Painful menstruation is a disorder that causes significant social losses and most often loss of labor force due to school absences during adolescence and inability to go to work in young adulthood. It is a condition that can be accompanied by nausea, vomiting, headache, irritability, diarrhea, and sometimes spreads to the waist area, accompanied by cramp-like pain in the lower abdomen. It is seen in approximately 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. : These people do not have a secondary disease that causes painful menstruation. Generally, complaints begin 1-2 years after menstruation begins and their severity increases until birth or the age of 23-27. It is more common in women who start menstruating at an early age and have long and heavy menstrual bleeding. There may be a familial predisposition. The frequency is higher in those whose mothers and sisters have painful menstrual periods. 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 and a detailed examination performed in a painless period (ultrasonography and rectal examination can be performed in virgins) will enable the diagnosis. . In this examination, no signs of gynecological disease can be detected. Menstrual pain in these patients begins either a few hours before or together with menstruation and can last up to 48-72 hours.
Since it is accepted that the most important cause of the disease is the substances called prostaglandin produced by the inner lining of the uterus, the production of prostaglandin substance is included in the treatment. blocking agents are used. Painkillers, which we call nonsteroidal anti-inflammatory drugs (indomethacin, ibuprofen, naproxen sodium, etc.), are the first option in treatment. These drugs are started to be used one day before or together with menstruation and are used for 1-3 days. It is used 1-4 times a day. Ha In 70-80% of patients, these medications are sufficient to relieve pain. They are the drugs to be preferred by adolescent girls and women who do not need birth control. Using these medications for 1-2 days every month usually does not cause any problems. However, those with stomach ulcers, asthma, liver and kidney failure should not use these drugs.
The second option in treatment is birth control pills. These medications would also be very suitable for women who 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. Progesterone-releasing intrauterine device (hormonal 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 situation should be taken into consideration here. Congenital anomalies should be considered in young girls who do not menstruate even though they reach 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, and this blood accumulates in the female organs. At the same time, there are recurring pains every month. Treatment will occur by cutting the membrane that blocks blood flow.
This type of menstrual pain occurs long after the first year of menstruation. Pain begins 1-2 weeks before the expected menstruation and continues for a few more days after the end of bleeding.
The most important reasons are; endometriosis, adenomyosis, myomas, moles (polyps) inside the uterus and in the cervix, adhesions formed between female organs due to previous infections, spiral, congenital uterine anomalies, ovarian cysts, psychological reasons, blood pooling syndrome in the pelvis. In the past, retrovertia of the uterus was also considered a cause of pain, and surgery to correct the uterus was recommended. However, inverted uterus correction surgeries are not performed today. The most important findings that distinguish the pain from primary dysmenorrhea are that it begins after adolescence and occurs 1-2 weeks before menstruation. The reasons listed above are usually revealed during the examination of the patient. If no finding can be detected during the patient's examination, the given medication If it does not respond to medication, an operation called laparoscopy is recommended for diagnosis and treatment. With laparoscopy, the woman's abdominal and female organs are examined directly visually. Some causes can be corrected by laparoscopy. Treatment of secondary dysmenorrhea is possible by treating the underlying disease. For example, painful menstrual periods can be treated by removing myomas in women with myomas, removing these cysts in women with ovarian cysts, removing skin tags (polyps), and correcting congenital anomalies in accordance with the procedure. As can be understood from the above information, women with painful menstrual periods can be diagnosed by themselves. It is not a disease that can be treated 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 and the underlying causes, if any, should be revealed and the treatment planned.
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