Lecture of dysmenorrhea (dysmenorrhea)

2021-03-18 12:00 AM

About events occurring in the uterus, particularly in the cervix, in the uterine waist, endocrine-related phenomena, vasomotor nerves

General perception

Few women have no signs when menstruation. But usually the unpleasant signs of menstruation are not heavy and the woman can bear it. For example, back pain slightly, abdominal cramps before or during menstruation and in many cases the discomfort stops immediately after bleeding.

Dysmenorrhea is menstrual period with abdominal pain, pain that penetrates the spine, spreads down the thighs, spreads to the entire abdomen, accompanied by headaches, breast tenderness, nausea, nervous instability.

For many years, people have divided the scriptures into two categories, the primary and the secondary. Primary epilepsy occurs after puberty, or rather, at the first cycle of the ovary. Usually functional, that is, there is no physical damage. Secondary dysmenorrhea occurs after many years of painless menstruation, now painful, also known as late menstruation, acquired dysmenorrhea. Secondary dysmenorrhea is often caused by physical causes such as the posterior uterus, cervical filling, uterine fibroids in the waist of the uterus, making it difficult for menstrual blood to escape. Endometriosis is the most obvious physical cause of dysmenorrhea, due to congested menstrual blood in the foci of the uterine lining.

In the US, it is found that each year up to 140 million hours of labor are lost due to primary epilepsy and this is also a remarkable social disease.

Pathophysiology research

In terms of the events that occur in the uterus, particularly in the cervix, in the uterus, the phenomena related to the endocrine, vasomotor and biochemical processes, one also finds remarkable features note. The uterine muscles and uterine waist change with period. During the estrogen phase, the uterine muscle has rapid and mild contractions. During the progesterone phase, contractions are more sparse but stronger. Strengthening of the uterine muscle is not as painless as the primary tonic of the uterine muscles as it is. Although hyperotonia and uterine contractility are always common in cases of the neuromuscular system, in contrast there are many cases of hypertonia and increased contraction from the bow without the menstruation. For uterine contractions, estrogen is also found to have a softening and elastic effect. Under the action of progesterone, the uterine waist increases tonic, closed and solid. Under the action of progesterone, the uterine lining secretes prostaglandin F2a. The amount of prostaglandin F2a increased in the blood (blood count) and in the menstrual cycle of the menopausal men. All of these events suggest a role of progesterone in the mechanism of neurogenesis. Clinical experience over the years, it has been determined that the menstrual cycles with oocyte (luteal, progesterone) have menstruation (except in cases of entity damage).

The role of vasomotor and vegetative nerves has also been identified. In the period of estrogen, the sympathetic nervous system increases, adrenaline relieves pain. During the progesterone phase, or in the case of progesterone administration, acetylcholine sensitivity increases and causes pain.

Anemia leads to spasm and spasms gradually to pain. It has been likened to anemia that causes spasms and pain to be like angopectoris (angopectoris). However, the cause of the epilepsy is complex and sometimes contradictory. There are cases that seem to be the cause, but when treatment resolves the cause, the cause is gone but the menstruation is still not gone. On the contrary, there are cases where there is a clear cause that the sect should have had the scripture but not the scripture.

Classically, people often divide the functional meridians into different types of the spasmodic system, the menstrual system, the anemia, congestive and psychological system. But this division seems just artificial, man-made, but actually just different stages of a process in the general mechanism. For each case, the manifestation of one stage was more prominent than the other or vice versa, so it was mistakenly thought that there might be different.

Clinical research

It is difficult to determine the rate of having epilepsy because it depends on human factors, individual factors for pain sensitivity. All different degrees of mildness can range from mild discomfort, a feeling of heaviness in the pelvis during menstruation to the point of severe pain in bed for 24 to 48 hours, not doing anything. There are no specific statistics, but it is estimated that about 1 in 10 women are classified as menstrual. Primary epilepsy within 5 years after puberty accounts for 20-25% of girls with epilepsy. Most are mechanical, physical causes are very rare. May be due to:

The uterine vessels constrict and cause anemia.

The uterus has too much squeezing.

Narrow cervical canal makes it difficult for menstrual blood to drain.

Underdeveloped uterus,

Low threshold for pain stimulation.

Emotional state of mind.

Late epilepsy (secondary)

Occurs many years after puberty, after many years of normal menstruation, at 30-40 years old, the effect of pregnancy is almost not clear. Epilepsy can happen in people who have had multiple births, but it can also happen in people who have not had any pregnancies. There are people with epilepsy before pregnancy, until pregnancy, childbirth but return period, menstrual period as before. However, secondary dysmenorrhea is less common than primary dysmenorrhea, accounting for only 20-30% of cases of epilepsy.

The cause can be lifting muscles, possibly physical, but mostly due to physical causes such as:

Endometriosis is in the uterine muscle layer or outside of the uterus.

Fibroids.

Abnormal position of the uterus (posterior contraction of the uterus).

Inflammation of the uterus.

Cervical stenosis scars due to previous surgical procedures.

Cervical polyps or basal tumors in the hole with the uterus (preventing menstrual bleeding).

There is a thing called dysmenorrhea mambranacea, which is a special form, the cause is unknown. Patients with colic cramps like pain resulting from a miscarriage caused by a strong contraction of the uterus. Until the large fragments of the uterus are ejected, sometimes the uterus is printed in a triangle, and the pain subsides and decreases rapidly. That membrane is the shedding membrane, the uterine lining is under long-acting progesterone. The cause of the prolonged action of the corpus luteum has not been determined.

Symptoms of menstrual endometriosis are long-lasting pain that can appear early before or before menstruation, but lasts even after menstruation clears. In some cases, it lasts so long that when the pain is relieved or the pain is gone for a few days, it may turn to a new period.

Treatment

Epilepsy can sometimes be completely resolved if the cause of the disease is clearly identified. These are the cases of epilepsy due to damage to the entity such as mechanical constriction, endometriosis, cervical infection ...

In the majority of cases, if not symptomatic therapy, it is usually preventive treatment based on the pathophysiological factors of the neuromuscular system. For endometriosis, it is mainly treated with medical methods, sometimes by surgery.

For young women, the more conservative the treatment, the better. Medical treatment using synthetic progestins, including norethisterone, is the best atrophy of the uterine lining and the most powerful anti-estrogen. Birth control pills, pills that contain high levels of progestins and low levels of estrogen can be used. Treatment lasts from 6 months to 1 year. Surgical intervention includes curettage, dissection or removal of endometriosis, depending on the general circumstances.

Other physical injuries also require intervention. For example, if the cervical hole has to be dilated many times, the fibrous polyps must be sandy, the uterus falls behind too much, sometimes the uterus hangs in the front, etc.

Dysmenorrhea treatment facility n ă ng

The treatment of neuromuscular dominance is very extensive and abundant due to the diverse nature of the cause, ranging from analgesics to surgery. The pain relievers here can be divided into two groups: the sleep-inducing, sleep-inducing group such as morphine, codeine, pethidine, palfium) and antipyretic analgesics such as pyrazalone and products (acetanilin, phenacetin), acid salicylic and articles, quinoline and articles. The mechanism of action is peripheral if the drugs do not induce sleep, while the drugs that induce sleep work on the central level. Psychological treatments for pain. In addition, psychotherapy is always necessary and often has too good results.

Hormone therapy

For the neuromuscular system in most cases, it brings good results, including severe dysmenorrhea. Theoretical basis is based on known pathophysiological facts, there is no amenorrhea in the non-oocyte menstrual cycles, although the actual pathogenesis mechanism has many contradictions and unknown points, not explained yet. Using progestin as in the treatment of endometriosis to inhibit oocyte release, with very good results. The pain relief or pain relief effect of the drug also affects the patient's psychology and reinforces the results of treatment.

In cases where the nervous system is too severe, the use of ineffective combination drugs may be indicated for surgery in Cotte, removal of the anterior sacral plexus. However, this method does not always bring satisfactory results.

In short, if the treatment of secondary dysmenorrhea due to mechanical causes has many obvious directions, then the treatment of neuromuscular dominance is much more complicated and ambiguous. However, there can be an acceptable regimen in most cases. It is hormone therapy in combination with central or peripheral analgesics, psychoactive drugs, and phytonutrients. Psychotherapy is always as useful as other gynaecological functional diseases. Indications for topical gynecological treatment such as cervical dilatation, surgery, today have much limited metastasis.