PAINFUL MENSTRUATION (DYSMENORRHEA)
Painful menstruation is a disorder that causes absenteeism from school in adolescence, and significant social losses and the most frequent loss of workforce due to inability to go to work in young adulthood. There is a picture accompanied by nausea, vomiting, headache, irritability, diarrhea, and accompanied by cramp-like pain in the lower abdomen, sometimes spreading to the lumbar region. It occurs in about 60% of women. In some cases that do not receive adequate medical treatment and have a severe course, women have to apply to health institutions almost every month.
There are two main types of painful menstruation.
1- Primary Dysmenorrhea:
There is no secondary disease that causes painful menstruation in these people. Generally, complaints begin 1-2 years after the onset of menstruation and their severity increases until the birth or the age of 23-27. The incidence is higher in women who start menstruation at an early age and whose menstrual bleeding is prolonged and excessive. There may also be a family predisposition. The frequency is higher in those whose mothers and sisters have painful menstruation.
It is accepted that the most important cause of this disease is the substances called prostaglandins, which are synthesized by the inner lining of the uterus (endometrium) during menstruation and cause contractions and pain in the uterus. It is also suggested that women with painful menstruation have a depressive nature and that these patients have stenosis in the cervix.
For diagnosis, a detailed medical history, a detailed examination in a painless period (ultrasound and rectal examination can be done in virgins) will enable the diagnosis to be made. In this examination, no signs of any gynecological disease can be detected. Menstrual pain in these patients begins either a few hours before or with menstruation and can last for 48-72 hours.
Causes of the disease
Since it is accepted that the most important cause of the disease is the substance called prostaglandin produced by the inner lining of the uterus, substances that prevent the production of prostaglandin are used in the treatment. Pain relievers (indomethacin, ibuprofen, naproxen sodium, etc.), which we call nonsteroidal anti-inflammatory drugs, are the first option in treatment. The use of these drugs are started one day before or during menstruation and are used for 1-3 days. It is used 1-4 times a day. In 70-80% of patients, these drugs are sufficient to relieve pain. They are the drugs to be preferred in adolescent girls and women who do not need birth control. The use of these drugs for 1-2 days each month usually does not cause a problem. But those with stomach ulcer, asthma, liver and kidney failure should not use these drugs.
The second option in treatment is birth control pills. These drugs will also be very suitable for women who anyhow need birth control. It will provide cure in 90% of patients. Progesterone hormone can also be used in treatment. It can be given as a daily pill, or a 3-month injection. The progesterone-releasing intrauterine device (hormone spiral), which has been used in recent years, is very effective in the treatment of painful menstruation.
2- Secondary Dysmenorrhea:
Painful menstruation occurs due to another underlying organic disease. A special case should be noted here. Congenital anomalies should be considered in young girls who do not menstruate despite reaching the age of menstruation, but have pain in the lower abdomen every month. Congenital membranes that block the path of menstrual blood prevent the blood from flowing out; this blood accumulates in the female organs. At the same time, there are recurrent pains every month. The treatment will take place by cutting the membrane that blocks the blood flow.
Causes of the disease
This type of menstrual pain occurs long after the onset of menstruation. The pain begins 1-2 weeks before the expected menstruation and continues for several days after the end of the bleeding. The most important reasons are respectively; endometriosis, adenomyosis, fibroids, moles (polyps) in the uterus and cervix, adhesions between female organs due to previous infections, spiral, congenital uterine anomalies, ovarian cysts, psychological causes, blood pooling syndrome in the pelvis.
In the past, uterine inversion (retroverti) was also considered as a cause of pain, and surgical correction of the uterus was recommended. However, today, reverse uterus correction operations are not performed. The onset of pain after adolescence and its occurrence 1-2 weeks before menstruation are the most important findings that distinguish it from primary dysmenorrhea. During the examination of the patient, the reasons listed above are usually revealed. If there is no finding in the examination of the patient and if she does not respond to the drugs given, an operation called laparoscopy is recommended for diagnosis and treatment. With laparoscopy, the abdominal and female organs of the woman are directly visually inspected. Some causes can be corrected with laparoscopy.
Treatment of secondary dysmenorrhea is possible with the treatment of the underlying disease. For example, removal of fibroids in women with fibroids, removal of the cysts in women with ovarian cysts, removal of moles (polyps), correcting congenital anomalies with correct procedures, can treat painful menstruation due to them. As it can be understood from the information above, painful menstruation is not a disease that women can self-diagnose and cure with simple painkillers, because there may be very serious underlying causes and they may need urgent treatment. For this reason, patients should first be examined by a gynecologist and obstetrician, the underlying causes, if any, should be revealed and treatment should be planned.