Any discomfort such as pain in the lower abdomen or soreness in the lower back before or after menstruation or during menstruation, which is so severe that it affects life and work, is called dysmenorrhea. Clinically, dysmenorrhea is divided into primary and secondary. Primary dysmenorrhea refers to dysmenorrhea of the reproductive organs without obvious organic lesions, which often occurs at or shortly after the first menstruation, mostly in unmarried or non-pregnant women. Secondary dysmenorrhea is mostly caused by organic lesions in the reproductive organs, such as endometriosis, pelvic inflammatory disease, intrauterine foreign bodies or cervical stenosis. We will only talk about the problems related to primary dysmenorrhea. Before and after menstruation and during menstruation, there can be mild lower abdominal pain, swelling, lumbago, breast tenderness and weakness, which are physiological phenomena. If it is manifested as the period or before and after menstruation, periodic occurrence of lower abdominal distension, cold pain, stabbing pain, hidden pain, cramping pain, cramping pain, tearing pain breast distension, anal swelling, chest tightness and irritability, sadness and irritability, heart alarm and pain, pain extended to the sacral and lumbar back, even involving the thighs and feet, often accompanied by systemic symptoms: nausea and vomiting, stomach pain and diarrhea, tiredness and weakness, pale face, cold limbs, cold sweat, fainting and fainting. The symptoms include nausea and vomiting, stomach pain and diarrhea, tiredness, pale face, cold limbs, cold sweat and fainting. When it affects normal work and study, it is called dysmenorrhea. The high incidence, wide range, close cycle and great pain seriously affect the work and study of women and reduce the quality of life.
Prevalence of dysmenorrhea.
Dysmenorrhea caused by endocrine disorders in women is one of the unconquered problems in the world of medicine today. The (British) Journal reported that 90% of women with menstrual cycles in the United States have dysmenorrhea, and 36% have been or often have dysmenorrhea. Dysmenorrhea is the most important reason for absence from work or inability to exercise in the United States. A survey by a British medical authority reported that 80% of women worldwide have varying degrees of dysmenorrhea. Dr. Kennedy, a gynecologist at Oxford University, said at the British Society for Scientific Achievement conference, “Two-thirds of women suffer from menstrual pain and three-quarters are too ill to work…” China as early as 1978, the National Women’s Menstrual Physiological Constants Collaborative Group, a survey and analysis of more than 130,000 women’s menstrual physiological constants in 29 provinces, cities and autonomous regions, dysmenorrhea accounted for 33.19%, mild 45.73%, moderate 38.81%, and severe 13.55%. Primary dysmenorrhea in teenage girls accounts for 75%. The incidence of dysmenorrhea at home and abroad is on the rise every year, and the incidence of dysmenorrhea abroad is much higher than that at home.
Modern medical etiology and pathology.
(A) primary dysmenorrhea The cause is not yet 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 the flow of menstrual blood poor and causes retention of menstrual blood, thus stimulating the uterus to contract and 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.
Pathological mechanism of primary dysmenorrhea: It is related to prostaglandins in the endometrium. The highest prostaglandin content has been measured in the endometrium, and the endometrial and blood prostaglandin levels are higher in patients with dysmenorrhea than in normal women. The prostaglandin PGE2 has an inhibitory effect on uterine contraction, while PGE2a stimulates uterine muscle contraction and raises uterine tone. When PGE2 decreases or PGE2a increases, dysmenorrhea increases. The level of prostaglandins varies in the same woman in different menstrual cycles, but there is a relationship between its level and pain.
(ii) Secondary dysmenorrhea Most often seen in post-childbearing and middle-aged women, caused by pelvic inflammation, tumors 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 aggravates 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 The pain to palpation is obvious.
TCM etiology and pathogenesis.
This disease belongs to the category of menstrual abdominal pain in TCM, which is caused by injury caused by emotion and will, carelessness in life and living, or the six sexes as different causes, physical factors, changes in the special physiological environment during and before and after menstruation, resulting in “non-glorification” or “non-circulation”. The location of the disease is in the ramus and uterus, and the changes are in the qi and blood, manifesting as painful evidence. The deficiency is due to weakness of qi and blood, deficiency of liver and kidney; the actual is due to qi stagnation and blood stasis, cold condensation in the uterus or damp-heat injection.
Clinical manifestations
1. Dysmenorrhea mostly occurs in unmarried and unborn women and starts within 1-2 years after menarche.
2. The pain is mostly on the first 1-2 days of menstruation, and is colicky, cramping or distending pain in the lower abdomen, radiating to the lumbosacral region and inner thighs, with periodic episodes.
3.It may be accompanied by nausea, vomiting, diarrhea, dizziness or frequent urination and other discomforts, and in severe cases, pallor, cold sweat or even deficiency.
4.No abnormal findings in gynecological examination.
Diagnosis
I. Basic examination: There is no objective method to check pain.
II. Further examination: laparoscopic examination to remove dysmenorrhea caused by organic pelvic lesions has a reference value for diagnosis.
III. Diagnostic points
1.With the clinical manifestations of the disease, especially menstrual cyclic lower abdominal pain.
2.No abnormalities in gynecological examination can be diagnosed.
3.Primary dysmenorrhea needs to be distinguished from dysmenorrhea caused by endometriosis, pelvic inflammatory disease, intrauterine device, etc.
Treatment methods
I. General treatment
Strengthen exercise, enhance physical fitness, pay attention to psycho-psychological treatment, eliminate young people’s fear and tension of menstruation. Avoid strenuous exercise during menstruation and prevent cold and dampness.
Western medicine treatment
One or more of the following drugs can be used.
1.Anti-pain agent Take it 5-7 days before menstruation, for 7 days. Compound aspirin 0,5g, 3 times a day. Anti-inflammatory pain 25mg, 2 times a day.
2.Antispasmodics Atropine 0,5mg subcutaneously or intramuscularly in case of pain.
3.Sedative For dysmenorrhea caused by psychogenic factors. Luminal 0,03g, 1-3 times a day. Valium 2,5-15mg 3 times a day.
4.Estrogen therapy Indicated in cases of uterine dysplasia, which can promote uterine development, thickening of the muscular layer and increased blood flow.
Ethylene estradiol 0,25-0,5mg once a day. Take it for 22 days starting on the 5th day of menstruation, and it can be used for 3-6 cycles.
5. Progestin May inhibit uterine contractions, either one.
Progesterone 20mg, intramuscular injection, once daily, starting 1 week before menstruation, for 5-7 days.
Progesterone 4-8mg, once daily, 1 week before menstruation, for 5-7 days.
Ethisterone (gynecomastia tablets) 2,5-5mg once a day, 1 week before menstruation, for 5-7 days.
6. Combined application of estrogen and progestin can inhibit ovulation and prostaglandin synthesis to relieve pain.
Chinese medicine treatment
I. Treatment based on evidence
1. Qi stagnation and blood stasis: pain in the abdomen before or during menstruation, refusal to press, low menstrual flow, or poor menstruation, purple blood with clots, pain decreases under the clots, pain subsides after menstruation, accompanied by swelling of the chest and ribs and breasts, dark tongue or stasis points, string or slippery pulse. Relieving pain by removing blood stasis. Representative formula: Diaphragmatic Stasis Removal Soup.
2. Cold and damp stagnation: cold pain in the abdomen before or during menstruation, relieved by heat, refusing to press, low menstrual flow, dark and lumpy; fear of cold and body pain, nausea and vomiting, pale and dark tongue, white and greasy coating, sunken and tight pulse. Warming the menstruation and dispersing cold, activating blood circulation and relieving pain. Representative formula: Shao Abdominal Expelling Blood Stasis Soup, or Angelica Sinensis Four Inversions Soup.
3. Damp-heat congestion: pain in the abdomen during menstruation, refusal to press, deep red menstruation, thick mass, lumbosacral distension and pain, or low-grade fever, or usual yellow and thick band, pain in the lower abdomen, short yellow urine, red tongue, yellowish greasy moss, string or slippery pulse. Clearing heat and relieving dampness, resolving blood stasis and relieving pain. Representative formula: Clearing heat and regulating menstruation with peony soup.
4. Weakness of Qi and Blood: vague pain in the abdomen during or after menstruation, rubbing and pressing, low menstrual flow, light color, thin texture, fatigue, yellowish complexion, or loss of appetite, pale tongue, thin white fur, weak pulse. Benefiting Qi and replenishing Blood, regulating menstruation and relieving pain. Representative formula: Bajhen Yimu Tang, or Da Ren Yuan Decoction.
5. Yang deficiency and internal coldness: cold pain in the abdomen during or after menstruation, with heat to relieve, late menstruation, low volume, light red and thin menstruation, soreness and coldness of the waist and knees; clear and long urine or nocturnal urination, light red tongue, white moist coating, sunken pulse. Warming the menstruation and dispersing cold, regulating blood and relieving pain. Representative formula: warming menstruation soup, or ten whole tonic soup.
6.Deficiency of liver and kidney: pain in the abdomen after menstruation, dull color of menstruation, small amount, thin quality, lumbosacral swelling, dizziness and tinnitus, red tongue, little moss, weak pulse, weak ulnar pulse. Benefiting the kidney and nourishing the liver, regulating menstruation and relieving pain. Representative formula: Tone Liver Soup, or Da Ying Decoction, or Xiao Ying Decoction.
Acupuncture treatment
1.Body acupuncture: Take Guan Yuan, Zhong Ji, Qi Hai, Foot San Li, Double San Yin Jiao.
2, ear acupuncture: take the uterus, sympathetic, endocrine, kidney.
Single prescription
1.Musk dysmenorrhea cream Externally applied at acupuncture points.
2.Tianqi Dysmenorrhea Capsules Take orally 3-5 capsules 3 times a day with boiled water.
3.Yunnan Baiyao Take 0.5-1g per day, once every 4 hours, 3 times a day, with boiled water.
Massage: select the lumbosacral sides of the ayurvedic points, Guan Yuan and Sanyinjiao, and press for 5-10 minutes.
IV. Prepared Chinese medicine
1.Jiu mei xiang huan pills 9g/time, 2 times/day, taken orally, for qi stagnation and blood stasis type.
2.Yi Mu Paste 10ml/time, 3 times/day, orally, for Qi stagnation and blood stasis.
3.Aiwon-Wuang Pill 9g/time, 2 times/day, taken orally, for stagnation of cold and dampness.
4.Bazhen Yimu Pill or Ten Perfect Tonic Pill 10g/time, 2 times/day, taken orally, for cold and damp stagnation.
5.Extended pain relief tablets 5 tablets/time, 3 times/day, taken orally, for all types of dysmenorrhea.