Treatment of puberty dysmenorrhea

The goals of treatment of puberty dysmenorrhea

• Pain relief.
• Correction of the vegetative tone and mental status.
• Restoration and correction of menstrual irregularities, normalization of hormonal parameters.
• Elimination or alleviation of symptoms of the main organic causes of dysmenorrhea (genital endometriosis, acute and chronic inflammatory processes in the pelvic organs).

Indications for hospitalization

Hospitalization is necessary in the following cases:

• the need for surgical examination and treatment;
• severe forms of dysmenorrhea with a predominance of pronounced vegetative and psychopathic reactions.

Non-drug treatment

Important conditions for successful treatment are:

• observance of the working and waking hours;
• regulation of the diet with increasing consumption during perimenstrual days of easily digestible and vitamin-rich foods and exclusion of products based on milk and coffee;
• increase in the general tone of the practice of therapeutic and health gymnastics;
• it is possible to use individual or collective psychotherapy.

A good effect from the effect on triggers points (acupuncture, acupuncture, magnetotherapy) has been proved. Reflexotherapy is more effective in combination with exercise therapy, diet, psychotherapy.

In the treatment of dysmenorrhoea, the application of preformed therapeutic-physical factors remains valid: diadynamic therapy, fluctuation, amplipulse therapy.

Medication for puberty dysmenorrhea

The basic treatment of any form of dysmenorrhea should include the combined administration of antioxidants and preparations containing magnesium salts.

It is proved that vitamin E along with a decrease in the intensity of peroxidation of unsaturated fatty acids, from which prostaglandin is formed, is involved in the process of mobilization of endorphins from hypothalamic-pituitary structures and intestinal walls. Vitamin E is used continuously at a dose of 200 to 400 mg / day.

Magnesium activates more than three hundred enzyme reactions, inhibits prostaglandin synthetase, is involved in the synthesis of all known neuropeptides in the brain. It has a general tonic and soothing effect, positively affects the tone of the vessels, has a diuretic effect, promotes active excretion of bile, has antimicrobial properties, lowers cholesterol in the blood and tissues, prevents the formation of calculi in the kidneys. Magnesium is necessary for the normal operation of B vitamins.

From magnesium-containing medicinal substances, the complex of magne B ₆ serves as a drug of choice for patients with dysmenorrhea . The pyridoxine hydrochloride contained in it provides better penetration and retention of magnesium within the cell. Prophylactic dose (1 tablet 3 times a day) should be given to patients with clinical symptoms of chronic magnesium deficiency, but with normal blood plasma levels. In patients with hypomagnesemia and severe manifestations of magnesium deficiency, it is necessary to prescribe the drug in a therapeutic dose (2 tablets 3 times a day). The drug is taken continuously for 4 months by courses 2 times a year, for a long time.

In patients with mild dysmenorrhea, a preserved rhythm of menstruation and an undisturbed ratio of estradiol and progesterone at the end of the menstrual cycle, it is justified to prescribe NSAIDs 1 dose of the drug 1-2 times per day on the first day of painful menstruation.

With an average severity of functional dysmenorrhea, combined with manifestations of premenstrual syndrome, it is advisable to start taking the drug 1-3 days before menstruation, 1 tablet 2-3 times a day.

Patients with severe manifestations of dysmenorrhea should take 3 tablets per day during all days of painful menstruation.

Currently, there is a wide range of NSAIDs: acetylsalicylic acid, indomethacin, ibuprofen, rofecoxib, naproxen, paracetamol, ketoprofen, diclofenac and many others. These drugs serve as a means of choice for young girls who do not want to use COC for the treatment of dysmenorrhea, and also when these drugs are contraindicated.

In patients with mild to moderate dysmenorrhea with clinical manifestations of vagotomy, NLP with a normal level of estradiol, gestagenes are included in the treatment. As is known, under the influence of progesterone, the production of prostaglandins decreases not only in the endometrium, but also in the neuromuscular structures, the central nervous system and other tissues. Adding progesterone to the treatment of dysmenorrhea leads to the disappearance of not only pain, but also many other symptoms, contributing to the restoration of the normal ratio of progesterone and estradiol to the luteal phase of the cycle. The inhibitory effect of progesterone on the contractile activity of myofibers causes a significant decrease or disappearance of painful uterine contractions. Of the progestogens, the most optimal is the use of natural progesterone.

Dydrogesterone, unlike other synthetic progestogens, is completely devoid of estrogenic, androgenic, anabolic effects, mineralocorticoid and glucocorticoid activity, does not affect the lipid spectrum of the blood and the hemostasis system.

According to the literature, the effectiveness of treatment depends on the daily dose of progesterone. In patients taking the drug at 10-15 mg / day, dysmenorrhea was stopped in 60-80% of cases, at a dose of 20 mg / day - more than 90% of patients.

Patients with a severe form of dysmenorrhea with a high level of estradiol with a predominance of parasympathetic tone as a mandatory component of the therapeutic effect are prescribed monophasic COCs containing 20 μg of ethinyl estradiol. Such drugs help to reduce ovarian hyperactivity and balance prostaglandin-dependent reactions in the body of patients with dysmenorrhea on the eve and during menstruation.

In inflammatory processes, first of all, it is necessary to exclude the tuberculosis etiology, in the future - to treat the inflammation in a complex way taking into account the causative agent of the infectious process and the use of physiotherapy.

Treatment of external genital endometriosis in girls is a more difficult task, often requiring surgical treatment. Internal endometriosis in girls is rare. If this disease is detected, an effective treatment with agonists of GnRH COC (depot form of triptorelin, buserelin, goserelin) for 3-4 months with the connection of low-dose monophasic COCs in the last month of treatment with GnRH agonists is performed. COC admission is continued until the patient wants to become pregnant.

Treatment of dysmenorrhea pubertal period in a hospital

Surgical treatment of girls with dysmenorrhea should be performed in hospitals that have an endoscopic operative unit. Laparoscopy is indicated for patients with the following pathology:

• resistant, not amenable to conservative treatment, dysmenorrhea (to clarify the cause of the disease);
• external genital endometriosis, including endometriotic ovarian cysts;
• malformations of the uterus and vagina (additional rudimentary horn of the uterus, doubling of the uterus with aplasia of one of the vaginas).

Indications for consultation of other specialists

It is necessary to consult a therapist, an endocrinologist: according to the indications - an appeal to a psychologist, a specialist of exercise therapy.

Evaluation of treatment effectiveness

Treatment is considered effective if it has achieved the set goals.

Further management

During the first year, dynamic monitoring is necessary once every 3 months. In the future, with a favorable course of the disease, it is advisable to conduct a follow-up examination of the patient every 6 months before adulthood (18 years), after which the girl with a detailed statement of the results of the dynamic examination and treatment is referred to the doctors who provide obstetric and gynecological care to adult women.

Forecast

When specifying the etiology of dysmenorrhea and the timely treatment of violations, the prognosis for the further reproductive function is favorable.