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Dysmenorrhea of adolescent period
Last reviewed: 23.04.2024
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From modern neurophysiological positions, the term "dysmenorrhea" refers to a wide range of neurovegetative, metabolic-endocrine, mental and emotional abnormalities, the leading manifestation of which is the pain syndrome caused by pathological accumulation in the endometrium on the eve of menstruation of degradation products of arachidonic acid (prostaglandins, thromboxanes, leukotrienes and monoamino acids); which enhance the afferentation of impulses that irritate the pain centers in the central nervous system.
Dysmenorrhea - painful periods. Primary dysmenorrhea begins during the puberty period and is not associated with anatomical disorders of the pelvic organs. Usually secondary dysmenorrhea begins at an older age and arises from diseases of the pelvic organs. The diagnosis of primary dysmenorrhea is established on the basis of clinical data, with the use of pelvic ultrasonography to exclude anatomical changes, as well as other clinical causes. Pain is stopped with non-steroidal anti-inflammatory drugs and sometimes with low-dose estrogen-progestin contraceptives. With secondary dysmenorrhea, the main pathology is treated.
ICD-10 codes
- N94.4 Primary dysmenorrhea.
- N94.5 Secondary dysmenorrhea.
- N94.6 Dysmenorrhea, unspecified.
What causes dysmenorrhea?
The most common primary dysmenorrhea. This condition begins during the puberty period and tends to decrease with age and after childbirth. Pain is supposed to be the result of uterine contractions and ischemia associated with the production of prostaglandins in the secretory endometrium. A combination of factors can lead to a violation of the outflow of menstrual blood through the cervix, a narrow cervical canal, through an improperly located uterus.
Common causes of secondary dysmenorrhea are endometriosis, adenomyosis, fibroids, and in some women, the infection of the cervical canal (as a result of conization, cryocoagulation or thermal cautery), which lead to painful periods. Pain is sometimes the result of a born submucous fibrous node or endometrial polyp through the cervix.
Pathogenesis of puberty dysmenorrhea
Primary dysmenorrhea is a cyclic pathological process that occurs with menarche, or 1.5-2 years after the establishment of ovulatory cycles. A mandatory attribute of functional dysmenorrhea is the absence of an organic pathology of the genital organs. Secondary dysmenorrhea is one of the bright clinical symptoms of organic pathology of the pelvic organs. Possible causes of secondary dysmenorrhea are external and internal endometriosis, malformations of the uterus and vagina, salpingitis and endometritis, uterine myomas, adnexa tumors, small pelvic adhesions, cervical stenosis, intrauterine pathology (polyps, submucous myoma, synechiae), foreign body in cavity of the uterus, abnormalities of vascular development and mesentery of the ovaries.
Symptoms of puberty dysmenorrhea
Pelvic pain can occur with the onset of menstruation or 1-3 days before menstruation. Pain can peak at 24 hours after the onset of menstruation and stop after 2-3 days. The pain is usually acute, but can be aching, can radiate into the lower back and legs. There may be headache, nausea, sometimes vomiting, constipation or diarrhea, urination disorders. Symptoms of premenstrual syndrome can occur at the beginning or during the entire period. Primary dysmenorrhea is suspected if symptoms appear soon after menarche or during puberty. The presence of secondary dysmenorrhoea is suspected if symptoms appear after puberty.
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Diagnosis of puberty dysmenorrhea
Diagnosis is based on anamnesis and clinical symptoms of the disease. For differential diagnosis of primary and secondary dysmenorrhea, anatomical changes in the pelvic organs are excluded by clinical studies, pelvic ultrasonography and examination for other disorders.
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Treatment of puberty dysmenorrhea
Symptomatic treatment of dysmenorrhea begins with adequate rest and sleep and regular gymnastics. Women with primary dysmenorrhea are examined to exclude anatomical changes in the pelvic organs. Persistent pain as a result of primary or secondary dysmenorrhea requires drug therapy; the appointment of non-steroidal anti-inflammatory drugs begins 24-48 hours before menstruation and lasts 12 days after the onset of menstruation. If this treatment is ineffective, then suppression of ovulation with the use of low-dose estrogen-progestin-only oral contraceptives is recommended. Sometimes hypnosis is useful. In severe pain of unknown origin, abortion of uterine innervation by presacral neovrectomy and dissection of sacroculent ligaments can help.
What prognosis is dysmenorrhea?
When specifying the etiology of dysmenorrhea and timely treatment of dysmenorrhea disorders with respect to further reproductive function, a favorable prognosis has been made.