Algomenorey (pain at periods) – the pain syndrome of different intensity accompanying periods. It is shown by the skhvatkoobrazny or aching pain in the lower departments of a stomach in the first days or in the course of all periods. Severe pains can worsen considerably health and limit activity of the woman. More often is the accompanying symptom of diseases of a female genital: anomalies of development and inflammatory processes of genitals, endometriosis. In the forecast treatment of the main pathology is important.
The most frequent disorder of menstrual function which is expressed in painful course of monthly bleeding is , or painful periods. The insignificant discomfort, the moderated, unsharply expressed morbidity of periods are noted to 70% of women from 14 to 45 years, another 10% of women complain of the intensive pains significantly influencing the general health and working capacity. Quite often is followed by vomiting (at 84%), diarrhea (at 79%), dizziness (at 23%), a headache (at 13,5%), faints (at 16%) women. If periods have painful and irregular character, then speak about such violation as .
The modern gynecology seriously belongs to an algomenorea problem as it can be the first signal of the violations happening in the woman's organism. At emergence of painful periods visit of the gynecologist is strongly recommended the woman.
The leading symptom at algomenory is pain in a stomach. Usually pain appears in the first days of menstrual bleeding or in 10-12 hours prior to its beginning. The pain syndrome accompanies periods 1-2 days, gradually abating. The nature of pains can be pricking, aching, pulling, but is more often skhvatkoobrazny, with distribution to a bladder, a rectum, a waist. At algomenory nausea, gastrointestinal frustration, weakness, irritability, bulimia, uneasiness, sleeplessness, or, on the contrary, drowsiness are quite often observed. Algomenorey, expectation of painful periods adversely affects health of the woman, her mental, emotional sphere, leads to violation of the intra family relations. On the basis of expressiveness of symptoms allocate three degrees of an algomenorea:
- easy degree of an algomenorea
It is characterized by moderate, short-term morbidity at menstrual bleedings, an insignificant indisposition which usually do not lead to violation of working capacity and level of activity. However, easy degree of an algomenorea can outgrow in more expressed, followed by strengthening of disease state and an indisposition over time.
- average degree of an algomenorea
It is shown by strong morbidity in the bottom of a stomach, nausea, the general weakness, headaches, a fever, a frequent urination. Besides, patients with average degree of an algomenorea can test a depression, intolerance of sound and olfactory irritants, noticeable deterioration in working capacity. Such state at algomenory demands the corresponding medicamentous correction which is picked up by the doctor.
- heavy degree of an algomenorea
It is characterized by sharply expressed belly-aches and a waist, the general weakness, headaches. The severe form of an algomenorea is followed by the increased temperature, diarrhea, vomiting, tachycardia, heartaches, unconscious states. In such state there is almost full decrease of the activity and working capacity. Heavy it is usually connected with congenital pathology of genitals.
In the mechanism of development of an algomenorea the leading role belongs to violation of synthesis of hormones that leads to increase in concentration of gormonopodobny substances – prostaglandins in fabrics. Prostaglandins cause the active uterine reductions promoting clarification of a cavity of a uterus from the torn-away endometrium. Besides, the numerous nervous terminations of an abdominal cavity are also irritated in response to reductions of a uterus and cause pain in the bottom of a stomach. Hormonal fluctuations cause as well the accompanying algomenorea symptomatology.
For the reasons leading to painful periods distinguish primary and secondary .
Classification of primary algomenorea
Manifestations of primary algomenorea are noted along with arrival of the first periods or within the first 3 years after its approach. To the forefront at primary algomenorea there is a pain syndrome. On a current primary it is subdivided on compensated and dekompensirovanny.
Compensated primary proceeds with an invariance of force and duration of pain during periods throughout a long time. If periods are followed by progressing of a pain syndrome, then speak about dekompensirovanny primary algomenorea.
On the accompanying symptoms accompanying approach of periods distinguish adrenergichesky and parasympathetic types of primary algomenorea.
The Adrenergichesky type of an algomenorea arises at increase in level of hormones of adrenaline, noradrenaline, dopamine that causes failure in all hormonal system of an organism. At this type of primary algomenorea of the patient feel a severe headache, heartbeat, temperature increase of a body, sleeplessness, violation of work of intestines (locks). Extremities get cyanotic coloring because of a spasm of small vessels, skin of a body and the person becomes pale.
At parasympathetic type of an algomenorea in cerebrospinal fluid serotonin hormone level increases. In this case primary it is characterized by vomiting, reduction in the frequency of serdtsebiyeniye and body temperatures, ponosam. Quite often there are hypostases on a face, extremities, an increase in weight, skin allergic manifestations.
Primary meets at patients of an asthenic constitution, emotionally unstable, easily excitable, with manifestations of a premenstrual syndrome more often.
Reasons of primary algomenorea
Among the reasons of primary algomenorea the following is the most widespread:
- dysplasia of development of connecting fabric, that is its underdevelopment by the time of the birth
Meets in 60% of cases of an algomenorea. The Soyedinitelnotkanny dysplasia in an organism can be also shown by changes in vessels of extremities, curvatures of a bone skeleton (scoliosis, flat-footedness), short-sightedness etc. The lack of magnesium blood is considered the leading reason of a dysplasia that is confirmed at biochemical blood test.
- tubercular damage of genitals (genital tuberculosis)
At tuberculosis of genitals it is shown with approach of the first periods, its aggravations occur in the fall and in the spring. Pains at periods have no accurate localization, are followed by an indisposition.
- neurologic frustration and diseases of nervous system
Tension, emotional instability lead to reduction of the threshold of painful sensitivity, an aggravation of painful perception and development of an algomenorea.
- underdevelopment (hypoplasia) of a uterus, excesses of a body of a uterus of a kzada or kpereda (giperantefleksiya), uterus malformations (two-way, two-horned uterus)
Primary in these cases it is caused by difficulty of outflow of menstrual blood from a cavity of a uterus and strengthening of uterine reductions.
Treatment of primary algomenorea
At suspicion on primary algomenoreyu consultation of the gynecologist is necessary. Gynecologic inspection of the patient, ultrasonography of bodies of a small pelvis, definition of the hormonal status is performed. Sometimes for exact definition of the main reason for an algomenorea carrying out inspection of system of digestion, blood circulation, an urination, mammary glands is expedient. Depending on the established algomenorea reason, not only the specialist gynecologist, but also the neurologist, the phthisiatrician, the psychotherapist can be engaged in its treatment.
Treatment of primary algomenorea should be begun with non-drug methods. At painful periods it is recommended to patients:
- to learn to calm down, relax and cope with stresses;
- to play sports;
- to exclude smoking and alcohol intake;
- not to overcool;
- to limit in the second phase of a menstrual cycle and during monthly physical activities and sex life;
- at pains to put a hot-water bottle on a stomach, to tighten knees to a breast.
Not to allow a decompensation of an algomenorea preservation of pregnancies, especially the first is important. Quite often primary passes independently after pregnancy and the child's birth. From methods of physiotherapeutic treatment at algomenory are effective an electrophoresis with novocaine on a zone of a solar plexus and reflexotherapy.
In the absence of efficiency from non-drug therapy at primary algomenorea medicines are appointed. At primary algomenorea which is followed by the expressed psychological symptoms purpose of soothing medicines is possible (diazepam, a valerian, ). For removal of pains spazmolitik and analgetics (analginum, , etc.), nonsteroid anti-inflammatory medicines are used (NPVP - indometacin, , phenylbutazone).
At primary algomenorea morbidity of periods considerably decreases or passes at regular reception of the hormonal contraceptive medicines including a combination of an etinilestradiol and a levonorgestrel or introduction of injection contraceptives. At primary algomenorea the good effect is reached by use of medicines of group of natural progestins.
During treatment of an algomenorea the menstrual calendar where it is necessary to reflect the feelings accompanying periods (pain, its duration, intensity, character, localization, other symptoms) and time in three months is recommended to conduct to consult at the gynecologist.
Classification of a secondary algomenorea
The painful periods observed at women are more senior than 30 years, are considered as secondary . Secondary occurs at 30% of women, at many in the average and severe form burdened by the accompanying symptoms and periodic decrease in working capacity. Secondary it is quite often combined by a menorragiya (plentiful periods).
Secondary , including other symptoms except pelvic pains, conditionally divide into four groups:
- secondary with psycho-emotional manifestations (bulimia, anorexia, depressions, irritability, changes in perception of taste and smells, etc.);
- secondary with vegetative manifestations (nausea, an abdominal distension, a hiccups, etc.);
- secondary with vegetovascular manifestations (headaches, dizziness, faints, tachycardia, a sleep of legs and hands, etc.);
- secondary with endocrine and exchange manifestations (vomiting, a skin itch, joint pains, sharp weakness, etc.).
Expressiveness of symptoms of a secondary algomenorea depends on age of the woman and her physical health. At deviations vegetovascular manifestations are more expressed in cardiovascular activity, at metabolic disorders — endocrine and exchange etc. After 40 years of the woman tendencies to depressive and to others psycho-emotional are subject to manifestations of an algomenorea. Quite often secondary is followed by a dispareuniya (pain at sexual intercourse) that is also the cause for inspection and treatment at the expert.
Reasons of a secondary algomenorea
Development of a secondary algomenorea is most often caused by diseases of bodies of a small pelvis. The diseases and states causing secondary are:
- endometriosis ();
- inflammatory diseases of the sexual sphere;
- endometrium polyps;
- tumors of a uterus and appendages;
- expansion of veins of a small pelvis;
- adhesive processes in bodies of a small pelvis;
- intrauterine contraceptives;
- pelvic neuritis;
- cicatricial narrowings of a neck of a uterus owing to intrauterine interventions (especially abortions).
Emergence of a secondary algomenorea is promoted by physical and intellectual overfatigue, the accompanying ekstragenitalny pathology, hypersensibility to own sex hormones (progesterone and estrogen). Patrimonial injuries, surgical termination of pregnancy, surgeries on a uterus and its appendages occur in the anamnesis at patients with secondary algomenorey.
The plan of inspection of patients from secondary algomenorey includes performing ultrasonic (ultrasonography), endoscopic (hysteroscopy, a laparoscopy), radiological (gisterosalpingografiya), tool (a diagnostic scraping of endometrium) researches of bodies of a small pelvis.
Important component of diagnostics of a secondary algomenorea is maintaining a menstrual calendar by the patient and drawing up the chart of pain for the subsequent choice of a method of treatment.
Treatment of a secondary algomenorea
Treatment of a secondary algomenorea is a treatment of the disease which caused it. If as the reason of a secondary algomenorea serve intrauterine contraceptives, then they are recommended to be removed. At endometriosis, adhesive processes, tumoral defeats of bodies of a small pelvis use different types of surgical interventions.
Treatment of the inflammatory diseases causing secondary is carried out taking into account the established reason and the activator with the subsequent physiotherapeutic procedures and sanatorium treatment. Also at a secondary algomenorea the simtomatichesky therapy directed to reduction of pains at periods (spazmolitichesky, analgetic, NPVP), weakening of psycho-emotional symptoms is appointed (demulcents). At emergence of painful periods it is necessary to remember that even easy degree of an algomenorea demonstrates functional or organic violations in an organism which it is better to diagnose and treat as it is possible earlier.
Prevention of an algomenorea
In the prevention of development of primary algomenorea observance of hygienic actions, hardenings, healthy nutrition, rational alternation of work and rest is important. The girl needs to be prepared for approach of the first periods in advance, to explain her physiology of a menstrual cycle. Prevention of a secondary algomenorea requires the prevention and treatment of diseases of the sexual sphere.