dysmenorrhea
Introduction
Introduction Dysmenorrhea refers to the occurrence of abdominal pain in the lower abdomen before and after menstruation or during menstruation, and there is general malaise, which affects daily life and work. Dysmenorrhea is divided into primary and secondary dysmenorrhea. After detailed gynecological clinical examination, there was no obvious abnormality in the basin. It was called primary dysmenorrhea, also called functional dysmenorrhea. Secondary dysmenorrhea refers to those with obvious lesions in the reproductive organs, such as endometriosis and pelvic inflammatory tumors. This classification method gives clinicians a more concise concept of two types of dysmenorrhea.
Cause
Cause
Etiology classification
First, primary dysmenorrhea
Causes of primary dysmenorrhea: seen in endometrial casts (membrane dysmenorrhea), uterine hypoplasia, uterine flexion, neck stenosis, poor posture and physical factors, allergic status and mental factors.
Second, secondary dysmenorrhea
Common causes of secondary pain: seen in endometriosis, congenital uterine malformation, vaginal septum, pelvic inflammatory disease, adenomyosis, uterine fibroids, pelvic venous congestion syndrome and intrauterine device.
mechanism
First, primary dysmenorrhea
(a) prostaglandins (PGs)
Studies have found that patients with dysmenorrhea have increased uterine pressure, increased frequency of contraction, uncoordinated contraction and rhythm disorder, and lead to decreased uterine blood flow and hypoxia, resulting in severe pain in patients. When the patient was given a 250 lug B2 receptor stimulant, hydroxysulphate, the uterine contraction disappeared, the local blood flow was significantly improved, and the pain was completely relieved. It can be seen that primary dysmenorrhea is caused by muscle ischemia caused by excessive contraction of the uterus.
The content of PGs in the intima and menstrual blood of patients with primary dysmenorrhea is significantly higher than that of women without dysmenorrhea, and in recent years, it tends to stagnate dysmenorrhea and endometrial release. Too much to do. The level of PGF2a in the membrane of normal and dysmenorrhea women during the first day of menstruation was determined. The mean value of PGF2a in the intima of normal women was 4.5 nmol/L (434 pg/mL). The mean value of PGF2a in the intima of patients with dysmenorrhea was 17.20 nmol/L/the difference was extremely significant. The release of PGs was the highest within 48 h of menstrual blood, which was consistent with the time and duration of clinical spastic pain, and the use of PGs synthesis inhibitors such as mefenic acid and carbazole derivatives (indomethacin), This is also illustrated by the efficacy of benzoic acid derivatives (ibuprofen) in the treatment of primary dysmenorrhea.
(two) autologous hormone factors
Primary dysmenorrhea often occurs in the ovulation menstrual cycle, indicating that primary dysmenorrhea is related to the release of autologous hormones after ovulation. The content of PGs in the intima also changed periodically. The concentration of PGFa increased gradually from the proliferative phase to the secretory phase, and the menstrual period peaked. Adolescent girls have no ovulation, no dysmenorrhea, when the PCs content is only 1/5 of the ovulation cycle; after oral contraceptives, the amount of PGs in the menstrual blood drops below the normal level, suggesting that ovarian flute hormone imbalance can affect the endometrium The synthesis on the D causes dysmenorrhea.
(three) vasopressin (AVP) factors
It is known that vasopressin containing arginine can cause strong contraction of the pregnant women's palace, and the local blood flow is significantly decreased. The plasma concentration of AVP and the responsiveness of the uterus vary with the menstrual cycle. Most sensitive at the beginning of menstruation. Patients with primary dysmenorrhea had a significant increase in plasma AVP concentration on the first day of the menstrual cycle, which was 14 times higher than that of the control group, and the use of deaminated ethyl oxytocin competitively inhibited the effect of AVP on the uterus, which can cause primary dysmenorrhea symptoms. Significant relief. Therefore, AVP may also be an important factor in primary dysmenorrhea.
(4) Spiritual elements
Pain often occurs in women with mentally immature and neurotic personality. Some girls have insufficient understanding of menstrual physiology, and they will feel fearful when they arrive. Bad stimuli such as learning, work stress or sudden changes in the environment, and unpleasant mood can cause dysmenorrhea through hormone changes in the hypothalamus-pituitary-ovarian axis. However, in recent years, it is difficult to blame mental factors for dysmenorrhea, and mental factors can have an impact on acute and chronic pain in any part of the body. It has no more unique effects on primary dysmenorrhea, so this A factor has not been taken seriously.
Second, secondary dysmenorrhea
Most women of childbearing age occur after several years of menarche. Endometriosis, adenomyosis, uterine fibroids, pelvic venous congestion syndrome or uterine malformations can cause secondary dysmenorrhea.
Examine
an examination
Related inspection
Obstetric B-ultrasound hysteroscopic vaginal cytology examination of laparoscopic squamous cell carcinoma antigen (SCC)
First, medical history
Ask about the history of menstruation in detail, including the cycle, menstrual period, menstrual volume, and the presence or absence of tissue discharge. Understand the causes of pain, such as excessive stress, anxiety, sadness, overwork or cold, and the whole process of pain, including the time, nature, extent and gradual increase of dysmenorrhea.
Second, physical examination
Pay attention to the general health status of birth, development and nutritional status. During gynecological examination, pay attention to the size, position, texture and activity of the uterus, presence or absence of protrusion or nodule, uterine fibular ligament and bilateral adhesions on the uterus, thickening, nodules or lump, tenderness and so on. Most patients can make a diagnosis by medical history and gynaecological examination.
Third, the device inspection
(1) B-scan
B-mode ultrasound is generally used to understand the presence or absence of organic lesions in the pelvic cavity, such as uterine fibroids, ovarian tumors, pelvic inflammation.
(two) laparoscopy
Can determine the location and extent of the lesion, such as pelvic inflammatory disease; can also diagnose endometriosis or biopsy; can identify uterine malformations such as single-horned uterus, residual uterus, double-horned uterus, etc.; identify pelvic masses, such as inflammatory Mass, uterine fibroids and ovarian tumors.
(three) hysteroscopy
Can diagnose submembranous fibroids, intrauterine adhesions, intrauterine device incarceration and endometrial polyps, ulcers and inflammation.
(four) pelvic venography
Helps to diagnose pelvic venous congestion syndrome.
(5) Hysterosalpingography
Can help diagnose congenital uterine malformations such as single-angle, septal uterus, cervical stenosis and uterine adhesions.
Diagnosis
Differential diagnosis
It should be differentiated from the following symptoms:
1, blood stasis dysmenorrhea
Blood stasis dysmenorrhea is one of the symptoms of pelvic congestion syndrome.
Pelvic congestion syndrome (also known as pelvic septicemia) is a special condition caused by chronic pelvic venous stasis and is one of the main causes of chronic pelvic pain in gynecology. It is more common in women aged 30-50 years.
2, secondary dysmenorrhea
Secondary dysmenorrhea: more common in postpartum and middle-aged women, caused by pelvic inflammatory disease, tumor or endometriosis.
3, persistent lower abdominal pain
Severe pain in the abdomen lasted for more than an hour without relief.
4, primary dysmenorrhea
Primary dysmenorrhoea is a functional dysmenorrhea. Dysmenorrhea refers to menstrual pain, often spasmodic, concentrated in the lower abdomen, other symptoms include headache, fatigue, dizziness, nausea, vomiting, diarrhea, low back pain. It is a very common condition among young women. Primary dysmenorrhea is not associated with significant pelvic organic disease.
