Algodysmenorrhea

Quite a few women and girls face such a diagnosis as algomenorrhea. This disease manifests itself by the appearance of spasmodic or monotonous, pulling pains during the period of menstruation.

Algomenorrhea is the occurrence of sharp cramping or aching pains in the lower abdomen, lumbar and sacral spine during menstruation, accompanied by general malaise and decreased ability to work. They are caused by various reasons. Timely determination of the root cause of the pathology and quality therapy will allow a woman to avoid even more serious health problems in the future.

Primary algomenorrhea is associated with the accumulation of prostaglandins in the uterus, leading to the development of ischemia and pain syndrome. It is often observed in sexual infantilism or pathological bending of the uterine body. The cause of secondary algomenorrhea is inflammatory diseases of the genitals, uterine tumors, endometriosis, partial cervical canal closure, etc.

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Causes of algomenorrhea

If a woman has painful periods, she should not brush off such a problem. Pain is a signal from the body that there is a malfunction 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 varied:

• Endometriosis is a disease that mainly affects women of reproductive age. In this pathology, the cells of the inner layer of the uterine walls grow beyond their layer.
• Myoma is the formation of a benign neoplasm in the muscular layer of the female organ.
• Adenomyosis is a rather complex inflammatory process, as a result of which focal fusion of two layers of tissue of the uterine walls occurs: the myometrium (muscular tissue of the uterine wall) and the endometrium (inner mucous membrane of the uterus).
• Hyperretroflexion is an increase in segmental reflexes, which become more frequent due to a decrease in the inhibitory influence 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 significantly smaller than normal due to its underdevelopment.
• The uterus is incorrectly positioned in the pelvic cavity, which leads to a failure in the mechanism of menstrual blood removal from the uterine area.
• Violation of the integrity of the inner layer caused by trauma, abortion, difficult childbirth, or surgery.
• The cause of algomenorrhea may also be an infectious and inflammatory disease affecting one or more organs of the reproductive system. These include, for example, salpingo-oophoritis (inflammation of the uterine appendages, fallopian tubes and ovaries), both acute and chronic.
• Physical inactivity and lack of physical activity can also cause painful symptoms.
• The development of pathology can be provoked by psychological diseases caused by increased excitability of the patient's central nervous system: a tendency to hysteria and hypochondria.

Symptoms of algomenorrhea

This pathology is mainly observed in women of childbearing age, quite often in case of infertility. The disease can be either congenital or acquired. Depending on the type of disease, the symptoms that appear vary somewhat.

In the case of a congenital pathology, pain symptoms begin to appear during the girl’s puberty, while acquired ones are a consequence of surgery, an infectious and inflammatory disease, and other factors.

The symptoms of algomenorrhea are as follows:

• Sleep disturbance.
• Often, the pain begins to bother a woman several days before the onset of menstrual discharge and stops after the onset or complete end of bleeding. The pain can be nagging or cramping. Their appearance can be expected in the lower abdomen, in the lumbar region and sacrum. Gradually, irradiation of pain can develop. The woman begins to feel that the pain begins to "give off" to the intestines, in the perineum, affecting the inner thighs.
• Disruptions in metabolic processes.
• Dry mouth.
• Flatulence.
• Headaches, sometimes quite severe.
• Temporary loss of ability to work.
• There may be increased secretion of fluid by the sweat-producing glands.
• Nausea, sometimes turning into a gag reflex.
• Very low vitality.
• Symptoms of diarrhea may occur.
• Dizziness, possible fainting.
• It is quite rare, but bulimia and anorexia can be observed.
• An increase in body temperature to 37ºС.
• Exhaustion of the nervous system, which can be observed against the background of severe pain.

Primary algomenorrhea

Doctors differentiate between primary and secondary forms of the disease. Primary algomenorrhea - it is also diagnosed as a functional pathology, does not affect the violation of the anatomical structure of female organs. It begins to manifest itself 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 temperature indicators of the woman's body can be significant and accompanied by pathological vaginal discharge, which has a characteristic unpleasant odor. In this case, the menstrual cycle can be disrupted, and the time of bloody discharge can be extended.

The pathology in question is divided into three types according to functionality:

• Spasmogenic algomenorrhea, accompanied by spasms of fairly high intensity (intensive contraction of the smooth muscles of the uterus occurs).
• Essential algomenorrhea. This is mainly a congenital pathology associated with a very low threshold of sensitivity in a woman.
• Psychogenic algomenorrhea is diagnosed in most cases in an adult woman, if she suffers from some kind of mental illness, or in a girl during puberty - this may be associated with fear of the first menstruation.

The symptoms of primary algomenorrhea are similar to those listed above. Their complex is individual for each woman suffering from this pathology. To the existing list we can add:

• Hiccups.
• Drowsiness.
• Cotton-wool legs syndrome.
• Possible swelling.
• Intolerance to certain odors.
• Aversion to certain foods.
• Numbness of the lower and/or upper limbs.
• Itchy skin.

Pain in primary algomenorrhea is cramping in nature. The predominant localization is the lower abdomen and lumbar region, much less often it can be felt in the groin area and in the area of the external genitalia.

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

The development of algomenorrhea can be promoted by the early onset of the menstrual cycle, failures in its course (a long period of bloody discharge). Not the least place in the appearance of this pathology is occupied by the presence of bad habits in a woman: smoking, alcohol, physical inactivity. As sad as it may sound, but today, primary algomenorrhea affects, to one degree or another, the majority of girls who have not yet given birth. This fact is very frightening for doctors, since 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 a correct diagnosis is perhaps one of the key moments in treatment. After all, the prescribed therapy depends on how accurately the cause of the disease is established. An incorrect diagnosis, therefore, an incorrect approach to treatment and, as a result, the patient, at best, will not have a solution to his problem, and at worst - will get complications from incorrectly prescribed medications.

Diagnosis of algomenorrhea includes the following studies:

• Questioning the patient about her complaints, how long they have been bothering her, and what symptoms accompany the pain during 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 the gynecological anamnesis: presence of specific diseases, hereditary predisposition. The doctor tries to obtain information on whether the patient's mother or grandmother suffered from this disease. How early the first menstruation occurred, the presence of surgical interventions affecting the genitals and other pelvic organs. Knowledge of the abundance of discharge during menstruation and the nature of pain symptoms is also essential.
• Ultrasound examination of the pelvic organs.
• Colposcopy or hysteroscopy is a diagnostic procedure that allows visual examination of the condition of the vaginal opening, the mucous membrane of its walls and the cervix close to the vagina. The examination is carried out using a colposcope or, respectively, a hysteroscope - a special medical device consisting of a binocular and a backlight lamp.
• Polymerase chain reaction (PCR) is a highly accurate information method of molecular genetic research. It makes it possible to identify various infectious and hereditary diseases (both in the acute and chronic stages) in the patient being examined.
• Taking a smear from the vagina, cervical canal and urethra. Microbiological examination of its flora.
• Determining 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 examination of abdominal organs.
• A consultation with a psychotherapist or psychologist is required.

Initially, the specialist's research is 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 diagnostics are the key to effective therapy and the basis of any course of treatment.

Treatment of algomenorrhea

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

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 - gynecologist, usually with antispasmodics and hormonal drugs. For example, this can be buscopan, flexen, no-shpa, oki and many others.

A painkiller that effectively relieves muscle spasms - Buscopan is prescribed for oral administration. The recommended dosage for adult patients and children over six years of age is three doses throughout the day, one to three tablets.

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

The following may be reasons for refusing to use this medicine: closed-angle glaucoma, pulmonary edema, myasthenia (an autoimmune disease manifested by weakness and pathological fatigue of skeletal muscles) diagnosed in the patient. This is atherosclerosis affecting the capillaries of the brain, megacolon (a developmental defect described as an anatomical enlargement of the colon), as well as individual intolerance to hyoscine-N-butyl bromide or other components of the drug.

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

In tablet form, the patient takes the medicine two to three times a day, 40 to 80 mg after the main meal. And in the form of injections, the 2% drug is administered quite slowly two to three times throughout the day in an amount of 2 to 4 ml (per injection).

The drug also has its contraindications. These are:

• Arterial hypertension.
• A steady increase in blood pressure immediately before the onset of menstruation.
• Bronchial asthma.
• Pylorospasm is a spastic contraction of the muscles of the pyloric section of the stomach, causing difficulty in emptying it.
• Angina pectoris.
• Ulcerative manifestations on the mucous membrane of the digestive tract.
• Colitis, including spastic ones.
• Gallstone disease.

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

The highly selective cyclooxygenase-2 inhibitor Celebrex is prescribed by a doctor for use 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. In case of sufficiently high activity of muscle spasms, the attending physician may prescribe a single dose of 0.4 to 0.6 g of the drug. After the acute pain has been relieved, it is advisable to return to the recommended dosage of 0.2 g.

If a woman has a history of kidney problems, the daily dose of the drug should be halved. In case of liver failure, the recommended dosage of the drug should not be adjusted.

Contraindications to Celebrex include a tendency to allergic reactions, hypersensitivity or complete intolerance to the components of this drug or sulfonamides. And also if a woman or girl has undergone surgery to install a coronary bypass graft or a representative of 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 properties.

The dosage of Ibuprofen is prescribed strictly individually and depends on the level of manifestation of pain symptoms. For mainly adult patients and girls who have already turned 12 years old, the doctor prescribes one or two tablets, administered three to four times a day immediately after meals. In case of 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 a daily intake of ibuprofen (the active substance of the drug) in the amount of 1.8 - 2.4 g. The maximum daily dosage should not exceed 2.4 g.

This drug should not be taken if a woman suffers from one of the following pathologies:

• Ulcerative and erosive lesions of the mucous membrane of the digestive tract.
• Bronchial asthma.
• Ulcerative colitis of non-specific form of manifestation.
• Leukopenia is a reduced number of leukocytes contained in a woman’s blood (less than 4000 in 1 μl of peripheral blood).
• Thrombocytopenia.
• Severe renal and/or hepatic dysfunction.
• Hypertension.
• Dysfunction of the heart muscle.
• A disease affecting the optic nerve.
• Pregnancy and lactation period.
• Hypersensitivity to nonsteroidal anti-inflammatory drugs or other components of the drug.

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

The drugs used in such situations, which belong to the third generation of medicines, include Mercilon, Femoden, Janine and others.

The method and schedule for taking microdosed ethinyl estradiol in combination with a progestogen chemical element can be found in any instructions included with the hormonal contraceptive prescribed by the gynecologist.

For example, Janine is administered orally, washing down the pills with a sufficient amount of water. The dose is taken once a day at a certain time, which must be strictly adhered to. The duration of the treatment course is 21 days, after which seven days are maintained without administration. Do not skip doses - this significantly reduces the effectiveness of the treatment.

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

In addition to the above-described therapy, a woman suffering from algomenorrhea receives general strengthening therapy. This term refers to taking vitamins (especially those of the B6 and E group), as well as minerals and microelements. In this situation, the presence of magnesium ions is especially necessary.

If secondary algomenorrhea is diagnosed, then, depending on the primary source, it may be necessary to include surgical intervention in the therapy, performed on the organs of the female reproductive system. The operation makes it possible to eliminate the anomaly in the structural structure of 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 achieve the fastest effect, a number of physiotherapy procedures are also included in the complex therapy protocol. In this situation, electrophoresis performed on a woman in the second half of the menstrual cycle works perfectly.

Such procedures as galvanic collar, ultrasound in pulse mode, phonophoresis with various solutions, low-frequency pulsed currents and some other procedures have also proven themselves to be excellent.

Medicines for algomenorrhea

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

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

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

If intramuscular or intravenous administration is necessary, the doctor prescribes injections or invasions of 10–20 mg of the drug.

It is strictly forbidden to include this drug in the treatment protocol if a woman has been diagnosed with myasthenia, liver and/or kidney dysfunction, closed-angle glaucoma, as well as if the body shows increased intolerance to the components of diazepam or the patient is pregnant.

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

Yarina is administered orally in the form of a pill, which is washed down with a sufficient amount of water. It is taken once a day at a certain time, which must be strictly adhered to. The duration of the treatment course is 21 days, after which seven days are maintained without administration. Do not skip doses - this significantly reduces the effectiveness of the treatment.

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

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

It is recommended to take the prescribed mefenamic acid immediately after meals, preferably with a sufficient amount of milk.

For mainly adult patients and girls who have already reached the age of 14, the doctor prescribes a single dosage ranging from 0.25 to 0.5 g, taken three to four times a 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 sufficient to reduce the daily intake, bringing it to 1.0 g.

If premenstrual pain torments 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 a day. The recommended duration of treatment is from 20 to 45 days, and longer if medically indicated.

This drug should not be taken by women with a history of gastric ulcer and duodenal ulcer, kidney pathology, problems with blood formation, 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 to prevent the occurrence of pain symptoms. And if pain is still felt when menstruation begins, then, against the background of taking prostaglandin reproduction inhibitors, its intensity is significantly lower than without the introduction of such drugs.

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

Baralgin does not depend on the time of food intake and is prescribed one or two tablets two or three times a day. In case of very strong spasmodic pain, baralgin in the form of injections or invasions is administered slowly in the amount of 2-5 ml intravenously or intramuscularly. The treatment course usually lasts three to four menstrual cycles.

Monogestagens have also shown high efficiency: norcolut, acetomepreginal, dydrogesterone, norethisterone, turinal, orgametril and duphaston. The drugs of this group are usually prescribed for use starting from the 14th-16th day of the menstrual cycle until 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.

Prevention of algomenorrhea

It is easier to prevent any disease than to treat it later. Parents should convey this principle to their children as early as possible. Prevention of algomenorrhea does not require any special efforts from a woman. And if these simple rules become a part of her life and are perceived as self-evident, then such a set of rules cannot be called an effort - it will simply be a correct lifestyle that will protect the female body from many diseases and simply unpleasant discomfort.

Recommendations for the prevention of algomenorrhea include:

• Correct, rational and balanced nutrition.
• Remove from your diet foods that contain stabilizers, colorants, preservatives and other chemicals.
• Giving up bad habits and eating at fast food outlets.
• Compliance with personal hygiene rules.
• Moderate physical activity, interspersed with adequate rest.
• Minimize the amount of strong coffee and tea you consume.
• For pleasure, do morning exercises and light jogging.
• It is advisable to visit the swimming pool and/or fitness center.
• If unpleasant symptoms appear, do not delay visiting a specialist. Timely diagnosis and careful implementation of the doctor's recommendations during treatment.
• Prevent infectious and inflammatory diseases affecting the pelvic organs.
• Watch your weight.
• It is advisable to undergo a preventive examination by a gynecologist twice a year.

Not paying attention to your health is simply a crime against nature. After all, seemingly harmless algomenorrhea, if ignored, can ultimately lead to infertility and deprive a woman of the chance to become a mother.

Prognosis of algomenorrhea

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

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

The main omen for a woman is the birth of a child. And if she begins to be bothered by the symptoms described above, she should not delay going to the doctor. Pain may indicate the development of a rather serious disease in the patient's body. There is only one conclusion. If a woman carefully follows all the requirements of her doctor, then there is a high chance 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 not to give up, your health, first of all, is in your hands.