Obstetrics and Gynecology - A. M. Gromova 2000

Menstrual Disorders
Forms of Menstrual Cycle Disorders
Algodysmenorrhea

Algomenorrhea is one of the most common gynecological disorders. It is worth noting that mild menstrual pain can sometimes occur even in healthy women and is not considered pathological. In such cases, discomfort is localized strictly to the genital area, lacks additional symptoms, and does not impair a woman's ability to work. Algomenorrhea, as a form of pathological menstrual dysfunction, is characterized by sharp, acute, or dull, aching lower abdominal and lower back pain during menstruation, accompanied by headaches, tachycardia, nausea and vomiting, bowel dysfunction, eyelid edema, fatigue, and occasional temporary fainting.

A distinction is made between primary (or neuropsychogenic) algomenorrhea, which is unrelated to genital pathology, and secondary algomenorrhea, caused by underlying conditions of the reproductive Organs (such as tumors, inflammation, infantilism, uterine malposition, and hyperestrogenemia). Primary algomenorrhea typically manifests with a woman's very first periods and is more frequently observed in nulliparous women.

The underlying cause of menstrual pain is spastic uterine contractions leading to myometrial ischemia. The primary factor driving these contractions is disordered prostaglandin synthesis, particularly involving PG F₂a. Hyperprostaglandinemia also explains the other associated symptoms of algomenorrhea (headaches, nausea, vomiting, diarrhea, etc.), as well as the fact that this condition predominantly accompanies ovulatory cycles (since progesterone promotes prostaglandin synthesis in the secretory endometrium). Endogenous opiates (endorphins, enkephalins) also play a role by blocking pain receptors within the Central Nervous system, thereby determining the patient's individual perception of pain intensity.

Primary algomenorrhea is primarily treated with medications that inhibit prostaglandin synthesis: naproxen (250 mg 2–3 times daily), indomethacin (metindol, 25 mg 3 times daily), brufen (250 mg 3 times daily), butadion, and acetylsalicylic acid (200 mg 4 times daily)—listed in order of their potency in inhibiting prostaglandin synthesis. It is recommended to start taking these medications 2–3 days prior to menstruation and continue through the first day of the cycle. Adjunctive therapies include novocaine Electrophoresis applied to the solar plexus area (8–10 alternate-day Procedures throughout the Menstrual cycle); local warmth (38–40°C) applied to the lower abdomen and feet 3–4 days before menstruation to help reduce smooth Muscle spasms; and acupuncture. Treatment may also include vitamin E (300 mg daily During the first 3 days of painful menstruation); antispasmodics, sedatives, and mild tranquilizers (valerian, relanium, trioxazine) administered at bedtime during the second phase of the menstrual cycle; and combined estrogen-gestagen preparations with a high progestin content (such as norinyl, ovidon, non-ovlon) taken cyclically from the 5th to the 25th day of the cycle, 1 tablet daily for at least three months.

Treatment of secondary algomenorrhea must focus on resolving the underlying condition: anti-inflammatory therapy for inflammatory origins, hormonal therapy for genital Endometriosis, and cyclic hormone therapy, gynecological massage, or spa therapy for genital infantilism. Surgical intervention is required in cases of anatomical malformations.