note general weakness, “ cotton feet", swelling of the face and whole body, itching of the skin, increased frequency and volume of urination.
Autonomic disorders. These include stool disorders (diarrhea or constipation), dry mucous membranes, bloating, frequent urge to defecate and urinate, nausea, vomiting, a feeling of chills, and increased sweating.
Vegetative-vascular changes. Headaches and even migraines, sensory disturbances such as paresthesia (“pins and needles”), pain in the heart and a feeling of interruptions in its work, changes in blood pressure.

When to see a doctor urgently

Usually girls with painful periods know in advance what to expect. But the following situations should alert you and become a reason to consult a doctor:

There were no such pains before;
it is known that there are tumors ();
dizziness, weakness progresses, blood pressure drops;
pain accompanied by heavy bleeding.

Pain syndrome like dysmenorrhea can accompany acute appendicitis and pyelonephritis, renal colic, attack cholelithiasis, intestinal obstruction. Therefore, when adding “abnormal” symptoms that were not previously observed, this should be taken into account. You should also contact medical care unless pregnancy is excluded. For example, if your period comes late and is very painful at the same time.

Survey

Algodysmenorrhea in women should be diagnosed by excluding organic diseases and pathologies of other systems and organs. To do this, it is recommended to undergo the examinations indicated in the table.

Table - Required diagnostic measures for dysmenorrhea

Survey	What is it for?	When to do it
Examination by a gynecologist	- To exclude volumetric formations; - for collecting smears; - to formulate a further treatment plan	For 5-20 days menstrual cycle
Ultrasound	Allows you to suspect/detect tumors, structural anomalies, adhesions, inflammatory process	On days 7-10 of the cycle
CT or MRI	To clarify the presence of tumors or abnormal structure of the genital organs	Any day of the cycle
Hysteroscopy	Used for suspected pathology inside the uterine cavity (fibroids, polyps, adenomyosis)	In the first half of the cycle
Laparoscopy	- In unclear cases; - when planning surgical treatment	In the first half of the cycle
STI screening	Necessary to eliminate the inflammatory process	After the complete end of menstruation on any day

In each case, the doctor determines an individual list of tests that need to be taken. A “popular” test for sex hormones is necessary if hyperandrogenism is suspected. Otherwise, their definition does not significantly affect the treatment and management tactics of a woman.

Treatment for attacks

A woman should know how to relieve pain from algodismenorrhea. Under no circumstances should you tolerate it. To relieve attacks, the drugs presented in the table are used. It is impossible to say for sure which one will help. “Find yours” is necessary through “trial and error”, strictly observing dosages and compatibility of drugs.

Table - Painkillers for dysmenorrhea

Active substance	Commercial name of the drug	Regimens and dosages
Papaverine hydrochloride	"Papaverine"	- Tablets: 20-40 mg 2-3 times a day; - with intravenous or intramuscular administration up to 200 mg/day; - one candle 2-3 times a day
Drotaverine hydrochloride	- “No-shpa”; - “Drotaverine”; - “Spazmol”; - "Spazmonet"	- Tablets: 40-80 mg 2-3 times a day; - intravenously or intramuscularly up to 240 mg/day
Ketorolac	- “Ketanov”; - "Ketorol"	- One tablet, no more than 90 mg/day; - intramuscularly or intravenously 10-30 mg every 6-8 hours
Diclofenac	- “Voltaren”; - “Dikloberl”; - "Naklofen"	- Tablets: 50 mg 2-3 times a day; - intramuscularly 75 mg every 12 hours; - rectal suppositories: 50 mg every 8 hours
Metamizole sodium	- “Analgin”; - "Baralgin"	- Intravenously or intramuscularly no more than 2 g/day (4 ampoules); - tablets: 500 mg up to 4 times a day
ASK	Aspirin	Tablets: 500 mg twice daily
Ibuprofen	- “Ibuprofen”; - “Burana”; - "MIG"; - "Nurofen"	- Tablets: one 3-4 times a day, no more than 1000 mg/day; - suppositories: one 60 mg every 4-6 hours
Indomethacin	- “Indomethacin”; - "Metindol"	- Tablets: one 25 mg 1-2 times a day, no more than 100 mg; - rectal suppositories: one 1-2 times a day

Preventing pain syndrome

For long lasting effect and pain prevention are subsequently used the following groups medications for continuous use.

Sedatives. Most often used alcohol solution or valerian tablets, Seduxen, drugs from the group of antidepressants. They help to establish connections between parts of the central nervous system and thereby reduce the pain threshold.
Oral contraceptives. These are some of the effective drugs that are most often used in treatment regimens for algodismenorrhea in women. They are selected taking into account the phenotype and hormonal profile. For example, “Jess”, “Dimia”, “Regulon”, “Novinet” are prescribed.
Gestagens. Considering that the deficiency of this particular group of hormones causes excess production of prostaglandins, it is effective to prescribe isolated gestagen preparations to relieve pain. For example, “Duphaston”, “Utrozhestan”, “Norkolut”.
Magnesium orotate. Magnesium is involved in the process of contraction and relaxation of muscle fibers, in the transmission nerve impulse. Microelement deficiency leads to spasm and pain. Therefore, women with dysmenorrhea are recommended to regularly take magnesium-based medications.
Enzyme therapy. Used for adhesions, endometriosis. Popular drugs are Wobenzym, Longidaza.
Anti-inflammatory treatment. Prescribed for active infections, including genital infections. Drugs from the group are used antibacterial agents taking into account the identified pathogens.

If organic diseases are detected (for example, endometriosis, fibroids, ovarian cysts), you can only get rid of pain during menstruation through surgical treatment - hysteroscopy, laparoscopy or abdominal surgery.

Non-drug treatments

To prevent new attacks or reduce the intensity of pain, folk remedies and physiotherapy can be used. High efficiency The following methods have been proven:

acupuncture;
hirudotherapy;
electrophoresis with novocaine or magnesium;
acupressure.

ethnoscience

Herbal infusions have anti-inflammatory, analgesic and calming effects. The recipes are easy to reproduce at home. And reviews from women confirm their high effectiveness.

Root. You need to take the root and grind it on a grater. Then pour one teaspoon of boiling water and let it brew for half an hour. Take a tablespoon twice a day during menstruation.
Horsetail . To prepare the solution, take a tablespoon of horsetail and pour two cups of boiling water. Leave for two to three hours. Take a quarter glass every hour until the pain decreases.
Strawberry leaves. For preparation, you should take wild strawberries, not garden ones. Grind the leaves, pour one tablespoon with 200 ml of hot water. Let stand for 30-60 minutes, take half a glass two to three times a day.
Valerian with mint and. Take valerian and mint herbs in equal parts, and twice as many chamomile flowers. Mix. Take a tablespoon of the mixture and pour a glass of boiling water. Let it brew for 30 minutes, drink two tablespoons two to three times a day during menstruation.

Is it possible to avoid

Algodismenorrhea, if this is the primary form, does not have serious complications, besides psycho-emotional stress girls waiting for their periods. Secondary dysmenorrhea may be complicated by infertility, acute surgical pathology, inflammatory processes. In any case, it is important to prevent the disease. The main recommendations are as follows:

healthy sleep of at least six to eight hours;
physical activity;
pregnancy and breastfeeding;
psycho-emotional calm;
sexual literacy;
regular examination by a gynecologist.

Dysmenorrhea, according to some data, occurs in eight out of ten girls reproductive age. You can cope with pain only together with a specialist - the doctor will help identify the cause and prescribe medications. Treatment of algodismenorrhea consists of relieving attacks of pain, as well as regimens to prevent episodes in the future.

Algodismenorrhea - most women probably don’t even know what it is. The nature of this pathology should be thoroughly understood, because it is directly related to reproductive system women. This is a condition of the body in which there is constant pain, severe pain occurs during menstruation, and general weakening of the body is observed. Causes of occurrence this state a little, when turning to a specialist, a woman will be able to get rid of the factors that provoke it. Treatment of algodismenorrhea requires timely complex therapy. If a woman ignores the symptoms, the disease begins to progress and gets worse general state.

What is algodismenorrhea

Algodysmenorrhea is a condition in girls in which they experience temporary or constant discomfort from attacks of pain of aching or cramping nature.

The diagnosis of algodismenorrhea is quite common, occurring during menstruation in approximately 30-40% of women surveyed.

Every tenth woman of reproductive age experiences partial or complete loss of working capacity during menstruation. Algodismenorrhea can be primary and secondary. The first manifests itself in adolescence and is not related to diseases of the genital organs. The second appears after the age of 30 as a result gynecological diseases of various nature.

Causes

The causes of algodismenorrhea are different nature. Primary algodismenorrhea can develop due to:

Mechanical disorders. These include any condition that interferes with healthy outflow menstrual blood.
Endocrine– active synthesis, slow decay of prostaglandins, which are responsible for muscle contractions of the uterus. The number of contractions of the uterine muscles increases, arteriole spasm appears, impairing the blood supply to the myometrium, increasing the sensitivity of the uterine walls to pain. As a result, pain, diarrhea, nausea, tachycardia, chills, hyperhidrosis, and dizziness develop.
Etiology neuropsychiatric causes lies in the individual reduction of the pain defect, rejection of the feminine essence, denial sex life and myself as a woman, a mother.
Constitutional reasons include– underdeveloped myometrium, uterine hypoplasia, its weak muscles cannot stretch sufficiently so that all menstrual blood fits into the cavity of the organ. This causes irritation and painful sensations.

Secondary algodysmenorrhea develops in women as a result of gynecological diseases, previous surgical therapy, pathological conditions of the uterus, its damage due to complicated childbirth, and curettage. The most common cause of the development of a secondary condition is adenomyosis and external endometriosis.

The process of separation of the functional layer is accompanied by an irritative process, provoking an active increase in the number of prostaglandins. As a result, the woman faces intense pain and general malaise. In some cases, fibroids interfere with the outflow of menstrual blood, which causes severe pain.

The pathogenesis of the secondary form is often associated with the development of chronic inflammatory diseases. Inflammatory processes provoke an adhesive process that disrupts the location of the uterus, creating obstacles to the outflow of menstrual blood. Inflammatory processes cause tissue swelling that compresses nerve fibers, exacerbating muscle contractions of the uterus.

Experts constantly talk about the importance of promptly treating emerging inflammation. The neglected process will cause numerous complications, including pathology such as algodismenorrhea.

Symptoms

Algodismenorrhea clinic requires increased attention on the part of the woman and the attending physician. The most common symptoms of the disease are pain before, during and after menstruation. Usually they reach their highest degree of severity during menstruation. Quite often, discomfort and pain occur with general weakness.

The primary form of pathology is usually diagnosed in young girls whose menstrual cycle is just beginning to establish. Many people have a visible lack of body weight, and their psyche may be labile. Pain during secondary menstruation occurs more often in women who have crossed the 40-year mark. During the interview, the doctor finds out that the woman had an induced abortion in the past; the pathology is accompanied by existing gynecological diseases. Many women suffer from infertility.

With algodismenorrhea of the primary form, the girl encounters the following manifestations:

headache;
fainting;
pain in the heart area;
vomit;
memory impairment;
eating disorder;
depression;
insomnia;
constant drowsiness;
unstable emotional state.

Quite often the disease is accompanied by joint pain, flatulence, dry mouth, skin rashes, itching.

When a woman encounters a secondary form of pathology, she may experience the following symptoms:

increased body temperature;
, which partially reduce intensity after the end of menstruation;
menstrual irregularities;

A woman should know that constant painful sensations during menstruation - this is not normal condition, but a symptom of a developing pathology.

Pain indicates a problem; it manifests itself 12 hours before the onset of menstruation. Gradually, the impulses increase, covering the lower abdomen and lumbar region. At the first stage of development of the pathology, pain is observed for several hours, then recedes. It periodically occurs in the first days of menstruation, without delivering big problem, the woman continues to live as usual. The secondary stage is characterized by constant pain throughout the entire menstruation. It negatively affects a woman’s life and reduces her productivity.

Diagnostics

Diagnosis of the disease is carried out based on the patient’s complaints. First, the doctor needs to conduct a survey to determine the onset of pain, the presence or past of gynecological diseases, abortions, surgical intervention on the genitals. After the interview, the doctor needs to conduct an examination and prescribe, if necessary, an ultrasound, CT and MRI of the pelvic organs. Also, a woman must get tested for STDs and hormone levels. In some cases, diagnostic curettage, hysteroscopy, and laparoscopy are prescribed. If necessary, a woman should undergo examination by a urologist, psychologist, or psychotherapist.

How to treat

Treatment of algodismenorrhea does not have general instructions, it is individual for each woman, since the nature of the pathology in patients is different.

If we consider secondary pathology, then before the specialist begins necessary therapy, it eliminates all major concomitant gynecological diseases. To stop painful attacks, painkillers are prescribed. The patient should take them in the recommended amount, without increasing or decreasing the dosage.

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Primary algodismenorrhea can be cured only using an integrated approach. The specialist deals with the correction of all systems, which this moment work with violations. Other specialists may be involved if necessary. The duration of treatment in this case increases.

Begin treatment with non-steroidal anti-inflammatory drugs. These include:

Nimesil.
Naproxen.
Ibuprofen.
Indomethacin.

Basic active ingredients prescribed medications help reduce the production of prostaglandins in the body. This allows you to short time reduce the intensity of pain. If a woman is already for a long time lives with a pathology, pain during menstruation is severe, performance decreases, then non-steroidal anti-inflammatory drugs should be started 2 days before the start of menstruation. This will allow the woman to endure this period easier.

The attending physician also prescribes drugs that directly affect the muscles of the uterus, relieving painful spasms. Tablets cope effectively with this:

No-shpa.
Baralgin.
Spasmalgon.

With primary algodismenorrhea, there is a deficiency of magnesium in the body, which also causes spasms and pain. Medicines based on magnesium salts are prescribed - this is Magne B6.

Hormonal drugs are prescribed for treatment. They are selected individually after delivery necessary tests V different days cycle. Based on the results, the doctor can see signs hormonal dysfunction, luteal phase failure. It is prohibited to select hormonal medications on your own. A properly selected product will correct the menstrual cycle and eliminate the unpleasant symptoms of pathology. Can be assigned:

Janine.
Logest.
Lindineth.

IN mandatory The patient is prescribed a long course of antioxidants.

Vitamin E is effective. It must be taken for a long time to get the desired result. To stabilize the functioning of the nervous system, tranquilizers and drugs may be prescribed sedative effect. The use of infusions of valerian and other plants is completely justified. Tazepan may be prescribed.

A woman should receive all the required vitamins in the required amount. Can be assigned:

Decamevit.
Multitabs.

Therapy for algomenorrhea includes not only taking prescribed medications, but also useful herbal decoctions. A woman must reconsider her lifestyle. First of all, this concerns nutrition. Presence excess weight increases the risk of developing pathology. The diet should consist of healthy vegetables, fruits, low-fat varieties fish, meat. A doctor helps you create a diet. It is necessary to give up alcohol and strong coffee. Bad habits should also be eradicated. The presence of physical activity should be kept within a reasonable range. Excessive passion for fitness, swimming, running, and strength training is not encouraged. This is also worth discussing with your doctor.

To get rid of existing psycho-emotional disorders the woman should visit a psychotherapist. He not only conducts sessions, but also teaches self-relaxation methods. This is necessary to get away from constant stress and worries. A woman should clearly create a work and rest schedule and remove overexertion. She can attend prescribed physical therapy sessions. The procedures and their number are selected by the doctor individually.

A woman facing primary algodismenorrhea should know that it responds well to treatment. Following the doctor’s recommendations and working on yourself will allow you to stabilize the body’s condition in a short time. Regular gynecological examinations, maintaining active, healthy image life, lack of stress and worries - best helpers in maintaining women's health.

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What drugs to choose for the treatment of algodismenorrhea?

Treatment of algodismenorrhea - one of the most common pain syndromes in women - mainly involves the prescription of drugs of two classes. For quick, situational relief of pain, analgesics are used, but to achieve “long-term” improvement in a woman’s condition, she is often prescribed systematic use of oral contraceptives. In case of severe blood loss due to menstruation, a comprehensive treatment regimen may include general strengthening drugs based on iron and vitamins.

Primary dysmenorrhea develops due to a sharp increase in the production of prostaglandins (Pg), primarily F2a and E2, which accumulate in the endometrium and cause platelet aggregation, vasoconstriction, irregular contractions of myometrial fibers and, in general, uterine ischemia. Pg synthesis is controlled by cyclooxygenase (COX), the activity of which, in turn, is regulated by sex hormones - estrogens and progesterone. The described mechanism determines the main approach to the treatment of dysmenorrhea: the prescription of oral hormonal contraceptives based on ethinyl estradiol and gestagen, which “turn off” ovulation, and/or the use of painkillers that inhibit COX and disrupt the synthesis of “painful” Pg.

For young girls who do not yet have regular sex life, but suffer from algodismenorrhea, it comes to the fore use of NSAIDs. Of the drugs in this group can be used as selective inhibitors COX-2 and drugs non-selective action(COX-1 and COX-2 inhibitors). Selective drugs have an undoubted advantage, which are to a much lesser extent than non-selective agents, inhibit the synthesis of gastroprotective Pg, which means they pose a much lower risk of developing gastralgia and erosive and ulcerative lesions of the gastrointestinal tract. These include celecoxib (Celebrex), which provides persistent analgesia. In the first days of pain, it is taken 400 mg at a time and, if necessary, another 200 mg should be taken on the first day. In subsequent days, its use may be limited to a single dose per day (200 mg). Short-term use of Celebrex for dysmenorrhea, providing a quick and lasting analgesic effect, is practically not accompanied by negative side reactions. It should be noted that celecoxib has the advantage of no effect on bleeding time and blood clotting. As a result, taking this drug does not lead to increased menstrual flow.

In some cases, NSAIDs are used for algodismenorrhea for preventive purposes: doctors can prescribe this group of drugs to patients 1-2 days before menstruation and continue taking them in the following days while the pain syndrome persists.

Among non-selective NSAIDs, the drugs of choice include ibuprofen (Nurofen, Faspik, Burana), which has a pronounced analgesic and anti-inflammatory effect. It is an over-the-counter product. However, when recommending this drug to a patient, you should make sure that she does not have erosive and ulcerative diseases of the gastrointestinal tract, allergic reactions to NSAIDs and especially disorders of the blood coagulation system, since an important condition treatment of algodismenorrhea is to minimize the risk of increased menstrual bleeding.

Most other NSAIDs in oral form available by prescription. However, if a pharmacy visitor needs a strong NSAID to relieve acute pain, she can be offered, for example, ketoprofen (OKI, Ketonal, Flexen) or piroxicam in the form of suppositories (again, taking into account contraindications); Unlike oral analogues, they are allowed to be sold without a prescription.

If the patient has contraindications to the use of NSAIDs (which, as we noted, are by no means limited to gastrointestinal diseases), then she can be prescribed drugs based on paracetamol (Panadol, Efferalgan) or metamizole sodium (Analgin, Baralgin M), which do not have an ulcerogenic effect , but at the same time they also have a less pronounced analgesic effect. In order to increase the analgesic effect of these drugs, it is advisable to combine them with antispasmodics, for example, drotaverine hydrochloride (No-shpa, Spazmol) or hyoscine butyl bromide (Buscopan).

Recall that there are many combination drugs containing an analgesic component in combination with antispasmodics. Some of the most famous OTC drugs of this kind are Spazmalgon, Spazgan, Bral, Baralgetas, in which metamizole sodium is “flavored” with pitofenone and fenpiverinium bromide. The last two components, complementing analgesic effect first, they exhibit a direct myotropic effect on smooth muscles, which helps relieve painful spastic contractions and eliminate vasoconstriction, which, as already mentioned, is one of the factors of uterine ischemia during dysmenorrhea. Note that all of these antispasmodic components are contraindicated for glaucoma.

Good therapeutic effect with algodismenorrhea, it can be achieved by using a number of combined analgesics. An example is the drugs Sedal-M and Pentalgin. In addition to the analgesic “rod” in the form of paracetamol and metamizole sodium, they also contain small doses of caffeine, codeine and phenobarbital, which act as synergists that significantly enhance the effect of the two analgesics. Let us remind you that in addition to the “simple” Pentalgin, pharmacies also offer the drug Pentalgin-N: instead of paracetamol, it contains a stronger analgesic in the form of naproxen (a drug from the NSAID group).

If we talk about women who have regular sex life, then for them the drugs of choice should be considered hormonal contraceptives, among which preference is given to low-dose oral contraceptives. In the vast majority of cases (up to 90%) these funds provide positive effect and reduce the pain of menstruation. WITH therapeutic purpose they are used for 3-4 months in a row; in severe cases, their combination with analgesics or NSAIDs is rational.

The issue of choosing a specific drug is easier if a woman uses contraceptives periodically. In this case, she should simply be recommended a monophasic drug, as well as low- or micro-dose hormonal contraceptives III generation, containing 20-30 mcg of ethinyl estradiol (estrogen) in combination with a progestin component. These drugs not only “turn off” ovulation, which is mainly associated with pain and other manifestations of dysmenorrhea, but also effective means treatment of many gynecological diseases leading to the development of secondary algodismenorrhea. They prevent the development of inflammatory diseases of the pelvic organs, prevent the development benign neoplasms ovaries and uterus, have a positive effect on the course of endometriosis. Finally, their long-term use reduces the risk of developing uterine fibroids. Preparations containing low- or micro-dose ethinyl estradiol in combination with a progestin component include:

Femoden, Logest (gestagen component - gestodene at a dose of 75 mcg);
Mercilon, Marvelon, Regulon, Novinet (desogestrel - 150 mcg);
Microgynon, Miranova, Triregol (levonorgestrel - 150, 100 and 75 mcg, respectively);
Janine (dienogest - 2 mg);
Belara (chlormadinone - 2 mg);
Yarina (drospirenone - 3 mg);
Silest (norgestimate - 250 mcg), etc.

Sometimes, for dysmenorrhea, pure gestagens (without ethinyl estradiol) are prescribed - Charozetta (desogestrel), Norkolut (norethisterone), etc.

We emphasize that if a woman did not use contraceptives hormonal drugs, then their selection and prescription should be carried out by a doctor. In this case, the pharmaceutical specialist can only give the patient general information about the properties of various drugs in this group.

And in conclusion, about one more aspect of pharmacotherapy. Algodismenorrhea is often accompanied by abundant uterine bleeding, exceeding the normal menstrual level. This leads to increasing iron deficiency, manifested by anemia, general weakness and soreness of the body. Therefore, for complex treatment menstrual irregularities Iron supplements are often prescribed - Sorbifer-Durules, Totema, Maltofer. Among the drugs this series We can especially highlight the over-the-counter product Fenyuls, which, in addition to iron, which eliminates hematopoietic disorders, contains a complex of B vitamins and ascorbic acid, improving the general condition of the patient by normalizing metabolism. Another advantage of the drug is the dosage form: Fenyuls capsules contain microdialysis granules, which ensure the gradual release of iron and other active components into the blood.

And one more important aspect pharmacotherapy... Dysmenorrhea is often accompanied by heavy uterine bleeding that exceeds the normal menstrual level. This leads to increasing iron deficiency, which causes a decrease in adaptive and protective forces body, metabolic disorders. These negative changes in a woman’s body are manifested by a wide range of symptoms: general weakness, drowsiness and nervousness, pallor skin, dryness and flaking of the skin, deterioration appearance hair and their increased loss, thinning and increased fragility nail plates, etc. To eliminate iron deficiency against the background of dysmenorrhea, drugs based on this trace element are often prescribed - Sorbifer-Durules, Fenyuls, Totema, Maltofer, etc.

We emphasize that all of the listed drugs, except for the drug Fenyuls, belong to the prescription segment. Fenuls is the only iron-containing product approved for sale without a doctor’s prescription. Another important difference between Fenyuls is that in addition to iron (in the form of sulfate), it also contains a complex of B vitamins (calcium pantothenate, pyridoxine, riboflavin, thiamine), vitamin PP and ascorbic acid, which increase the absorption of iron and normalize the metabolism of fats, proteins and carbohydrates. Thanks to this, rapid clinical improvement in the patients' condition is achieved. It is impossible not to note the special dosage form drug: Fenyuls is available in the form of microdialysis granules that provide gradual release active ingredients from capsules, which guarantees good tolerability of the drug. Fenyuls is taken 1 capsule per day after meals during menstrual periods.

Algodismenorrhea is an unpleasant nagging pain in the lower abdomen and in lumbar region before the onset of critical days, which can last until the end of menstruation. According to ICD-10, the code for this pathological condition is recorded on the sick leave as 94.4 if the disorder appears for the first time. The secondary manifestation of pathology is recorded as 94.5. If this disorder has an unspecified etiology, then its ICD-10 code will be written as 94.6.

Causes

By definition in healthy body There should be no algodismenorrhea, so it is important to understand the causes of this disease. In the first place among the causes of pain, one can put inflammatory processes that occur in the genital organs (vagina, uterus, tubes, ovaries). The list of causes of inflammatory diseases themselves is quite extensive: a simple cold, hypothermia, infectious diseases, consequences of abortion, cysts, various neoplasms, etc. But do not be afraid, because algomenorrhea, first of all, is a signal to pay attention to the condition of your body. During menstruation, the uterus swells and increases in size, so it begins to put pressure on other pelvic organs. A visit to a gynecologist and an ultrasound examination will help identify or exclude the causes of the inflammatory disease.

The second cause of premenstrual pain may be a psychological aspect. The girl is childish and not ready for adult life, and on a psychological level rejects his growing up. Primary algodysmenorrhea is caused, as a rule, by the desire to be a child longer. This desire is inherent in every person, but growing up is inevitable, and it is necessary to find positive aspects at every age.

Support for a loving mother and timely information about critical days During puberty, girls will help to overcome these difficulties with ease.

If after the first menstruation the pain is quite severe and lasts more than three to four months, there is cause for concern. In this case, you should consult a doctor, because the sooner the cause is found out, the easier it will be to eliminate it. Treatment, as a rule, consists of psychocorrection, which allows the girl to feel like a woman.

The underlying cause of painful menstruation may be fear or reluctance to become pregnant. Fortunately, modern pharmaceutical industry today can offer a whole arsenal of tools to help avoid unwanted pregnancy.

More often psychological aspect It is primary algodismenorrhea that is generated, so we can say with a significant degree of confidence that this disorder is not associated with pathology or any disease.

Another reason is the presence of a pathology, for example, a bent uterus. There is no inflammatory process, but algodismenorrhea is present. Again, at an appointment with a gynecologist you can identify this pathology and try to eliminate this cause of painful menstruation, since in the future it may develop due to the incorrect position of the uterus in the body.

Clinical manifestations

The symptoms of a disorder such as primary algodismenorrhea are not as pronounced as with secondary pathology. Therefore, diagnosing the disease in this case can be difficult.

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

pain in the lower abdomen, which occurs a few hours before the start of menstruation and can last several days, and sometimes until the end of menstruation;
abundant menstrual flow;
violations general well-being(headache, weakness, increased fatigue, sleep disturbance and lack of appetite).

In some cases, symptoms are complemented by elevated temperature body, which can be slightly elevated (low-grade fever) or to febrile levels.

Also, symptoms of algodismenorrhea can be supplemented by symptoms of inflammatory or dystrophic processes in the pelvic organs:

copious vaginal discharge;
itching and burning in the genitals;
pain during sexual intercourse;
swelling of the labia and other symptoms.

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

Treatment of algodismenorrhea

During the examination, the treating gynecologist will find out the cause and prescribe complex treatment. In addition to painkillers, the list of treatment methods may include the following: unconventional method like brisk daily walking. This is because many inflammatory diseases often occur against the background of congestion in the pelvic organs, and during physical activity they are intensively enriched with oxygen, which helps eliminate inflammation. In the event that this is primary algodismenorrhea, treatment will include not only physical exercise, normalization of lifestyle and taking painkillers, but also consultation with a psychologist.

Before going to the doctor, you can check at home whether there are inflammatory processes in the genitourinary system. The first test is a litmus test, sold at any pharmacy, and sometimes included with packs of pads. As a rule, a shift in pH to the acidic side indicates the presence of fungi and pathogenic microflora, and as a consequence, the presence of an inflammatory process in the genitourinary system. Regular douching with chamomile and washing with a weak soda solution will partially return the pH to the correct range.

Treatment of such a disorder with medications consists of taking analgesics and antispasmodics. This is the case if the causes of the pathology are not identified and are purely psychosomatic in nature. If it is established that a woman suffers from some inflammatory diseases genital area, treatment with antibiotics may be required (the sensitivity of microorganisms to them is first determined).

Also, according to indications, taking into account the causes of a disorder such as algodismenorrhea and its symptoms, the doctor may prescribe physiotherapeutic procedures.

Description:

Pain during menstruation resulting from infantilism, abnormal position of the uterus, inflammatory processes in the genitals, with endometriosis and other diseases, as well as with increased excitability of the central nervous system. It is usually observed in young women (often with infertility). The pain appears several days before menstruation, is often very severe and is accompanied by headache, nausea, vomiting and dizziness. When menstruation begins, it goes away on its own.

Symptoms:

Cramping pain during menstruation or a few days before it is localized in the lower abdomen and radiates to lumbar region, less often in the area of the external genitalia, groin and thighs. The pain is paroxysmal and quite intense, accompanied by general weakness, nausea, vomiting, spastic headache, dizziness, fever up to 37ºC, dry mouth, bloating, fainting and other disorders. Sometimes the leading symptom becomes one that bothers you more than pain. Severe pain is debilitating nervous system, contribute to the development of an asthenic state, reduce performance.

Causes:

The cause of severe pain during menstruation can be any disease such as, for example, fibroma, and others. Wherein traditional methods treatments do not always work, you need to contact experienced specialist, that is, to a doctor who can accurately determine why you have strong pain during menstruation.
The second reason for painful menstruation is sometimes a lack of physical activity.

Treatment:

Treatment of algodismenorrhea consists in eliminating the causes that give rise to it. Analgesics and tranquilizers are used to relieve pain.
The main method of treatment is the use of inhibitors of prostaglandin synthetase synthesis, also called non-steroidal anti-inflammatory drugs. These include: acetylsalicylic acid(aspirin) in a dose of 0.25–0.75 g 3–4 times a day after meals, paracetamol - 0.5–1.0 g 2–4 times a day, ibuprofen (Brufen) 0.2–0 .4 g 3–4 times a day after meals, naproxen (Naprosyn) - 0.25–0.5 g 3–4 times a day after meals, diclofenac (ortofen, voltaren, revodina) - 0.025–0.05 g 2–3 times a day after meals, indomethacin (metindole) - in the same doses or rectally in the form of suppositories. Such drugs as ketazone, surgam, piroxicam, ketoprofen, sulindac, mefenamic acid, reopirin, pyrabutol, butadione, donalgin, nifluril, etc. are successfully used in appropriate doses. The main principle of treatment with prostaglandin synthesis inhibitors is early (precautionary) administration. medicines 2–4 days before the onset of menstruation (the onset of pain) and over the next 2–4 days. In this case, menstrual pain, if it does appear, is much less pronounced against the background of treatment and is easier to tolerate by patients. Very useful is the use of combined drugs such as renalgan (baralgin, trigan, maxigan, minalgan, spazgin, spazmalgin, spasmalgon, veralgin), containing in addition to analgin in sufficient high dose(0.5 per tablet, 2.5 per 5 ml ampoule) two effective antispasmodics. These drugs are prescribed 1-2 tablets 2-3 times a day (regardless of meals) according to the above scheme in advance, and if the effect is insufficient or very strong menstrual pain(“menstrual colic”) can be administered intramuscularly or intravenously in a dose of 2–5 ml, slowly over 3–5 minutes, sometimes in a mixture with antihistamines (diphenhydramine 1% - 1–2 ml, chloropyramine (suprastin) 2% - 1 ml) and sedatives (Relanium, Sibazon 0.5% - 2 ml) drugs. Treatment is usually carried out over 3-4 menstrual cycles. In case of ineffectiveness or insufficient effectiveness, COCs (combined oral contraceptives) are used to treat both types of algodismenorrhea in the absence of contraindications.

The most effective are drugs with a high content of the gestagenic component (ovidon, rigevidon, microgynon, marvelon), which are used according to the contraceptive scheme for 21 days, starting from the 1st (5th) day of the menstrual cycle. The administration of “pure” gestagens is quite effective: norcolut (norethisterone), turinal, acetomepregenol, orgametril, duphaston (dydrogesterone) - 5–15 mg per day from the 14th-16th to the 25th day of the menstrual cycle. Previously used intramuscular injection progesterone 1% - 2-3 ml daily or every other day before menstruation - 4-6 injections. E. M. Govorukhina proposed a method of treatment by desensitization with hormones, which consists of intradermal injection 8–10 days before menstruation of 0.1 ml of estradiol dipropionate 0.1% and the same dose of 1% progesterone solution into the area of the inner surface of the forearm at a distance of 3 cm from the first injection. There are 3 such courses in total. According to I.L. Luzina and L.P. Bakuleva, a good therapeutic effect in primary algodismenorrhea is achieved by the use of a-tocopherol acetate (vitamin E) at a dose of 300 mg per day in the first three days of painful menstruation.

If prostaglandin inhibitors are insufficiently effective, it is advisable to combine them with antispasmodics (papaverine, platyphylline, metacin, atropine, no-spa, halidor, buscopan). The sublingual use of calcium antagonists is quite effective: nifedipine (Corinfar, Cordafen, Adalat), phenigidine 10-30 mg once, recommended by Italian and French authors. In some cases, it is useful to use ergot alkaloids internally - 0.1% solution of ergotamine hydrotartrate or dihydroergotamine (dihydroergotoxin) - 10-20 drops each.

In almost all cases of algodismenorrhea, one should strongly warn against the use of narcotic analgesics.
Hardware physiotherapy carried out in the second phase of the menstrual cycle or on the eve of menstruation is widely used: electrophoresis and phonophoresis of solutions of novocaine, trimecaine, magnesium sulfate, antipyrine, sodium bromide on the lower abdomen and area solar plexus, galvanic collar according to A. V. Shcherbak with calcium, bromine, nicotinic acid, ultrasound on the lower abdomen in pulsed mode, low-frequency pulsed currents (DDT, SMT), short-wave diathermy, central electroanalgesia, etc.