Menstrual cramps (algomenorrhea) is a pain syndrome of varying intensity that accompanies menstruation. It is manifested by cramping or aching pain in the lower abdomen during the first day or during the entire menstruation. Severe pain can significantly worsen a woman’s well-being and limit her activity. More often it is a concomitant symptom of diseases of the female genital sphere: anomalies of development and inflammatory processes of the genital organs, endometriosis. The causes of pain during menstruation are found out during a gynecological examination (examination, ultrasound, hysteroscopy). In the prognosis, the treatment of the underlying pathology is important.
ICD 10
N94.4 N94.5 N94.6
General information
The most common disorder of menstrual function, expressed in the painful course of monthly bleeding, is menstrual cramps, or painful menstruation. Minor discomfort, moderate, mild pain of menstruation is noted by up to 70% of women aged 14 to 45 years, another 10% of women complain of intense pain, significantly affecting overall well-being and ability to work. This disease is often accompanied by vomiting (in 84%), diarrhea (in 79%), dizziness (in 23%), headache (in 13.5%), fainting (in 16%) of women. If menstruation is painful and irregular, then they talk about such a violation as algodismenorrhea.
Modern gynecology takes the problem seriously, since it can be the first signal of violations occurring in a woman’s body. When painful menstruation occurs, a woman is strongly recommended to visit a gynecologist.
Causes
Primary
Among the causes of primary menstrual cramps, the most common are the following:
- Congenital dysplasia of connective tissue development. It occurs in 60% of cases of menstrual cramps. Connective tissue dysplasia in the body can also be manifested by changes in the vessels of the extremities, bone skeletal curvature (scoliosis, flat feet), myopia, etc. The leading cause of dysplasia is considered to be a lack of magnesium in the blood, which is confirmed by a biochemical blood test.
- Genital tuberculosis. With tuberculosis of the genitals, menstrual cramps manifests itself with the onset of the first menstruation, its exacerbations occur in autumn and spring. Pain during menstruation does not have a clear localization, accompanied by malaise.
- Neurological disorders. A tense state, emotional instability lead to a decrease in the threshold of pain sensitivity, an aggravation of pain perception and the development of menstrual cramps.
- Uterine abnormalities: underdevelopment (hypoplasia) of the uterus, excesses of the uterus body posteriorly or anteriorly (hyperanteflexia), malformations of the uterus (bicuspid, bicornular uterus). Primary menstrual cramps in these cases is caused by difficulty in the outflow of menstrual blood from the uterine cavity and increased uterine contractions.
Secondary
The development of secondary menstrual cramps is most often caused by diseases of the pelvic organs. Diseases and conditions that cause secondary form are:
- endometriosis (adenomyosis);
- inflammatory diseases of the genital area;
- endometrial polyps;
- tumors of the uterus and appendages;
- dilation of the pelvic veins;
- adhesive processes in the pelvic organs;
- intrauterine contraceptives;
- pelvic neuritis;
- scarring of the cervix due to intrauterine interventions (especially abortions).
The occurrence of secondary menstrual cramps is promoted by physical and mental fatigue, concomitant extragenital pathology, hypersensitivity to their own sex hormones (progesterone and estrogens). In the anamnesis, patients with secondary menstrual cramps have birth injuries, surgical termination of pregnancy, surgical interventions on the uterus and its appendages.
Pathogenesis
In the mechanism of development of this disease, the leading role belongs to a violation of hormone synthesis, which leads to an increase in the concentration of hormone–like substances – prostaglandins in tissues. Prostaglandins cause active uterine contractions that help to cleanse the uterine cavity from the rejected endometrium. In addition, numerous nerve endings of the abdominal cavity are also irritated in response to uterine contractions and cause pain in the lower abdomen. Hormonal fluctuations also cause concomitant symptoms of this disease.
Classification
Primary form
For reasons leading to painful menstruation, primary and secondary form are distinguished. Manifestations are noted simultaneously with the arrival of the first menstruation or during the first 3 years after its onset. Pain syndrome comes to the fore with primary form. Downstream, primary form is divided into compensated and decompensated.
- Compensated primary form proceeds with the immutability of the strength and duration of pain during menstruation for a long time.
- If menstruation is accompanied by the progression of pain syndrome, then they talk about decompensated primary form.
According to the concomitant symptoms accompanying the onset of menstruation, there are adrenergic and parasympathetic types of primary algomenorrhea.
- The adrenergic type of menstrual cramps occurs when the level of the hormones adrenaline, norepinephrine, dopamine increases, which causes a malfunction in the entire hormonal system of the body. With this type of primary algomenorrhea, patients experience severe headache, palpitations, fever, insomnia, intestinal dysfunction (constipation). Limbs acquire a bluish color due to spasm of small vessels, the skin of the body and face becomes pale.
- With the parasympathetic type of menstrual cramps, the level of the hormone serotonin increases in the cerebrospinal fluid. In this case, primary algomenorrhea is characterized by vomiting, a decrease in heart rate and body temperature, diarrhea. Often there are swelling on the face, limbs, weight gain, skin allergic manifestations.
Primary menstrual cramps is more common in patients with asthenic physique, emotionally unstable, easily excitable, with manifestations of premenstrual syndrome.
Secondary form
Painful menstruation observed in women over 30 years of age is considered as secondary algomenorrhea. Secondary algomenorrhea occurs in 30% of women, many in moderate to severe form, burdened with concomitant symptoms and periodic disability. Secondary algomenorrhea is quite often combined with menorrhagia (heavy menstruation).
Secondary menstrual cramps, which includes other symptoms besides pelvic pain, is conditionally divided into four groups:
- secondary algomenorrhea with psycho-emotional manifestations (bulimia, anorexia, depressive states, irritability, changes in the perception of taste and smells, etc.);
- secondary algomenorrhea with vegetative manifestations (nausea, bloating, hiccups, etc.);
- secondary algomenorrhea with vegetative-vascular manifestations (headaches, dizziness, fainting, tachycardia, numbness of the legs and arms, etc.);
- secondary algomenorrhea with endocrine-metabolic manifestations (vomiting, itchy skin, joint pain, sharp weakness, etc.).
The severity of the symptoms of secondary algomenorrhea depends on the age of the woman and her physical health. With deviations in cardiovascular activity, vegetative-vascular manifestations are more pronounced, with metabolic disorders — endocrine-metabolic, etc. After 40 years, women are prone to depressive and other psycho-emotional manifestations of algomenorrhea. Often secondary algomenorrhea is accompanied by dyspareunia (pain during sexual intercourse), which also serves as a reason for examination and treatment by a specialist.
Symptoms of menstrual cramps
The leading symptom in algomenorrhea is abdominal pain. Usually, pain sensations appear on the first day of menstrual bleeding or 10-12 hours before it begins. Pain syndrome accompanies menstruation for 1-2 days, gradually subsiding. The nature of the pain can be stabbing, aching, twitching, but more often cramping, with spread to the bladder, rectum, lower back. With algomenorrhea, nausea, gastrointestinal disorders, weakness, irritability, bulimia, anxiety, insomnia, or, conversely, drowsiness are often observed. Algomenorrhea, the expectation of painful menstruation adversely affects a woman’s well-being, her mental, emotional sphere, leads to a violation of intra-family relations. On the basis of the severity of symptoms, there are three degrees of algomenorrhea:
- a mild degree
It is characterized by moderate, short-term soreness with menstrual bleeding, minor malaise, which usually do not lead to a violation of working capacity and activity level. However, a mild degree of algomenorrhea may eventually develop into a more pronounced one, accompanied by an increase in the painful condition and malaise.
- the average degree
It is manifested by severe pain in the lower abdomen, nausea, general weakness, headaches, chills, frequent urination. In addition, patients with moderate algomenorrhea may experience depression, intolerance to sound and olfactory stimuli, and a marked deterioration in performance. Such a condition with algomenorrhea requires appropriate medical correction, selected by a doctor.
- severe degree
It is characterized by pronounced abdominal and lower back pain, general weakness, headaches. Severe form is accompanied by fever, diarrhea, vomiting, tachycardia, heart pain, fainting states. In this state, there is an almost complete decrease in activity and efficiency. Severe algomenorrhea is usually associated with congenital pathology of the genitals.
Diagnostics
If primary algomenorrhea is suspected, a gynecologist’s consultation is necessary. Gynecological examination of the patient, ultrasound of the pelvic organs, determination of hormonal status is carried out. Sometimes, in order to accurately determine the main cause of algomenorrhea, it is advisable to conduct an examination of the digestive system, blood circulation, urination, and mammary glands. Depending on the identified cause of algomenorrhea, not only a gynecologist, but also a neurologist, a phthisiologist, a psychotherapist can treat it.
The examination plan for patients with secondary algomenorrhea includes ultrasound, endoscopic (hysteroscopy, laparoscopy), X-ray (hysterosalpingography), instrumental (diagnostic endometrial scraping) studies of the pelvic organs. An important component of the diagnosis of secondary algomenorrhea is the maintenance of a menstrual calendar by the patient and the drawing up of a diagram of pain sensations for the subsequent choice of a treatment method.
Treatment
Primary menstrual cramps
Treatment should be started with non-drug methods. With painful menstruation, patients are recommended to:
- learn to calm down, relax and cope with stress;
- do sports;
- eliminate smoking and alcohol consumption;
- do not overcool;
- limit physical activity and sexual activity during the second phase of the menstrual cycle and during menstruation;
- in case of pain, put a heating pad on your stomach, pull your knees up to your chest.
To prevent decompensation of algomenorrhea, it is important to preserve pregnancies, especially the first one. Often, primary algomenorrhea passes on its own after pregnancy and the birth of a child. Among the methods of physiotherapeutic treatment for algomenorrhea, electrophoresis with novocaine on the solar plexus zone and reflexotherapy are effective.
In the absence of effectiveness from non-drug therapy for primary algomenorrhea, medications are prescribed. With primary algomenorrhea, accompanied by pronounced neuropsychiatric symptoms, it is possible to prescribe sedatives (diazepam, valerian, trioxazine). Antispasmodics and analgesics, nonsteroidal anti-inflammatory drugs are used to relieve pain.
With primary algomenorrhea, the painfulness of menstruation is significantly reduced or passes with regular intake of hormonal contraceptives, including a combination of ethinyl estradiol and levonorgestrel, or the introduction of injectable contraceptives. With primary algomenorrhea, a good effect is achieved by using drugs of the natural progestin group.
During the treatment of algomenorrhea, it is recommended to keep a menstrual calendar, where you should reflect your feelings accompanying menstruation (pain, its duration, intensity, nature, localization, other symptoms) and consult a gynecologist once every three months.
Secondary menstrual cramps
The treatment consists in the therapy of the primary disease. If the cause of secondary algomenorrhea is intrauterine contraceptives, then it is recommended to remove them. With endometriosis, adhesive processes, tumor lesions of the pelvic organs, various types of surgical interventions are used.
Treatment of inflammatory diseases that cause secondary algomenorrhea is carried out taking into account the identified cause and pathogen, followed by physiotherapy procedures and spa treatment. Also, with secondary algomenorrhea, symptomatic therapy is prescribed, aimed at reducing pain during menstruation (antispasmodic, analgesic, NSAIDs), weakening of psycho-emotional symptoms (sedatives). When painful menstruation occurs, it should be remembered that even a mild degree of algomenorrhea indicates functional or organic disorders in the body, which should be diagnosed and treated as early as possible.
Prevention
In preventing the development of primary algomenorrhea, it is important to observe hygienic measures, hardening, proper nutrition, rational alternation of work and rest. By the onset of the first menstruation, the girl must be prepared in advance, explain to her the physiology of the menstrual cycle. To prevent secondary algomenorrhea, it is necessary to prevent and treat diseases of the genital sphere.
