First, what is dysmenorrhea: dysmenorrhea (dysmenorrhea), refers to the period before and after or during menstruation, the lower abdomen spasmodic pain, and general discomfort, serious impact on daily life. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea is also known as functional dysmenorrhea when no obvious abnormality of the pelvic organs is found after detailed gynecological clinical examination. Secondary dysmenorrhea refers to those with obvious lesions in the reproductive organs, such as endometriosis, pelvic inflammatory disease, tumors, etc.
Primary dysmenorrhea: The cause of dysmenorrhea is not fully understood. Dysmenorrhea occurs shortly after menarche and is sometimes closely related to psychological factors. It may also be caused by spasmodic contraction of the uterine muscles, resulting in ischemia of the uterus. It is mostly seen in cases of uterine dysplasia, narrowing of the cervical opening or cervical canal, and excessive flexion of the uterus, which makes menstrual blood flow poorly and causes retention of menstrual blood, thus stimulating the uterus to contract causing dysmenorrhea. In some cases, during menstruation, the endometrium is shed in sheets, and the uterus contracts strongly before discharge causing pain, and the symptoms are relieved after discharge, called membranous dysmenorrhea. Primary dysmenorrhea can mostly be relieved after childbirth.
Secondary dysmenorrhea: Mostly seen in post-childbirth and middle-aged women, caused by pelvic inflammation, tumor or endometriosis. Endometriosis is the growth of endometrial tissue outside the uterine cavity, such as the myometrium, ovaries or other parts of the pelvic cavity, which also has cyclic changes and bleeding, and causes pain during menstruation because the blood cannot flow out, and gradually worsens dysmenorrhea due to adhesion with the surrounding adjacent tissues and organs, and internal examination can reveal an enlarged and hard uterus with poor activity, or hard irregular nodules or masses can be found in the rectal fossa of the uterus, and tenderness is It is obvious.
The symptoms of dysmenorrhea are the periodic occurrence of lower abdominal distension, cold pain, burning pain, stabbing pain, hidden pain, cramping pain, cramping pain, tearing pain, pain extending to the sacral and lumbar back, even involving the thighs and feet, often accompanied by systemic symptoms: breast distension, anal swelling, chest tightness, irritability, sadness, insomnia, headache, dizziness, nausea and vomiting, stomach pain and diarrhea, tiredness and fatigue. The symptoms include: breast pain, anal swelling, chest tightness, irritability, sadness, insomnia, headache and dizziness, nausea and vomiting, stomach pain and diarrhea, fatigue, pale face, cold limbs, cold sweat and fainting. The high incidence, wide range, cycle, pain, seriously affect the majority of women’s work and study, reducing the quality of life.
Third, the etiology of dysmenorrhea: there are many factors that cause dysmenorrhea, the common ones are as follows:
(1) Cervical stenosis is mainly an obstruction to the outflow of menstruation, causing dysmenorrhea.
(2) Uterine dysplasia poorly developed uterus easily combined with abnormal blood supply, resulting in uterine ischemia and hypoxia and causing dysmenorrhea.
(3) Abnormal position of the uterus can affect the smooth flow of menstrual blood and cause dysmenorrhea if the position of the uterus is extremely retroflexion or anteflexion.
(4) Mental and nervous factors Some women are overly sensitive to pain.
(5) Genetic factors dysmenorrhea in daughters is related to dysmenorrhea in mothers.
(6) Endocrine factors abdominal pain during menstruation is associated with elevated progesterone in the luteal phase.
(7) Elevated prostaglandin (PG) content in the endometrium as well as in menstrual blood, and prostaglandin E2 (PGE2) has an effect on the uterine muscle fibers to make them contract causing dysmenorrhea. The prostaglandin content in the endometrial tissue of menstruating patients is significantly higher in normal women.
(8) Excessive contraction of the uterus. Although the contraction pressure of the uterus in patients with dysmenorrhea is basically the same as that of normal women (the normal pressure is about 4.9 Kpa), the contraction of the uterus lasts longer and is often not easily relaxed completely, so dysmenorrhea due to excessive contraction of the uterus occurs.
(9) Uterine contractions are abnormal. Patients with dysmenorrhea often have abnormal contractions of the uterus, thus often leading to ischemia of the uterine smooth muscle, and ischemia of the uterine muscle can in turn cause spasmodic contractions of the uterine muscle, resulting in pain and dysmenorrhea.
(10) Gynecological diseases such as endometriosis, pelvic inflammatory disease, adenomyosis, fibroids, etc. Intrauterine devices (commonly known as birth control rings) are also likely to cause dysmenorrhea.
(11) Dysmenorrhea is caused by the first menstruation of young girls, psychological stress, poor circulation of Qi and blood due to sedentary lifestyle, poor operation of menstrual blood, love of cold drinks and cold foods such as pears.
(12) Strenuous exercise during menstruation, cold or too little clothing and cold leading to Qi and blood stagnation, are prone to trigger dysmenorrhea.
(13) Bad air is stimulated by certain industrial or chemical odors, such as gasoline, scented water, etc., which cause dysmenorrhea.
D. Diagnosis of dysmenorrhea
1. The diagnosis of dysmenorrhea is divided into “primary” and “secondary”.
(1) Primary dysmenorrhea, refers to gynecological examination, no obvious organic lesions of the reproductive organs, mostly occurs in adolescent girls 2-3 years after the first menstruation or young women who have given birth.
The diagnosis of primary dysmenorrhea is mainly to exclude the possibility of secondary dysmenorrhea. A detailed medical history should be taken, noting the time of pain onset, type and characteristics. Based on.
① Onset within 1 to 2 years after menarche ;
② Pain starts a few hours before the appearance of menstrual blood or before that, and the pain lasts for no more than 48 to 72 hours;
③The nature of pain is spasmodic or similar to labor and delivery pain;
④Negative gynecological duplex examination or anal examination. The diagnosis of primary dysmenorrhea can be made.
(2) Secondary dysmenorrhea, with obvious organic lesions of the reproductive organs, gynecological examination, B-type ultrasound imaging, laparoscopy and other technical examination of pelvic inflammatory disease, uterine tumors, endometriosis lesions causing dysmenorrhea.
Diagnosis of secondary dysmenorrhea A history of recurrent pelvic inflammatory disease, irregular menstrual cycle, excessive menstruation, IUD placement, infertility, etc. can help to diagnose secondary dysmenorrhea. Through double and triple diagnosis, some causes of dysmenorrhea can be found, such as uterine malformation, uterine fibroids, ovarian tumors, pelvic inflammatory masses, etc. The nodular thickening of the uterosacral ligament detected by anal examination is especially important for the early diagnosis of endometriosis.
2, other tests: such as blood sedimentation, white belt bacterial culture, ultrasound pelvic scan, hysterosalpingography, diagnostic scraping, and finally the application of hysteroscopy and laparoscopy can clarify the cause of dysmenorrhea at an early stage. Hysteroscopy can detect small lesions missed during scraping, such as small fibroids, polyps, ulcers, etc., and provide a valuable diagnostic basis, which can be performed after scraping.
3.According to the degree of dysmenorrhea, it can be divided into 3 degrees.
(1)Mild: Pain in the small abdomen is obvious during or before and after menstruation, accompanied by lumbar soreness, but can hold on to work without systemic symptoms, and sometimes need to take painkillers.
(2)Moderate: unbearable pain in the abdomen during or before and after menstruation, accompanied by soreness in the lumbar region, nausea and vomiting, and unheated extremities, with pain relief measures for a while.
(3)Severe: pain in the abdomen during or before and after menstruation, restlessness, seriously affecting work, study and daily life, bed rest, with lumbar pain, pale face, cold sweat, cold extremities, vomiting and diarrhea, or anal swelling, no obvious relief by pain relief measures.
V. Treatment of dysmenorrhea
(a) General treatment: physical exercise to enhance physical fitness. Pay attention to the regularity of life, work and rest, proper nutrition and sufficient sleep. Pay attention to the publicity and education of menstrual physiology, through explanation and persuasion, eliminate the patient’s fear, anxiety and mental burden. Enhance menstrual hygiene, avoid strenuous exercise, overexertion and cold.
(ii) Drug treatment.
(i) Ovulation inhibition: If the patient is willing to control fertility, oral contraceptive tablets (cotrimoxazole tablets or cotrimoxazole megestrol tablets) are the drugs of choice for the treatment of primary dysmenorrhea.
②Prostaglandin synthesis inhibitors (pgsi): such as fenpropathrin. Side effects: Gastrointestinal reactions and central nervous system symptoms, rarely causing bronchospasm and temporary renal impairment.
③ β-receptor stimulants: commonly used β2-receptor stimulants are: hydroxymethylisobutyrin, trade name sulbutamol and m-hydroxyisobutyrin, trade name m-hydroxy salbutalin (terbutalin).
④Calcium channel blocker: apply nifedipine (nifedipine, nifedipine), trade name: cardiac pain, lisinopine. ⑤ vitamin b6 and magnesium-amino acid chelate.
⑥Cottonol and Chinese patent medicines: Chinese patent medicines include Gui Zhi Fu Ling Wan or Tao Ren Cheng Qi Tang, etc.
(C) Chinese medicine treatment: with acupuncture.
Six, dysmenorrhea care methods
1, pay attention to and pay attention to menstrual hygiene, premenstrual and menstrual period eat less cold and spicy and other stimulating food.
2, usually to strengthen physical exercise, especially the weak. Attention should also be paid to improving the nutritional status and to actively treating chronic diseases.
3, eliminate the nervousness and fear of menstruation, lift the ideological concerns, the mood should be happy. You can participate in labor and exercise appropriately, but pay attention to rest.
4, the onset of pain can be symptomatic treatment, can take atropine tablets and Valium tablets, can relieve pain. If the pain cannot be relieved for a long time, you can make appropriate Chinese medicine evidence-based treatment. In addition, drink some hot brown sugar ginger water will also receive good results.
Seven, dysmenorrhea precautions and contraindications
1. Drink less coffee, tea, cola, chocolate and other caffeine-containing beverages.
2, prohibit the consumption of alcohol, especially for women prone to edema.
3, abstain from cold food during menstruation: such as watermelon, bananas, mangosteen, green beans, etc.
4, keep warm, can accelerate blood circulation, at the same time make the tense muscle relaxation.
5.Drink more herbal tea or prickly lemon juice and hot milk, red pond water, etc.
6, practice yoga, bending, relaxation and other movements can help improve the problem of menstrual pain.
Eight, diet regimen
To reasonable nutrition, supplement vitamin E food. Vitamin E has the role of maintaining the normal function of reproductive organs and muscle metabolism, its high content of food are grain embryo, wheat embryo, egg yolk, beans, hard fruits, leafy vegetables, peanut oil, sesame oil, etc.. According to the identification needs of different manifestations of dysmenorrhea, foods that warm, smooth, resolve stasis, and nourish deficiency are given respectively. Foods that warm the menstruation and disperse cold such as brown sugar, ginger, cumin and so on. For those with Qi stagnation and blood stasis, foods that invigorate the blood and promote circulation should be eaten, such as celery, shepherd’s purse, spinach, scallions, cilantro and the like. For those who are weak and have insufficient qi and blood, it is advisable to eat foods that nourish qi and blood, such as chicken, pig liver, pig blood, beef liver, walnuts, lychee, cinnamon, jujube, yam, etc.
In addition, you should avoid foods that tend to trigger or aggravate dysmenorrhea: cream, ice cream, eggs, sugar, bread and flour products, coffee, black tea, chocolate, etc. Foods to relieve menstrual pain include: beans, celery, cucumber, tomatoes, onions, potatoes, spinach, radish, wheat, sesame seeds, walnuts, almonds, apples, grapes, fish, etc.