Dysmenorrhea

Description:

Is called a dysmenorrhea the feeling of pain and discomfort connected with periods.
Spasms during periods are a common problem for teenage girls and women. They can be shown in easy, average or heavy degree,  and are the most common cause of absences at school and compensatory holidays at work.  About 10% of girls  note an aggravation of symptoms during this period.  Though many girls do not suffer from a dysmenorrhea because their uterus continues to grow, the disease can be shown in the next years. Symptoms can begin in 1-2 days prior to periods, reaching a maximum of the expressiveness in the first day of a menstrual cycle, decreasing in the next days.

Dysmenorrhea reasons:

Primary dysmenorrhea is more widespread type of a dysmenorrhea and is connected with production  of prostaglandins. Prostaglandins are the natural substances produced  by cells  of an internal cover of a uterus and other parts of a body. Prostaglandins give to a uterus a tone.  However there are no reliable data that the level of prostaglandins  correlates with expressiveness of spasms.  Some women have the high level of prostaglandins, however do not note any unpleasant feelings in the period of periods while other women with the low level of prostaglandins suffer from the expressed dysmenorrhea. Thus, spasms are connected not only with prostaglandins, but also depend on hereditary factors, a stress, constitutional features.  In the first 1-2 years after the beginning of periods the dysmenorrhea does not arise, however, in the subsequent when the ovulation begins, there can be an expressed pain syndrome.  Prostaglandins can also make a headache, sick, vomiting and a diarrhea. Probability that the woman will suffer from spasms if at it:
- family history of a dysmenorrhea is observed;
- constant stresses;
- there is no sufficient exercise stress;
- there is a dependence on caffeine;
- there are  inflammatory diseases of bodies of a small pelvis.

Dysmenorrhea symptoms:

Primary dysmenorrhea is usually observed at teenage age, within three years of menarche. At a dysmenorrhea the woman tests sharp, pristupoobrazny spasms, as a rule, localized in suprapubic area. Pain can irradiate in a hip or a waist. The dysmenorrhea can be followed by nausea, vomiting, diarrhea, fatigue, temperature increase, a headache, dizziness. Pain usually develops within several hours after the beginning of periods.  Some women notice that painful monthly disappear after they gave birth to the first child. It can be connected with stretching of a uterus or that fact that the birth improves blood supply of a uterus and muscle performance.
The secondary dysmenorrhea is defined as menstrual pains because of pathology of bodies of a small pelvis. This state usually arises after the period of painless periods.  It differs from primary dysmenorrhea in the fact that pain is caused by anomalies or diseases of a uterus, pipes or ovaries.
Are the most common causes:
- inflammation of pelvic bodies;
-  myoma;
- intrauterine contraceptives;
- endometriosis;
- existence of commissures;
- functional cysts of ovaries;
- benign or malignant tumors of ovaries, intestines or bladder;
- inflammatory diseases of intestines.

Diagnosis:

The anamnesis of a disease and physical survey is enough for diagnosis of primary dysmenorrhea. The patient points to  typical pain during periods, and physical inspection finds physiological indicators. The doctor has to perform careful gynecologic inspection to exclude more serious disease.  As a rule, the dysmenorrhea should be differentiated with a premenstrual syndrome (PMS). The pains connected with PMS, as a rule, are followed by morbidity of mammary glands and abdominal distention. Symptoms of PMS are shown prior to the beginning of periods and stopped soon after its beginning.  
Circumstances which can indicate a secondary dysmenorrhea:  
- the dysmenorrhea which is observed during the first 1-2  cycles after menarche (inborn obstructions);
- the beginning of a dysmenorrhea is the share of age after 25 years;
- the beginning of a dysmenorrhea is caused by pregnancy complications: extrauterine pregnancy or threat of a misbirth;
- the anomalies of pelvic bodies found at medical examination;
- infertility (endometriosis, inflammatory diseases of bodies of a basin or other reasons of formation of hems is possible);
- an irregular menstrual cycle (to exclude an adenomyosis, myoma, polyps), a dispareuniya;
- inefficient therapy by non-steroidal anti-inflammatory drugs, oral contraceptives.

Treatment of the Dysmenorrhea:

Choice drugs for most of women with primary dysmenorrhea are non-steroidal anti-inflammatory drugs (NPVP) which prevent education and release of prostaglandins. Aspirin is not used for treatment of a dysmenorrhea because is not rather powerful in a usual dosage. The response to reception  of NPVP usually happens within 30 - 60 minutes.  From the NPVP group most often apply an ibuprofen and Naproxenum.
If the patient has contraindications to use of NPVS, purpose of acetaminophen (taylenol) is shown. Heat applied on painful area can give relief.    The heat bath twice a day is shown. In 90% of cases of a dysmenorrhea contraceptive tablets are effective.  Contraceptive drugs reduce the volume of menstrual liquid and suppress an ovulation. They can be chosen as the first line of therapy.
Alternative treatment. Having just changed position of a body, it is possible to reduce a pain syndrome. The simplest method - an embryo pose at which knees rise to a breast, embracing a hot-water bottle or a pillow. At  situation "cats" the woman leans on hands and knees, slowly curving a back. The inclination of a basin is one more popular pose in yoga: the woman lies on spin with the bent knees, and then lifts a basin and buttocks.
Dietary recommendations for simplification of spasms include increase in a diet of cellulose, calcium and complex carbohydrates, decrease in consumption  of fats, red meat, caffeine, salt and sugar. Smoking as it was established, makes heavier a current of a dysmenorrhea. Some researches show that group B vitamins, first of all B6 vitamin, magnesium and fish oil (an acid omega-3) can also help to reduce spasms.
Physical exercises are capable to reduce pain at periods due to production in a brain of endorphines - natural anesthetics of substances.  And the orgasm can force the woman to feel more comfortably, releasing tension in pelvic muscles.