Дисменорея — это патологический процесс цикличного характера, который характеризуется спазмообразными или реже ноющими болями в области проекции матки, отдают в поясницу в период месячных. Так же сопровождаются психическими вегетососудистыми и нейроцыркуляторными симптомами.
Болезненные месячные относятся к самой часто встречаемой гинекологической патологии, приблизительно у 32 — 53% женщин детородного возраста. У 10% из них боль носит настолько интенсивный характер что мешает работать. Чаще на боль во время месячных жалуются женщины с излишним весом, одинокие женщины и те у которых матери страдали на эту же патологию.
Причины возникновения боли во время месячных
При первичной дисменореи нарушается функция гипоталамо — гипофизарно — яичниковой системы баланс простагландинов и эстрогенов нарушен в сторону последних. Эстрогены стимулируют продуцирование простагландинов, окситоцина и вазоактивных веществ благодаря этим веществам во время месячных повышается маточная сократимость, что приводит к ишемии матки и раздражительности нервных волокон повышая при этом чувство боли. Диагноз первичной дисменореи ставится на основе отсутствия гистологического изменения слизистый половых путей при гинекологическом обследовании, молодой возраст 16 — 25 лет, и соответствующая клиническая картина.
При вторичной дисменореи которая возникает в следствии органических изменениях в органах малого таза. Чаще у женщин которым за 30 лет на фоне острых и хронических воспалительный гинекологических заболеваний, абортов, и т. д. Самой частой причиной вторичной дисменореи есть эндометриоз. Диагноз вторичной дисменореи ставится на основе инструментальных методов исследования таких как: УЗД, гистероскопия, лапароскопия для внешних форм эндометриоза.
Головная боль во время месячных
Причины возникновения головной боли во время месячных те же самые, что и при болях в низу живота вазомоторное действие гормонов на сосуды головного мозга их спазм вызывает раздражение нервных волокон и чувство боли.
Снять такую боль можно с помощью спазмолитиков «Спазмалгон», не стероидных противовоспалительных препаратов таких как «Ибупрофен», «Мовалис». Среди гомеопатических препаратов можно использовать «Ременс», «Мастодинон», «Меналгин». Блокаторы кальцевых каналов и препараты магния так же можно использовать при головной боли во время месячных так как они снимают спазм сосудов тем самым устраняют причину возникновения боли. Витамины группы В6 они способствуют нормализации корково — подкорковым связям его назначают в дозировке по100 мг в день.
Лечение
Должно быть комплексным и индивидуальным. Не стероидные противовоспалительные препараты назначают в течении первый двух троих дней от начала менструации, потому что в этот период максимальная концентрация простагландинов в крови. Их можно использовать вместе с комбинированными оральными контрацептивами так как они усиливают действие друг — друга. Не стоит забывать про опасное действие НПВП на слизистую желудка поэтому принимать их нужно по 1 таблетке в день запивая большим количеством питья. Самым безопасным в этом плане есть «Мелоксикам» он в меньшей мере раздражает слизистую желудка.
Самыми эффективными препаратами при лечении дисменореи есть комбинированные оральные контрацептивы, они способствуют снижению уровня эстрогенов в крови тем самым уменьшают все вазоактивные вещества и гормоны которые способствуют появлению болей во время месячных. Такие препараты назначают женщинам которые нуждаются в контрацепции и используют их по той же схеме. Курс лечения на протяжении 3 — 6 месяцев. Назначают низко дозированные КОК (Ярина, Жанин, Регулон, Марвелон).
Витамины группы Е по 300 — 400 мг в день, а также группы В по 100 мг в день. Можно использовать физиотерапию и иглоукалывание так же имеют высокий терапевтический эффект. Необходимо не забывать о правильном питании и режиме дня в такие дни избегать значительных физических и психических нагрузок.
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Если Ваш менструальный цикл имеет отклонения от нормы (слишком длинный или короткий), присутствует резкая боль, кровянистые выделения до менструаций и длительное время после них или в середине цикла, следует обязательно обратиться к гинекологу. Главный врач, Врач акушер-гинеколог, гинеколог-эндокринолог, гинеколог детский, врач ультразвуковой диагностики, д.м.н., профессор
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