Algodismenorey – the painful periods which are followed by violation of the general state. Arise at anomalies of development of a uterus, hormonal violations, hypererethism of TsNS, organic damages of a uterus owing to some inflammatory and not inflammatory diseases, abortions and the complicated childbirth. The aching or skhvatkoobrazny pains in the lower part of a stomach in the first days of periods are characteristic of an algodismenorea. Weakness, nausea, hypostases, headaches, dizzinesses, perspiration, violations of a chair and decrease in working capacity are possible. The diagnosis is established on the basis of the anamnesis, complaints and these objective researches. Tactics of treatment depends on a cause of illness.
Algodismenorey – the skhvatkoobrazny or aching pains in the first days of periods arising against the background of a general malaise. Is a widespread disease, comes to light at 30-50% of women of reproductive age. In every tenth case is followed by the expressed working capacity violation. Can be primary (essentsialny) or secondary (symptomatic). Primary demonstrates at teenage age. As a rule, it is not connected with diseases of female genitals. Secondary usually develops after 30 years against the background of inflammatory or not inflammatory gynecologic diseases, after the complicated childbirth, rough abortions etc. Treatment is performed by experts in the field of gynecology.
The reasons of development of primary algodismenorea can be mechanical, endocrine, neuropsychogenic and constitutional. Refer to number of the mechanical reasons anomalies of development of a uterus, violation of position of a uterus (giperantefleksiya), an atresia of a neck of a uterus and other pathological states creating an obstacle for normal outflow of menstrual blood. Excessively active synthesis and the slowed-down process of disintegration of prostaglandins is the endocrine reason of an algodismenorea.
Prostaglandins increase a sokratimost of a muscular layer of a uterus, cause a spasm that involves deterioration in blood supply a miometriya, and influence nervous fibers in a uterus wall, increasing their sensitivity to pain. The long angiospasm, strengthening of reductions of a uterus and increase in painful sensitivity provoke a pain syndrome. Connect with increase in level of prostaglandins also other symptoms of an algodismenorea: nausea, diarrhea, increase of heartbeat, oznoba, , dizziness and so forth.
Among the neuropsychogenic reasons of development of an algodismenorea experts call individual reduction of the threshold of painful sensitivity, the hidden rejection of the female essence, denial of sexual aspects of life and themselves as women and mothers. Infantility is the constitutional cause of an algodismenorea. The hypoplasia of a uterus and insufficient development a miometriya reduce ability of body to stretching during periods. Pressure upon walls of a uterus increases, it causes irritation of sensitive nervous fibers and emergence of a pain syndrome.
Secondary (symptomatic) results from inflammatory and not inflammatory diseases of female genitals, surgeries, solderings in a small basin, the complicated childbirth and injuries of a neck of a uterus at a scraping. Are the most common cause of development of a secondary algodismenorea and external endometriosis. Pains during periods at these diseases are caused by a deskvamation of geterotopichesky sites of endometrium.
The office of cages is followed by irritation of a large amount of nervous fibers in the uterus wall, a peritoneum, other bodies and fabrics containing geterotopichesky cells of endometrium and causes sharp increase in level of prostaglandins. Emission of prostaglandins provokes intensive pains and a general malaise. At many patients secondary develops against the background of submucous myoma of a uterus. Myoma interferes with outflow of menstrual blood, the uterus begins to be reduced more intensively, pressure in its wall increases, nervous fibers are irritated, prostaglandins are thrown out, pain develops.
Algodismenorey also quite often appears at inflammatory diseases, especially – chronic, it is long current. It is connected with the fact that the inflammation provokes formation of solderings, and adhesive process involves violation of an arrangement of a uterus and emergence of mechanical obstacles to normal outflow of menstrual blood. Besides, the inflammation is followed by hypostasis of fabrics and a sdavleniye of nervous fibers and in itself causes the pain aggravated by reductions of a uterus.
In some cases develops after installation of the intrauterine spiral stimulating production of prostaglandins. At some patients symptoms of an algodismenorea appear after a rough scraping during abortion or after the complicated childbirth. The rupture of a back leaf of a wide ligament of uterus or a varicosity of a small pelvis are the cause of an algodismenorea in such cases. Sometimes at a secondary algodismenorea the office of "a uterus mold" - a state at which the functional layer of endometrium is not exposed to fusion in a uterus cavity is observed, and leaves it in the form of an integral film. Allocation of such film is followed by very intensive skhvatkoobrazny pains.
Primary usually comes to light at sensitive, emotionally unstable girls of an asthenic constitution with tendency to deficiency of body weight. Secondary it is more often diagnosed for women 30 years are aged more senior. In the anamnesis at patients abortions, installation of an intrauterine spiral, childbirth, operations on bodies of a small pelvis, infertility, inflammatory (the endometritis, tservitsit, adneksit, salpingit, ooforit) and not inflammatory (, interstitsialny fibroma of a uterus, endometriosis, ovaries) diseases of female genitals come to light.
Patients show complaints to pain and deterioration in the general state. The pain syndrome at algodismenory arises along with the beginning of periods or several hours prior to its beginning. Pains are more often skhvatkoobrazny, is more rare – pulling, aching or holding apart. Irradiation to the area of a waist, area of a groin, a crotch, a rectum or the top part of an internal surface of hips is possible. Intensity of a pain syndrome at algodismenory can differ. Are possible as the moderate pains which do not have significant effect on working capacity, well eliminated with usual analgetics or spazmolitika, and extremely intensive, demanding rendering professional medical care.
Violation of the general state at algodismenory is shown by vegetovascular, exchange and emotionally psychological frustration. Shortly before the beginning of periods and in the first days monthly the woman suffering from algodismenorey becomes sensitive and irritable, excessively worries in insignificant occasions. Steady decrease in mood, drowsiness, increase or a loss of appetite, a perversion of taste and intolerance of smells can be observed.
Vegetative and vascular disorders at algodismenory are shown in the form of a hiccups, an eructation, nausea, vomiting, dryness in a mouth, diarrheas, an abdominal distension, heat, a fever, temperature increase to subfebrilny figures, increase of an urination, dizzinesses, a headache, faints and preunconscious states, pains and unpleasant feelings in heart, increase or reduction in the frequency of warm reductions, premature ventricular contraction, a sleep and a cold snap of extremities. Violations of exchange at algodismenory are demonstrated by a skin itch, increase in amount of the emitted urine, the general weakness, feeling of weakness in legs and flying joint pains.
At diseases of female genitals the clinical picture of an algodismenorea can become complicated or change a little because of imposing of symptoms of the main disease. Depending on features of a current allocate two forms of an algodismenorea – compensated and dekompensirovanny. With the compensated disease form symptoms remain stable for many years with patients. At patients with a dekompensirovanny form strengthening of pains and aggravation of violations of the general state comes to light eventually.
Diagnostics of an algodismenorea
The diagnosis is exposed on the basis of complaints, the anamnesis and these additional researches. The gynecologist finds out when the patient algodismenorey for the first time had pains at periods what duration of pains whether pains are followed by violation of the general state, whether the patient with algodismenorey gynecologic diseases suffers, whether there was in the anamnesis childbirth, abortions and female genital operations. During the poll the doctor establishes at what age periods what duration of a cycle whether often there are violations of a cycle and periods are how plentiful began.
After collecting complaints and clarification of the anamnesis the expert performs gynecologic inspection, takes dab from the tservikalny channel, a vagina and an urethra. Then the woman from algodismenorey is directed to the inspection including ultrasonography of bodies of a small pelvis, the general blood tests and urine, the analysis on diseases, sexually transmitted and a research of level of hormones. Apply KT and MPT of a small pelvis to specification of data of ultrasonography. At algodismenory, presumably caused polipozy and endometriosis, appoint hysteroscopy and a separate diagnostic scraping. In some cases carry out a laparoscopy. If necessary the patient of algodismenorey is directed to the urologist, the psychologist, the psychotherapist and other experts.
Treatment of an algodismenorea
Treatment of an algodismenorea is performed in out-patient conditions. A classical method of treatment is the pharmacotherapy in combination with physical therapy. In the presence of gynecologic diseases tactics is defined depending on the main pathology. The patient algodismenorey appoint the nonsteroid resolvents suppressing synthesis of a prostaglandinsintetaza. Administration of drugs at algodismenory is recommended to begin in 2-4 days prior to the beginning of periods and to stop in 2-4 days after its beginning. Use aspirin, paracetamol, an ibuprofen, , diclofenac and their analogs.
At algodismenory also widely apply the combined means which part the analgetic and is. If is followed by very intensive pain syndrome, medicines during 3 or 4 cycles enter intravenously or intramuscularly, sometimes – in combination with soothing and antihistamines. In the absence of effect of analgetics and spazmolitik to patients with algodismenorey appoint the oral contraceptives containing an ethenylestradiol and levonorgestret.
In the second phase of a cycle or shortly before the beginning of periods of patients of algodismenorey direct on and an electrophoresis with sodium bromide, magnesium sulfate, trimekainy or novocaine. To patients with algodismenorey appoint a short-wave diathermy, diadynamic currents and ultrasound. Some experts apply reflexotherapy. In the presence of psychoemotional violations treatment at the psychologist or the psychotherapist is shown. Patients of algodismenorey are given psychological support, appoint demulcents, relaxations teach techniques, lead explanatory discussions about the nature of an algodismenorea and its safety for life.
To the women suffering from algodismenorey recommend to refuse addictions, to avoid the use of hard kofeinsoderzhashchy liquors, to normalize a day regimen, whenever possible to eliminate stressful factors, to lose weight (in case of surplus of body weight), to keep to the balanced diet, to keep moderate physical activity. Primary , as a rule, will well respond to treatment. The forecast at a secondary algodismenorea depends on a look and features of a course of the main disease.