MENSTRUAL PAIN
by dr. Emilia ova, Sp.OG, M.med, PhD
What is menstrual pain?
Pain during menstruation is often known as dysmenorrhea (from the Latin word for menstrual pain). Disturbance during menstruation is not only a pain but some women experience a set of symptoms (often expressed as well as the discomfort / pain) called premenstrual syndrome. Because they are in the same condition in women so familiar in this paper will be discussed sequentially.
Dysmenorrhea divided into two primary and secondary dysmenorrhea. Is called primary dysmenorrhea when not accompanied by pelvic organ abnormalities, while secondary dysmenorrhea is called when any organ abnormalities such as endometriosis, myoma uteri, adenomyosis uteri or chronic pelvic inflammatory disease. Dysmenorrhea experienced by approximately 45-95% of women of reproductive age. Although dysmenorrhea is not fatal, but its effects can be very annoying and affect the psychological condition of women. Do not forget dysmenorrhea is the principal cause of absences from work and school.
What is the mechanism occurs dysmenorrhea?
Back then, people respond as normal menstrual pain. People often scapegoat on emotional or psychological condition, an error of understanding about sex or relationships that are not harmonious. Research is now able to unlock the mystery of the mechanism of dysmenorrhea.
Primary dysmenorrhea usually occurs during the first 6-12 months after menarche (first menses) after the cycle of ovulation has occurred. During menstruation, endometrial cells release substances released by the uterus which contains prostaglandins. This substance causes ischemia of the uterus through the movement of uterine muscle contraction and vasoconstriction. Increased levels can be measured in prograglandin menstrual blood of women who experience severe dysmenorrhea, especially in the first two days of menstruation. Vasopressin also acts like prostaglandin.
Menstrual Pain Cycle Symptoms Massage
Secondary dysmenorrhea can occur any time after menarche, but usually in the 20s or 30s after the menstrual cycle is relatively painless. Secondary dysmenorrhea may also be due to increased prostaglandin but in this case accompanied by other abnormalities in the pelvis. The main cause is endometriosis, myoma, ademomiosis, endometrial polyps, chronic pelvic inflammatory disease and use of IUD.
Risk of dysmenorrhea
Primary dysmenorrhea
• early menarche age (<12 years)
• Nullipara (no children)
• Mens long or many
• Smoking
• family history
• Obesity
Secondary dysmenorrhea
• Endometriosis
• adenomyosis
• Myoma
• IUD
• pelvic inflammatory disease
• Endometrial Malignancy
• Cysts ovarii
• pelvic congenital malformations
• Cervical Stenosis
Know the disease history of dysmenorrhea
Primary dysmenorrhea can be distinguished from secondary dysmenorrhea with a way of knowing history. Important information including age of menarche, bleeding or abnormal vaginal fluids, dyspareunia and a history of pregnancy.
Primary dysmenorrhea
• From 6-12 months after menarche
• Pain lower abdomen / pelvis during menses begin until 8-72 hours
• Back Pain
• Pain quadriceps / in
• Headache
• Diarrhea
• Nausea / vomiting
Secondary dysmenorrhea
• Start 20s or 30's, initially painless menses
• infertile (not fertile)
• Mens lots or irregularly
• Dyspareunia (painful intercourse)
• Vaginal fluid
• lower abdominal or pelvic pain all the time
• Pain not relieved by drugs NSAIDs
Know dysmenorrhea from physical examination
The physical examination should be carried out fully. For young women were not married then the abdominal examination was sufficient. In women who are married will need to also do a pelvic examination. Ultrasound examination is sometimes required when suspect secondary dysmenorrhea.
Primary dysmenorrhea
• Tender lower abdomen
• Tender uterus or a normal pelvic examination (cervical stenosis / narrowing of the cervix may cause the flow of blood through menstruation)
Secondary dysmenorrhea
• Palpable mass abnormalities
• rocking Cervical Pain
• Pain adneks local press or palpated during
• vaginal or cervical fluid
• Abnormal vaginal (mucosal tear, masses, prolapse)
• abdominal or pelvic examination is normal not to get rid of disorder. We recommend that if there is suspicion of abnormality, the ultrasound examination, MRI, or laparoscopy hysterosalfingoskopi.
Should a laboratory examination for dysmenorrhea?
Dysmenorrhea diagnosis is usually based on clinical symptoms. However, laboratory examinations are often required to remove and clarify the causes of secondary dysmenorrhea. Examination includes:
• to assess the existence of a complete blood infection or malignancy
• Urine to exclude urinary tract infection
• human chorionic gonadotropin level to rule out ectopic pregnancy
• Wipe the cervix to get rid of gonococcus and Chlamydia STD / PRP
• Feces guaiac to rule out gastrointestinal bleeding
• Speed ponder the blood to see subacute salpingitis.
Treatment of dysmenorrhea
Most women have never consulted a doctor to treat dysmenorrhea. Usually the first treatment with OTC NSAIDs or anti-pain and hot compresses. Dysmenorrhea treatment aimed at reducing symptoms and inhibiting processes that cause these symptoms.
Drugs NSAIDs reduce prostaglandin production by inhibiting cyclooxigenase and was used as the principal therapy dysmenorrhea. When taken early before the resulting pain and are sufficient, its success is very high for pain relief in mens. About two-thirds of women successfully treated with NSAIDs. In emergency conditions, women who do not respond to NSAIDs may be given narcotic preparations. Women who do not improve with NSAIDs therapy tend to have pathological abnormalities such as endometriosis.
COX-2 specific inhibitors are also effective in eliminating pain menses. How it works primarily by reducing the symptoms of the digestive tract. But the latest experiment dubious safety for the cardiovascular system so that now not available on the market.
Common analgesics such as aspirin and acetaminophen are also useful to reduce menstrual pain, especially if it is not resistant to NSAIDs.
Contraceptive pill will also relieve the pain by inhibiting ovulation monthly menses and also will reduce the number of menses. In one experiment, 65% of women free from pain by using birth control pills (Proctor, 2006).
• Ibuprofen 400 mg PO Q4-6h; not to Exceed 3.2 g / d
• naproxen (Anaprox, Naprelan, Naprosyn, Aleve) 500 mg PO followed by 250 mg Q6-8h; not to Exceed 1:25 g / d
• Diclofenac (Cataflam) 25 mg PO bid / tid
• hydrocodone and acetaminophen (Vicodin, Lorcet-HD, Lortab) 1-2 tab or cap PO Q4-6h PRN pain
Prevention dysmenorrhea
• Stop smoking
• One trial RCT showed a significant correlation between weak low-vegetarian diet and a decrease in symptoms (Proctor, 2006)
• Exercise can reduce menstrual pain by increasing blood flow and endorphin release substances
• One RCT experiments also indicate that acupuncture can improve symptoms.
Complications that may occur
• When the diagnosis of secondary dysmenorrhea is not exhaustive, the abnormalities that cause it can cause morbidity, including sterile
• social isolation or depression
Prognosis / successful therapy
• The prognosis of primary dysmenorrhea is very good with the use of NSAIDs
• Prognosis of secondary dysmenorrhea varies depending on the underlying disease process
Menstrual Cramps Video Animation: What causes the Pain?
Premenstrual syndrome (PMS), which is a combination of physical and emotional disturbances that occurred in a woman between the time after ovulation and menstruation occurs. Common symptoms of PMS such as depression, irritability, crying, very sensitive and mood swings (“moody”). Symptoms of PMS called premenstrual dysphoric severe disorder (PMDD) or late luteal phase is also called dysphoric disorder) and occurs in a fraction of women who experienced disruption to activities.
What causes PMS?
STDs still a mystery, since it involves a lot of symptoms and is difficult to establish a definite diagnosis. Several theories developed to explain the cause, but there is no satisfactory. Most evidence says that PMS occurs because of changes or interactions between sex hormone levels and brain chemicals called neurotransmitters. PMS is not associated with factors or certain personality type. Numerous studies show that psychological stress has nothing to do with big STDs.
What are PMS symptoms?
The symptoms associated with PMS with long enough and severe symptoms that vary from cycle to cycle period. Symptoms associated with mood is: angry, easily irritated / offended, anxious, depressed, depression, crying, overly sensitive and excessive mood swings. PMS symptoms and physical signs such as fatigue, abdominal bloating, breast pain, acne and changes arising appetite. For some women PMS can be controlled with medication and lifestyle changes such as sports, nutrition and support of family or friends.
How to ensure an STD?
Tools that help establish the diagnosis with an STD is a menstrual diarrhea, which recorded the physical and emotional symptoms during the month. When changes occur consistently around ovulation (midcycle or 70-10 days before menses) and kept there until the time period, then maybe women suffering from PMS. Creating mens diarrhea will help health workers diagnose, also provide an understanding of women to their bodies. When the diagnosis of PMS is made and women understand it, will generally be easier to overcome the interference. Diagnosis of PMS can be difficult because mirim with illness and other psychological conditions. There are no laboratory tests to check the women affected by PMS or not, but rather used to rule out other conditions like PMS. Other similar conditions such as depression, PMS, water retention (edema idiophatic), chronic fatigue, hypothyroidism, and Irritable Bowel Syndrome.
Key clue in the diagnosis of PMS is a symptom free period after your period until the next ovulation. If there is no grace period and symptoms continue then it is likely not an STD. PMS symptoms may aggravate other diseases, but STDs can not be the sole cause of ongoing symptoms. Necessary blood tests and others to eliminate other causes. Another way to help determine the diagnosis of PMS is to use drugs to stop ovarian function. If these drugs can eliminate the symptoms then the most likely diagnosis of PMS.
How to cope with PMS?
Treatment of STDs as difficult to diagnosis. Several types of therapy can be used to treat this condition although there are not proven scientifically. On the other hand, not all women fit the scientific-based therapy.
Its general management is healthy galive style like: sports, family support and friends, avoid salt before the menses, reduce caffeine, stop smoking, reduce alcohol and reducing sugar. Some studies suggest the use of vitamin B6, vitamin E, calcium, and magnesium because it provides benefits.
The drugs used to treat symptoms of PMS can be a diuretic, pain relievers, birth control pills, ovarian function suppressing drugs and antidepressants.
• Diuretics: spironolactone
• Analgesics: NSAIDs
• Pill
• Discounter ovary: danazol
• Antidepressants: fluoxetine, paroxetine
It should be understood that these drugs will not be effective for relieving the physical symptoms, often requiring a combination of diet, and exercise.
Self-management to control PMS
Women can control or reduce symptoms of PMS by changing your way of eating, exercise and respond to everyday life. Try the following trick.
Ordering diet
• Eat a little, but often to reduce bloating / feeling full
• Limit salt and salty foods to reduce bloating and fluid resistance
• Choose foods with complex carbohydrates such as fruits, vegetables and grains
• Choose a diet rich in calcium. But if can not eat dairy products then need to add a calcium supplement.
• Take a multivitamin supplement
• Avoid caffeine and alcohol
Exercising regularly
Minimum of 30 minutes doing exercise such as walking, cycling, swimming or other aerobic activities. Regular exercise will help improve health and eliminate the symptoms of fatigue and depressive mood.
Reduce stress
• Sleep enough
• Perform or respiratory muscle relaxation in reducing headaches, anxiety or difficulty sleeping
• Try yoga or massage for relaxation and stress relief
Book
Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol. Nov 15 1982; 144 (6) :655-60.
Berkley KJ. A life of pelvic pain. Physiol Behav. Oct 15 2005, 86 (3) :272-80.
Durain D. Primary dysmenorrhea: assessment and management update. J Midwifery Women’s Health. Nov-Dec 2004; 49 (6) :520-8.
French L. Dysmenorrhea. Am Fam Physician. Jan 15, 2005; 71 (2) :285-91.
Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. Apr 1, 2006; 332 (7544) :749-55.
Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. May 13, 2006; 332 (7550) :1134-8.
