Headache, nausea, constipation or diarrhea, pain in the lower back as well as frequent urination often occur, vomiting less common.
Under dysmenorrhea refers uterine pain around menstruation around. Pain can use with the menses or precede them by 1-3 days. The pain reached about 24 hours after hemorrhage beginning its maximum and disappear after 2-3 days altogether. Mostly they are stinging, but also a spasmodic, throbbing or dull, constant duration pain occurs. You can radiate into the legs. Headache, nausea, constipation or diarrhea, pain in the lower back as well as frequent urination often occur, vomiting less common. The symptoms of premenstrual syndrome can throughout the duration of menses or only partially occur. Sometimes Endometriumgerinnsel or -ceramic be ejected. Etiology dysmenorrhea can primary (more common) or secondary (caused by abnormalities of the pelvis) be Primary dysmenorrhea The symptoms can not be explained by structural gynecological diseases. It is believed that the pain of uterine contractions and ischemia is due, presumably by prostaglandins (eg. Prostaglandin F 2a, a strong fibroids Triales stimulant and vasoconstrictor) and other inflammatory mediators (produced by the secretory endometrium) are triggered. They might also extend the uterine contractions and reduce blood flow to the myometrium. Among the factors may include the following: passage of menstrual tissue through the cervix A narrow cervix An incorrect position of the uterus sedentary Fear of menstruation Primary dysmenorrhea begins within one year after menarche and almost always occurs in the ovulation cycles. The pain usually occurs with the onset of menses (or shortly before) and holds for the first 1 to 2 days; it is described as spasmodic and overlaid by a continuous pain in the lower abdomen, which may radiate to the back or the thigh. Malaise, fatigue, nausea, vomiting, diarrhea, pain in the lower back or headache may occur. Risk factors for severe symptoms include the following: early menarche long or heavy menstrual smoking family history of dysmenorrhea With age and after pregnancy are often the symptoms improve. In about 5-15% of women with primary dysmenorrhea the cramps are so severe that it affects daily routine and absenteeism in school or at work führen.Sekundäre dysmenorrhea The symptoms are a result of changes in the pelvic area. Almost any abnormality or alteration in the pelvic area can lead to dysmenorrhea. Common causes include endometriosis (the most common cause) Uterine adenomyosis leiomyomas Less common causes include congenital malformations (eg. As uterus bicornis uterus subseptus, vaginal cross septum), cysts and tumors of the ovary, pelvic inflammatory disease, pelvic congestion, intrauterine adhesions, psychogenic pain and intrauterine devices (IUDs), in particular copper or levonorgestrel-releasing IUD. Levonorgestrel-releasing IUD cause less cramping than copper-releasing IUD. In some women, an extremely narrow cervix (as a result of cone biopsy, LEEP [Loop Electrical Excision Procedure] or cryo or Thermokauterisierung) is present which reacts with pain to the attempt of the uterus to expel the tissue. Occasional pain on the passage of a stalked submucosal leiomyoma or endometrial polyps are due through the cervical canal. Risk factors for severe, secondary dysmenorrhea are the same as for primary dysmenorrhea. Usually a secondary dysmenorrhea begins in adulthood, unless it is caused by congenital malformations. Clarification history The history of the current disease should include the symptoms the complete development of menstruation, including age at onset of menses, duration and amount of bleeding, duration and regularity of the cycle and respect menses. Doctors should also ask about the age at which symptoms began her type and severity factors that alleviate the symptoms or worsen (including the effects of contraceptives) degree of disruption of daily life effect on sexual activity, the presence of abdominal pain unrelated to menstruation to review of Organysteme should include accompanying symptoms such as cyclic nausea, vomiting, bloating, diarrhea and fatigue. The history should known causes, including endometriosis, uterine fibroids adenomyosis or clarify. It is determined the method of contraception, particularly the use of an IUD. The sexual history includes past or current sexual Missbräuche.Körperliche examination The gynecological examination focuses on the identification of the responsible for the secondary dysmenorrhea causes. Vagina, vulva and cervix are examined for lesions and lesions that protrude through the cervix. It is sampled sacrouterinum a narrowed cervix, prolapsed polyps or fibroids, uterine tumors, adnexal tumors, thickening of the rectovaginal septum, induration in the pouch of Douglas and nodules in the ligament. The abdomen should examined for evidence of peritonitis werden.Warnzeichen The following findings are of particular importance: New or sudden pain Not cessation Santander pain fever Vaginal discharge evidence of peritonitis interpretation of the findings The warning signs do not indicate a dysmenorrhea as a cause of pelvic pain out. Primary dysmenorrhea is suspected if symptoms begin shortly after menarche or in adolescence. Secondary dysmenorrhea is suspected if the symptoms begin after adolescence. Patients are known causes, including uterine adenomyosis, leiomyoma, narrow cervix, protruding from the cervix mass or especially endometriosis. Endometriosis has at adnexal masses, thickening of the rectovaginal septum, induration in the pouch of Douglas and nodules sacrouterinum or ligament occasionally drawn for non-specific lesions in the vagina, vulva or cervix into consideration werden.Tests The aim of this study is the exclusion of structural gynecological diseases. Most following test are performed: pregnancy test pelvic sonography intrauterine and ectopic pregnancy be excluded by a pregnancy test. In cases of suspected pelvic inflammatory disease cultures of a cervical smear be created. The pelvic sonography is highly sensitive to resistance in the pelvic area (eg. As ovarian cysts, fibroids, endometriosis, uterine adenomyosis) and can locate lost and misplaced IUD. If these studies do not provide findings and clinical symptoms persist, additional tests are carried out, such as the following: hysterosalpingography or Sonohysterographie for the detection of endometrial polyps, submucosal fibroids or congenital anomalies An MRI to detect other abnormalities, including congenital malformations, or planned previously to confirm surgical procedures identified changes. Intravenous pyelography, but only if a uterine malformation is indicated as triggering or concomitant cause of dysmenorrhea. If all the tests show no conclusive evidence, a hysteroscopy or laparoscopy can be performed. A laparoscopy may be the crucial investigation because it allows a direct review of the entire pelvic region and genitals (also for anomalies). Treatment The underlying disorders are treated causally. General measures Symptomatic treatment begins with adequate rest and sleep and regular exercise. A low-fat diet and nutritional supplements such as ?-3 fatty acids, flaxseed, magnesium, vitamin E, zinc and vitamin B1 can be helpful. In women with primary dysmenorrhea the exclusion of structural gynecological disorders has a calming effect. Medicines should persist, the pain, NSAIDs are usually (relieve pain and inhibit prostaglandins) attempts. With an NSAID you start 24-48 hours before menses and passes it to 1-2 days after bleeding begins. Remains the NSAID administration has no effect, suppression of ovulation with a low-dose oral estrogen-progestin contraceptive can be attempted. Hormonal therapy with danazol, progestins (eg. As levonorgestrel, etonogestrel, depot medroxyprogesterone acetate) or gonadotropin-releasing hormone agonist or levonorgestrel-releasing IUD can reduce dysmenorrheale symptoms. A periodic analgesics may be required. Additional therapeutic measures currently hypnosis is being investigated as a treatment option. For more non-drug therapies, including acupuncture, acupressure, chiropractic and transcutaneous electrical nerve stimulation, although there is insufficient study results before, but some patients may benefit from it. In some patients with intractable pain of unknown origin laparoscopic presacral neurectomy and uterosacral Nervenablation over 12 months were effective. Summary dysmenorrhea is usually primary. Care should be taken to underlying structural lesions in the pelvic area. It should first be examined for structural gynecological diseases by sonography. An NSAID alone or an NSAID plus a low-dose oral contraceptive are usually effective.