Diagnosis of dysmenorrhea

A history of recurrent pelvic inflammatory disease, irregular menstrual cycles, menorrhagia, intrauterine device placement, infertility, etc. helps in the diagnosis of secondary dysmenorrhea.

Through bimanual and trimanual examinations, some causes of dysmenorrhea can be found, such as uterine malformation, uterine fibroids, ovarian tumors, pelvic inflammatory disease, etc. Rectal examination can determine whether the uterosacral ligament is nodular and thickened, which is particularly important for the early diagnosis of endometriosis.

Other examinations: such as erythrocyte sedimentation rate, leucorrhea bacterial culture, B-ultrasound pelvic scan, hysterosalpingography, diagnostic curettage, and finally hysteroscopy and laparoscopy can identify the cause of dysmenorrhea as early as possible.

Hysteroscopy can detect small lesions missed during curettage, such as small myomas, polyps, ulcers, etc., and provide valuable diagnostic basis. It can be performed after diagnostic curettage.

Primary dysmenorrhea

Primary dysmenorrhea often occurs during ovulatory menstruation, so there are no symptoms or only mild discomfort 1 to 2 years after menarche. Severe spasmodic pain often occurs in young women 1 to 2 years after menarche. If regular dysmenorrhea occurs at the beginning or spasmodic dysmenorrhea occurs after the age of 25, other abnormal conditions should be considered.

Dysmenorrhea usually begins with the onset of menstruation or a few hours before vaginal bleeding. It is often spasmodic and colic, lasting 1/2-2 hours. After the onset of severe abdominal pain, it turns into moderate paroxysmal pain, which lasts about 12 to 24 hours. It gradually disappears after the menstrual blood flows out smoothly. Occasionally, some people need to stay in bed for 2-3 days. The pain is in the lower abdomen. In severe cases, it can radiate to the lumbar region or the anterior medial thigh. About 50% of people have gastrointestinal and cardiovascular symptoms. Such as nausea, diarrhea, dizziness, headache and fatigue. Occasionally, there is syncope or collapse. Gynecological bimanual examination or anal examination is negative, and the diagnosis of primary dysmenorrhea can be made.

Secondary dysmenorrhea

Based on the medical history, gynecological examination and necessary auxiliary diagnostic methods, it is determined which gynecological disease causes dysmenorrhea.

(I) Pelvic endometriosis

Dysmenorrhea is the main symptom of endometriosis. The ectopic endometrial tissue in the ovaries, uterine cuboid ligaments, uterorectal fossa and pelvic peritoneum undergoes cyclical changes during the menstrual cycle as well as being affected by ovarian hormones.

(ii) Adenomyosis

Dysmenorrhea is one of the typical symptoms of this disease, which is caused by a benign disease caused by the invasion of the endometrium into the myometrium. There may also be an increase in menstrual volume or a prolonged menstrual period. Gynecological examination shows that the uterus is uniformly enlarged and spherical, with a hard texture, generally about the size of a 2-month pregnancy, and may be slightly tender.

(III) Uterine fibroids

Dysmenorrhea is not the main symptom of uterine fibroids, but submucosal fibroids can cause spasmodic pain during menstruation due to stimulation of uterine contraction. Patients often have menorrhagia, prolonged menstruation or irregular vaginal bleeding. Pelvic examination can reveal varying degrees of enlargement of the uterus, with a smooth surface or nodular protrusions.

(IV) Chronic pelvic inflammatory disease

Strengthen exercise. Lower abdominal pain and infertility are the main symptoms of chronic pelvic inflammatory disease. During menstruation, due to pelvic congestion or acute inflammation induced by menstruation, abdominal pain can be aggravated. Most patients have a history of infertility and acute pelvic inflammatory disease. Pelvic examination shows that the uterus is mostly posterior, with poor mobility, or even completely fixed.

(V) Reproductive tract malformations

During embryonic development, one side of the mesonephric duct can develop well, forming a well-developed unicornuate uterus. However, the other side of the mesonephric duct develops poorly, forming a rudimentary horn or primordial uterus, which is not connected to the opposite side and does not lead to the body. Primordial uterus generally has no uterine cavity, or has a uterine cavity but lacks endometrium; if the primordial uterus has functional response, manifested as periodic bleeding, dysmenorrhea may be caused by blood accumulation in the uterine cavity. Most patients are girls.

(VI) Intrauterine contraceptive device

Dysmenorrhea can also be seen in women with intrauterine contraceptive devices. This type of dysmenorrhea may be caused by an increase in prostaglandins produced by the endometrium, or it may be that the contraceptive device stimulates the rejection contraction of the uterine muscles, leading to spasmodic pain in the lower abdomen. Patients often have discomfort in the lower abdomen or lumbar region, and their menstrual symptoms are aggravated, manifested as dysmenorrhea. Improper placement of the contraceptive device or excessive size can also easily cause uterine contractions, leading to lower abdominal pain and dysmenorrhea.

(VII) Pelvic venous congestion syndrome

This disease is a female internal reproductive organ disease caused by chronic pelvic venous congestion. The main clinical manifestations include pelvic distension, lower abdominal and lumbar pain, and often accompanied by menorrhagia, increased leucorrhea and dysmenorrhea. The symptoms are often aggravated by fatigue, prolonged sitting or standing during sexual intercourse, or constipation. Some patients also have breast pain and bladder and rectal irritation symptoms.

There are many factors that cause dysmenorrhea, the most common ones are as follows:

(1) Cervical stenosis: It mainly causes obstruction of menstrual outflow, causing dysmenorrhea.

(2) Uterine hypoplasia: Poor uterine development is prone to abnormal blood supply, causing uterine ischemia and hypoxia, leading to dysmenorrhea.

(3) Abnormal uterine position: If a woman’s uterus is extremely retroflexed or anteflexed, it may affect the smooth flow of menstrual blood and cause dysmenorrhea.

(4) Psychological and neurological factors: Some women are overly sensitive to pain.

(5) Genetic factors: Dysmenorrhea in daughters is related to dysmenorrhea in their mothers.

(6) Endocrine factors: Abdominal pain during menstruation is related to increased progesterone in the luteal phase.

(7) Increased prostaglandin (PG) content in the endometrium and menstrual blood: Prostaglandin E2 (PGE2) can act on uterine muscle fibers to cause them to contract and cause dysmenorrhea. The prostaglandin content in the endometrial tissue of dysmenorrhea patients is significantly higher than that of normal women.

(8) Excessive contraction of the uterus: Although the uterine contraction pressure of patients with dysmenorrhea is basically the same as that of normal women (normal pressure is about 4.9Kpa), the duration of uterine contraction is longer and it is often difficult to completely relax, so dysmenorrhea occurs due to excessive contraction of the uterus.

(9) Abnormal uterine contractions: Patients with dysmenorrhea often experience abnormal uterine contractions, which often lead to ischemia of the uterine smooth muscle. The ischemia of the uterine muscle can cause spasmodic contractions of the uterine muscle, resulting in pain and dysmenorrhea.

(10) Gynecological diseases, such as endometriosis, pelvic inflammatory disease, adenomyosis, uterine fibroids, etc. The placement of an intrauterine device (commonly known as an IUD) in the uterus can also easily cause dysmenorrhea.

(11) When a girl has her first menstruation, she may suffer from dysmenorrhea due to psychological stress and prolonged sitting, which may lead to poor blood circulation and poor menstrual blood flow. She may also love to eat cold drinks and pears and other raw and cold foods.

(12) During menstruation, strenuous exercise, exposure to cold, or wearing too little clothing can cause blood stagnation and can easily lead to dysmenorrhea.

(13) Bad air quality: Dysmenorrhea can be caused by certain industrial or chemical odors, such as gasoline, banana oil, etc.

Endometrium

The lesions of endometriosis can be transferred to various parts of the body through the blood. When they are transferred to the lungs, the patient will develop "pneumothorax" during menstruation, with symptoms such as difficulty breathing, coughing up blood and nosebleeds.

Young women who often suffer from dysmenorrhea should pay attention! If the severity and frequency of your dysmenorrhea changes, or you experience difficulty breathing, coughing up blood, and nosebleeds during your menstrual cycle, then you may have "endometriosis."

Experts say that endometriosis is the main culprit for severe dysmenorrhea in women and ranks second among the causes of infertility. Once contracted, it is difficult to cure. After contracting the disease, patients develop black, pasty, tender "chocolate cysts" in their ovaries. As the disease worsens, the cysts rupture, causing adhesions in the uterus and affecting fertility.

The lesions of endometriosis can be transferred to various parts of the body through the blood. When transferred to the lungs, the patient will suffer from "pneumothorax" during menstruation, and symptoms such as difficulty breathing, coughing up blood and nosebleeds will appear. At present, the medical community has not yet reached a consensus on the cause of endometriosis, but it is generally believed that it is closely related to menstrual blood reflux.

If the patient gets married and has children, the ectopic uterine membrane will shrink after pregnancy, which will alleviate the condition. Early treatment will not affect women's fertility. Director Zhang suggested that young women should pay enough attention to dysmenorrhea and avoid strenuous exercise during menstruation to prevent menstrual blood from flowing back into the pelvic cavity along the fallopian tube.