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Abstract: The patient reported that she developed dysmenorrhea after giving birth to 2 children, and started to have cramping pain in the lower abdomen on the first day of each menstrual period, accompanied by nausea and vomiting, etc. The treatment with medication was not effective, and the dysmenorrhea recurred after stopping the medication. The symptoms of dysmenorrhea seriously affected her normal work and life, so she sought treatment at our hospital. She was confirmed to have adenomyosis, fibroids and secondary dysmenorrhea by ultrasound of uterine adnexa.
Basic information】Female, 42 years old
Disease Type】Uterine adenomyosis, fibroids, secondary dysmenorrhea
Hospital】Jinan Hospital of Integrative Medicine
Date of Consultation】January 2022
Treatment plan】Surgical treatment (laparoscopic total hysterectomy, bilateral salpingo-oophorectomy) + medication (ornidazole injection, levofloxacin mesylate injection, compound amino acid injection, sodium lactate ringer injection, tranexamic acid sodium chloride injection)
[Treatment period] 9 days of hospitalization
【Treatment effect】The operation process went smoothly, the body recovered well, and was discharged successfully
I. Initial consultation
Patient’s self-report: regular menstruation in the past, 14 years old at menarche, 4-7 days of menstruation, 26 days of cycle, moderate menstrual flow, no dysmenorrhea. Since the birth of her second child in 2016, she developed dysmenorrhea, which started on the first day of each menstrual period and was accompanied by nausea and vomiting, and the pain was present throughout her period. During this period, she was treated conservatively with oral ibuprofen granules, ketoprofen extended-release capsules and Yuanhu pain relief tablets, which were not effective, and the dysmenorrhea would still recur after stopping the medication. Since the symptoms of dysmenorrhea seriously affected her normal work and life, she came to our gynecology clinic on January 12, 2022, and was diagnosed with adenomyosis, fibroids and secondary dysmenorrhea by ultrasound of uterine adnexa, and was admitted to the hospital.
(Ultrasound of uterine adnexa)
II. Treatment history
The doctor recommended conservative treatment with GnRH-a, but since the patient had no fertility requirements, she gave up conservative treatment and requested surgery for complete treatment. Subsequently, we completed routine blood, urine, blood group, coagulation system, biochemical complete set, virus complete set, electrocardiogram, chest fluoroscopy, liver, gallbladder, pancreas, spleen, kidney and heart ultrasound, etc. The results did not show any obvious abnormalities and there was no contraindication to surgery. Combining the views of the patient and her family, it was decided to perform laparoscopic total hysterectomy + bilateral salpingo-oophorectomy on January 15.
She was given preoperative vaginal scrubbing for 3 days, postoperative cardiac monitoring, oxygen, continuous catheterization, acupressure and other care, and was given appropriate medication, including ornidazole injection and levofloxacin mesylate injection to prevent infection, compound amino acid injection and sodium lactate ringer injection for rehydration, and tranexamic acid sodium chloride injection to prevent postoperative bleeding.
III. Treatment effect
The patient’s operation was smooth, with good anesthesia, stable respiration and blood pressure, and intraoperative bleeding of about 100 ml. On the 5th postoperative day, the patient’s body recovered well, his vital signs were stable, he reported that his diet and sleep quality were acceptable, his urine and stool were normal, and there were no abnormal symptoms such as vaginal bleeding, fluid flow, abdominal pain and back pain. The patient said that the pain of the incision was gradually reduced and was not serious, and checked the situation of the patient’s abdominal incision, and saw that it was healing well, without redness, swelling and hard nodules, and without blood oozing.
IV. Notes
The patient gradually recovered after the surgery and the quality of life improved, which is gratifying for the doctor. After discharge from the hospital, patients need to pay attention to rest and diet to promote recovery.
1. Rest: after surgery, patients are advised to take sufficient rest, avoid overwork, do not do heavy physical labor, and ensure sufficient sleep.
2, diet: after surgery, you can increase nutrition according to personal preferences, such as shrimp porridge, egg custard, etc. You can also eat more fruits and vegetables rich in dietary fiber and vitamins, such as lettuce, cauliflower, oranges, etc.
3, other: postoperative patients are weak, in addition to care for the abdominal wound to avoid infection, you can wash the vulva with flowing warm water every morning and evening. If there is any discomfort, consult the doctor at any time.
V. Personal insight
Dysmenorrhea is very common in gynecological clinics and is divided into primary dysmenorrhea and secondary dysmenorrhea. For female patients with fertility requirements, they can choose conservative treatment with drugs, such as Chinese patent medicines, traditional Chinese medicine, contraceptives and progestins, etc. Note that conservative treatment usually requires adherence to the medication for 3-6 months for the effect to be more obvious. For patients with secondary dysmenorrhea without fertility requirements, if the effect of drug conservative treatment is not good and seriously affects the quality of life, surgical removal of the uterus can be chosen to solve the dysmenorrhea problem. As in the present case, since the patient did not require fertility, she requested surgery to fundamentally solve the problem of secondary dysmenorrhea.