WHEN THE RULES ARE PAINFUL

Painful, repetitive and sometimes debilitating, dysmenorrhea (painful menstruation) are particularly common in young women. What are the origins of painful periods ? What are the investigations and what treatments can we offer? Point with Dr. David Elia *.

What are the symptoms of painful periods?

Dr. David Elia dysmenorrhea represents the word of localized pain in the lower abdomen, usually in the middle, which are contemporary rules, that is, they occur either on the eve of the rules or the same day, and last from 1 to 4-5 days. This is pain like cramps or colic, sometimes quite violent and then requiring women to lie down or stop their activities.

They can also spill over the lower abdomen to move right or left and especially in the lower back, "in the back" as women say. These symptoms are accompanied by pain quite varied: nausea, headache, fatigue, malaise, diarrhea, vomiting, etc..

Thus, for some women, it's a catastrophe monthly. The rules to be renewed 14 times a year, we understand that this may represent an important source of absenteeism, or school for girls, is professional in all ages.

What are the women affected by menstrual cramps?

Dr. David Elia: most often affected by painful periods are girls, so much that is traditional to have hurt for the rules. They have not all bad, even if it is for a large proportion of them. They have what is called primary dysmenorrhea. That is to say we did not find any cause (ovarian cyst, uterine malformed?), Unlike secondary dysmenorrhea, which will be discussed later.

Attention was always thought pain during menstruation were happening in the minds of women. This is entirely false! It is not a symptom but a real psychological symptoms.

In fact, we now know that primary dysmenorrhea is caused by substances called prostaglandins. These are secreted into the arteries that feed the uterus at the rules and are potent contractors of the uterine muscle.

When the rules come in, the uterus to evacuate the blood and mucous membranes, and does so through the contractions. It's his way of expulsion: he gets ball shrinks, becomes hard. It is also the way it is to remove the baby during childbirth. The uterine muscle is extremely powerful and when it contracts under the effect of prostaglandins to evacuate the uterine lining and rules, it is particularly bad. The pains are not caused by the ovaries as women often say but by the uterus that begins in a ball and becomes extremely hard.

Why the rules are especially painful observed in girls and less in more mature women?

Dr. David Elia: we do not know. We note simply that the pain rules tend to spend time with. Previously they said they disappeared after the wedding because girls get married early. But now they are marrying later, there he is rather a matter of time.

It is true that pregnancy accelerates the disappearance of menstrual pain but time too. But if 25-28 years to primary dysmenorrhea is usually tamp, other women retain their life, they give birth or not. However, this phenomenon is rare.

The second scenario is called secondary dysmenorrhea. They are secondary to something that is not normal. The great disease is responsible for endometriosis.Thus, girls who have endometriosis, so-called secondary dysmenorrhea.However, as they have 16 years, we will not investigate and make a diagnosis.The other case involved a woman who so badly that undertakes investigations, such as a laparoscopy, which leads to the diagnosis of endometriosis. Since it is treated, the person has, in principle, worse.

Recall the definition of endometriosis: they are small pieces of uterine lining that are in places they should not be, as on the ovaries, fallopian tubes or the ligaments that attach the uterus to surrounding structures. Every rule, these small pieces of mucosa began to bleed in the stomach, which is extremely bad.Note that this is also a cause of infertility.

And endometriosis is discovered more often in older women, sometimes in a woman who was hurt for the rules, but also during intercourse (it wrong in the bottom of the belly) and is unable to have baby . Endometriosis is diagnosed by laparoscopy. Ideally, once treated, the woman is worse during his rule, or during intercourse and may be pregnant.

There are also many pain rule returning to 45-50 years. Most of the time, there is a specific form of endometriosis is called adenomyosis. It is the colonization of the muscle of the uterus by endometriosis. When the rules come in, it hurts.The adenomyosis is a frequent cause of pain secondary rules among women 40 to 50 years before menopause.

What solutions can you propose rules against pain?

Dr. David Elia: the pain of the rules are a commonplace phenomenon but socially awkward. If dysmenorrhea is identified as secondary, there are generally solutions. But usually we do not investigated (ultrasound, pelvic examination, laparoscopy?) Because they will be negative, reflecting a primary dysmenorrhea.In contrast, when for example a woman who was worse for several years suffers again, suspected endometriosis and then carried out investigations.

Treatment side, there are several cases.
If it is a girl who needs contraception, he was offered the pill. Indeed, in 90% of cases, the progestin pill (the classic), regardless of dosage, results in the termination of pain during menstruation. The mechanism is unknown. It is assumed that as the rules are less abundant with the pills, the contractions to evacuate the blood are less powerful and therefore are less painful. It also seems that dysmenorrhea requires inhibited ovulation by decreasing the pill while the production of prostaglandins.

In the remaining 10% of cases, are prescribed as first-line anti-inflammatory drugs (ibuprofen, mefenamic acid - Ponstyl ®??). Please note that today there are extremely ibuprofen faster action (10-15 minutes) as Spifen ® 400.
Aspirin should be avoided in these cases and paracetamol, yet widely used in this indication, I do not use the right molecule.
Under conditions where nothing works, even among girls who did not want the cause of contraception, then carried out investigations and found some secondary causes, most often endometriosis.