Pain during menstruation (dysmenorrhea)

About pain during the menstrual cycle

Every woman at least once in her life has encountered unpleasant and painful sensations during menstruation. For some, they occur occasionally with colds and weakened immunity, while others suffer from pain all their lives. Gynecologists of the Federal Scientific and Clinical Center FMBA say: “Pain during menstruation is not normal!”

In modern medicine, painful menstrual syndrome is regarded as a disease called “algodysmenorrhea” or “dysmenorrhea”. The first name is considered to be more accurate, but due to its length, the second name is more often used - dysmenorrhea.

There are two types of disease:

1. primary (functional) dysmenorrhea – observed in adolescence and in women aged 20-25 years. Repeats cyclically, pain occurs 12 hours before menstruation or on the first day of the menstrual cycle, lasts from 2 to 42 hours. It has an aching, cramping or bursting character, radiating into the intestines or bladder. The disease is not associated with pathological changes in the genital organs;
2. secondary (organic) dysmenorrhea – occurs against the background of pathological processes of the pelvic organs due to urogenital diseases and inflammatory processes. Characteristic of women after 25-30 years. It is characterized by heavy bleeding with clots and severe pain in the lower back. Pain appears and intensifies 1-2 days before the start of the menstrual cycle.

Headache during menstruation

Quite a large number of women suffer from headaches during menstruation. This condition is called menstrual cephalgia. The sensations experienced by a woman during this period vary in intensity: from a completely tolerable and unstable feeling of pressure inside the head to severe migraines that can temporarily deprive one of his ability to work. Headaches are often accompanied by nausea, changes in the perception of smell and taste, increased sensitivity to sounds, mood instability and sleep disturbances.

Menstrual pain can occur 2 days before menstruation and 3 days after it. They usually do not pose a health hazard, however, if cephalgic episodes recur, you should consult a doctor. The reason for this condition is a sharp change in hormonal levels during the menstrual cycle, which is especially typical for women suffering from disorders of the hypothalamic-pituitary system, which regulates the production of hormones. The main causes of headaches during menstruation include the following:

• a sharp drop in the level of the hormone progesterone;
• change in water-salt balance;
• menstruation-related changes in prostaglandin levels;
• chronic iron deficiency anemia, which is often observed in women with heavy and prolonged menstrual bleeding.

Eating disorders with excess carbohydrates and saturated fats in the diet, and excessively frequent consumption of strong coffee predispose to the appearance of headaches during menstruation. Cervical osteochondrosis, blood clotting disorders, and previous head and neck injuries also increase the likelihood of menstrual cephalgia.

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Causes of pain during menstruation

Depending on the type of dysmenorrhea, the causes of pain differ.

For functional dysmenorrhea causes:

• physiological – disruption of hormone synthesis. There is an increased production of prostaglandins - lipid substances that are responsible for contraction of the uterus during menstruation. An excessive amount leads to strong uterine contractions, which provokes pain. Increased production of adrenaline, norepinephrine, dopamine, and serotonin also leads to discomfort;
• psychological – low pain threshold, fear of pain, neurological disorders and psycho-emotional abnormalities that enhance and aggravate the perception of pain;
• vascular disorders;
• lack of magnesium in the blood.

Secondary dysmenorrhea is observed in patients with pathologies of the reproductive organs and can be caused by:

• abnormal location of the uterus, its underdevelopment and malformations;
• abnormal development of the genital organs, complicating the outflow of menstrual blood;
• endometriosis (proliferation of the inner layer of the uterine wall to other organs);
• inflammatory processes in the organs of the reproductive system;
• varicose veins of the pelvic veins;
• adhesions in the pelvis and fallopian tubes caused by inflammation of the tubes, ovaries or previous operations;
• uterine fibroids, ovarian cysts;
• sexually transmitted infections;
• installation of an intrauterine device;
• injury (consequence of surgery, frequent medical abortions);
• psychological and physical fatigue (frequent stress, violation of rest and work schedules).

Symptoms

Unpleasant sensations during or a few days before menstruation can be of varying degrees and intensity. If the ailment is not pronounced and is short-term, and the pain is not significant and does not affect the usual way of life, there is no need to worry. Slight discomfort in the lower abdomen in the first days of the menstrual cycle is considered normal for the body.

However, severe pain symptoms and accompanying ailments may indicate pathology in the body:

• pain syndrome: severe pain in the lower abdomen of various types (pulling, stabbing, cramping). It can radiate to the appendage area, lower back, intestines, bladder, inner thighs;
• psycho-emotional disorder: sleep disturbance, nervousness and irritability, anxiety, depression, excessive sensitivity, mood swings, odor intolerance, change in taste preferences;
• autonomic disorders: nausea, bloating, diarrhea or constipation, dry mouth, frequent urination, chills or fever, increased sweating;
• vegetative-vascular disorders: headache, dizziness, loss of consciousness, numbness of the extremities, facial swelling, tachycardia, bradycardia, heart pain;
• metabolic-endocrine manifestations (hormone imbalance): changes in body temperature (both decrease and increase), weakness, loss of strength, joint pain, swelling, limpness in the body (wool-like legs), itchy skin.

These symptoms may be signs of a minor pathology or indicate a serious illness. The multidisciplinary center of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency recommends that patients contact our specialists to determine the causes of the ailment and their treatment.

Depending on the severity of pain symptoms, dysmenorrhea is classified:

1. first degree (mild) – moderate, short-term pain in the lower abdomen. There are no violations of other body systems. Performance is maintained;
2. second degree (medium) - a pronounced nature of pain, accompanied by endocrine and autonomic disorders: weakness, nausea, vomiting, frequent urination, chills, insomnia, changes in mood, depression. Requires consultation with a doctor and prescription of medications;
3. third degree (severe) - severe, unbearable pain in the abdomen and lower back are supplemented by symptoms of the second degree. Accompanied by fainting, tachycardia, pain in the heart. Painkillers do not work, and the ability to work completely disappears.

If you experience monthly pain during your period, don't tolerate it! Over time, their intensity may increase, and pathological processes may develop into serious diseases. In our clinic, you can undergo a routine gynecological examination, which will help identify the causes of the ailment, detect concomitant diseases and begin adequate treatment.

Premenstrual syndrome (PMS) - symptoms and treatment

The development of treatment packages for patients with PMS should be approached taking into account the characteristics of each case. But the mandatory points in the treatment of all forms of premenstrual disorders are:

• normalization of the work and rest regime with dosed physical activity;
• rational balanced nutrition - a fractional low-calorie diet enriched with thiamine (vitamin B6), carotene (vitamin A), tocopherol acetate (vitamin E), ascorbic acid (vitamin C), minerals, polyunsaturated fatty acids, etc. [12].

Considering the high prevalence of inflammatory diseases of the female genital organs in patients with PMS, the main treatment is prescribed after identifying foci of infection and their treatment.

A highly effective first-line approach to treating PMS is psychotherapy . It includes a confidential conversation with the patient and an explanation of the nature of the disease. Psychotherapy is especially effective for mild PMS. During the treatment process, additional participation of the patient's partner is desirable to ease increasing tensions and misunderstandings.

Since PMS is accompanied by endocrine disruption, hormone therapy . When choosing medications, pregnancy planning should be taken into account. Thus, the complex treatment regimen for patients with PMS who plan to become pregnant includes the drug duphaston - taken from the 16th to the 25th day of the menstrual cycle for six months. In other cases, combined oral contraceptives (COCs) are prescribed, which must be taken in a contraceptive mode for three months [8].

The variety of premenstrual disorders is associated with the involvement of prostaglandins in the pathological process. Therefore, in the complex therapy of various forms of premenstrual disorders, it is necessary to include non-steroidal anti-inflammatory drugs (NSAIDs): diclofenac, ibuprofen, etc. They help get rid of pain that occurs before and during menstruation [12].

Due to the special role of the stress factor in the mechanism of development of premenstrual disorders, it is advisable to prescribe anti-stress therapy . It involves taking adaptogens, multivitamins, auto-training, aromatherapy, manual and water massage, vacuum therapy, and water procedures.

Patients with elevated serum prolactin concentrations are prescribed dopaminergic drugs (Dostinex). In patients with this indicator, ovulation is usually disrupted due to stress, so they should not use contraceptives in treatment, and to correct hormonal disorders in the second phase of the menstrual cycle, they are prescribed duphaston for six months.

Treatment for PMS should continue for three menstrual cycles. This is an approximate period; sometimes longer treatment is possible. It all depends on the individual characteristics of the body.

In extremely severe cases of PMS, it is possible to perform a bilateral oophorectomy —irreversible cessation of ovarian function. After this procedure, menstrual cycles stop, and along with them, PMS symptoms disappear. Operated patients are prescribed hormonal therapy until the age of 51, i.e., until the age when menopause usually begins [12].

Diagnostics

Diagnosis during menstrual pain should be comprehensive. At the initial examination, it is important to tell the doctor in detail what is bothering you. Based on complaints, symptoms, and a description of lifestyle, the gynecologist will be able to exclude acute abdominal syndrome (for example, appendicitis). After an oral interview, the doctor examines the patient and prescribes a series of tests. These include:

• gynecological smear (including flora, sexually transmitted diseases, hormonal function of the epithelium, cytology);
• clinical blood and urine analysis;
• biochemical blood test to determine the level of hormones in the blood;
• Ultrasound of the pelvic organs;
• vulvoscopy;
• colposcopy.

In our center of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, diagnostics are carried out according to international standards. The clinical diagnostic center, which is part of the clinic, guarantees the accuracy of the results and the speed of their provision. Modern equipment in the gynecology department allows for accurate diagnosis.

Causes of the unpleasant condition on critical days

There are many reasons for feeling unwell during menstruation:

• increased concentration of serotonin , which increases intracranial pressure and leads to nausea and headache;
• imbalance of water and salts . During critical days, the body does not remove water well, which accumulates in tissues, including the brain. An increase in the amount of fluid in the blood vessels leads to surges in blood pressure, accompanied by nausea and headaches in the crown and back of the head;
• release of waste into the blood . From there, harmful substances enter the intestines through the liver. The situation is aggravated by constipation. Unremoved toxins are absorbed back into the blood, causing poisoning of the body, accompanied by nausea and vomiting;
• unstable emotional state that occurs in women during the menstrual period. Your head may hurt from an incomprehensible feeling of guilt or unmotivated resentment;
• incorrect selection of oral contraceptives . Birth control pills contain hormones, and when a woman stops taking them before her period, a withdrawal state occurs, which provokes a hormonal imbalance that does not go away without a trace for the body;
• headache can be caused by blood loss during hypermenorrhea (heavy periods). A decrease in blood quantity leads to a decrease in the number of red blood cells that carry oxygen to the brain. Oxygen starvation occurs, and, as a result, pain in the head.

Prevention of pain during menstruation

Like any other disease, dysmenorrhea needs prevention. To prevent painful sensations during menstruation, you must follow several rules:

• visit a doctor regularly (if there are no complaints, once a year);
• promptly treat gynecological diseases;
• use contraception to avoid sexually transmitted infections and unwanted conception (as a consequence – abortion);
• follow the recommendations of the gynecologist;
• Consult a doctor immediately if you experience pain during your period.

Additional recommendations include: playing sports and leading an active lifestyle, abstaining from bad habits, maintaining a vitamin and mineral complex in the body, maintaining a daily routine, a balanced diet, regular sex life with a regular partner (for adult women).

How to treat

The gynecological department of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency determines and develops an approach to the treatment of dysmenorrhea individually for each patient. Depending on the causes of the disease, treatment can be preventive in nature with the prescription of medications (painkillers, antispasmodics, sedatives), or complex.

Complex therapy includes:

• taking antibiotics and anti-inflammatory drugs;
• restoration of hormonal balance;
• correction of the intake or type of oral contraceptives (installation of the IUD before birth is undesirable);
• surgery.

During therapy, consultation with related specialists (endocrinologist, mammologist, psychologist) may be indicated.

It is important to understand that relieving pain symptoms with painkillers is not a cure. Dysmenorrhea is a pathological condition and it must be treated comprehensively under the supervision of an experienced specialist!

You can make an appointment or get advice from our specialist by calling our number or filling out a convenient form on the website.

How to help yourself

On critical days, a woman needs to follow a number of simple rules:

• It is recommended to abstain from foods that make you thirsty . If you reduce the amount of water consumed, headaches will subside. You should eat food in moderation, avoiding overeating.
• For severe pain, you can take painkillers and rub lavender oil into your temples. A cold heating pad applied to the forehead helps a lot. It is useful to take a walk outside and then drink tea with mint or raspberries.
• If you have a headache while taking contraceptives, you need to contact a good gynecologist and find other pills . With increased blood loss, hypermenorrhea is treated.

The main condition for good health on critical days is not to invent problems for yourself, not to be nervous, and in case of obvious gynecological problems, not to self-medicate, but to go to the clinic.

Why do they trust us with their health?

• The Department of Gynecology has been providing high-tech medical care in the treatment of all types of gynecological diseases since 1987;
• Every year more than 2,000 patients come to us and receive professional medical care;
• For each patient, our doctors develop an individual treatment plan. In complex and critical situations, the multidisciplinary center allows you to gather a consultation with specialists in related fields and quickly determine treatment tactics;
• In daily practice, doctors use the latest international achievements and advanced treatment methods;
• The operating rooms are equipped with new high-tech equipment;
• We carry out more than 2,500 operations of varying complexity per year;

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• Doctors regularly take part in international congresses and research.