Dysmenorrhea is one of the most common gynecological pathologies that can significantly reduce the quality of life of women of reproductive age. About 95% of women have episodic dysmenorrhea, while 15% of them have severe dysmenorrhea and may limit daily activities.
Find out in the article on estet-portal.com what are the causes of dysmenorrhea, as well as what classes of medications are recommended to be used to relieve pain during the menstrual cycle.
- The concept and factors of development of dysmenorrhea
- Clinical classification approaches and causes of dysmenorrhea
- Medicines for treatment of dysmenorrhea
The concept and factors of development of dysmenorrhea
Dysmenorrhea is a cyclic pathological process characterized by the appearance of pain on the eve or in the first days of menstruation. Pain in dysmenorrhea is usually spasmodic in nature, localized in the lower abdomen and can radiate to the back, inner thighs, rectum, etc.
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Dysmenorrhea can significantly impair quality of life, reduce daily activities, and lead to missed work or school. In the US alone, dysmenorrhea is responsible for about 600 million missed work hours annually, which equates to a $2 billion loss. A study by A. Bahrami et al., in which 897 adolescent girls took part, showed that the presence of dysmenorrhea is associated with depression, a tendency to aggressive behavior and sleep disorders.
Factors that are directly correlated with the development of dysmenorrhea include smoking, early menarche, and a positive family history.
Dysmenorrhea is not associated with the duration of the menstrual cycle, however, as a rule, is accompanied by menorrhagia.
Clinical approaches to classification and causes of dysmenorrhea
There are primary (develops in the absence of organic lesions of the pelvic organs) and secondary (associated with the pathology of the pelvic organs endometriosis, chronic inflammatory diseases of the pelvic organs, myoma, etc. .) dysmenorrhea. The pathogenesis of primary dysmenorrhea is based on increased production of prostaglandins ─ powerful myometrial stimulators with vasoconstrictive properties.
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Hypersecretion of prostaglandins leads to increased tone of the uterus and provokes its irregular contractions, accompanied by the development of ischemia, hypoxia and pain. In women with primary dysmenorrhea, there is an increase in the concentration of prostaglandins in the endometrium, while their concentration directly correlates with the severity of the pain syndrome.
In addition, high levels of prostaglandins in the systemic circulation may contribute to the nausea, vomiting, fatigue, headache, and diarrhea that accompany pain in women with primary dysmenorrhea. Diagnosis of primary dysmenorrhea is based on a thorough analysis of anamnestic data (usually manifests 6-12 months after menarche, accompanies menstruation or occurs the day before, the duration of the pain syndrome is 8-72 hours) and the exclusion of organic lesions of the pelvic organs during a gynecological examination.
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Unlike primary, secondary dysmenorrhea can occur many years after menarche and is characterized by pain during the entire period of the menstrual phase. In some cases, pain may occur in the luteal phase of the menstrual cycle and increase with the onset of menstruation. The highest prevalence of secondary dysmenorrhea is observed among women aged 30-40 years.
The development of pain syndrome in secondary dysmenorrhea is due to the presence of gynecological pathology, although to a certain extent it is also caused by the production of prostaglandins. If secondary dysmenorrhea is suspected, additional examination methods are necessary: complete blood count, bacteriological studies for sexually transmitted infections, Pap test and transvaginal ultrasound. For very severe pain syndrome, laparoscopy may be appropriate.
Medicines for the treatment of dysmenorrhea
Modern strategy for the treatment of women with primary dysmenorrhea can significantly reduce or completely eliminate the pain syndrome and symptoms that accompany this pathology (nausea, vomiting, headache, diarrhea, etc.). Since the hyperproduction of prostaglandins plays a key role in the pathogenesis of primary dysmenorrhea, the use of drugs that inhibit their synthesis is the basis for the management of this pathological condition.
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Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used in the management of dysmenorrhea and are the treatment of choice for women with menstrual pain. The use of drugs of the NSAID group can effectively alleviate the manifestations of dysmenorrhea (level of evidence A), helps to suppress the activity of cyclooxygenases and, accordingly, block the synthesis of prostaglandins. The use of NSAIDs in the management of dysmenorrhea leads to significant pain relief in 80-90% of cases, helps to reduce the contractile uterus and the volume of menstrual blood loss by 20-30%. Representatives of NSAIDs that have been approved by the FDA (Food and Drug Administration, Food and Drug Administration, USA) for use in dysmenorrhea include: diclofenac,
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