原发性痛经的发病机制与防治

原发性痛经 (ｐｒｉｍａｒｙｄｙｓｍｅｎｏｒｒｈｅａ)是指月经期在生殖器官无器质性病变存在时发生的下腹疼痛、坠胀及其他不适感 ,常见于初潮 6 12个月后 ,初建立排卵周期时 ,主要表现为经期下腹部痉挛性疼痛 ,可放射至腰骶部、外阴、肛门及大腿内侧 ,部分患者伴有恶心、呕吐、头晕、乏力、水肿甚至虚脱。本文就原发性痛经的发病机制及防治作一简述。1　原发性痛经的发病机制原发性痛经是青春期常见疾患之一 ,其发病率文献报导差别很大 ,约 43% 90 % [1] ,37% 5 5 %影响了青少年的生活、学习和活动[2 ] 。其病因及发病机制讨论已久 ,认为…     

硝苯啶治疗原发性痛经112例分析

痛经为妇科常见病,盆腔内无明显病变者谓之原发性痛经。系因卵巢内分泌异常、子宫肌痉挛或精神紧张等因素引起。发病时患者表现为行经前后下腹部疼痛,或伴其他不适而影响工作与生活。治疗一般采用对症治疗,但效果不理想。O1994年以来,应用硝苯陡治疗原发性痛经112例,疗效满意,报道如下。一、一般资料112例患者均为门诊病入,年龄16～33岁,平均19岁。未婚76例,已婚43例,病史l～16年,就诊时发病时间l～Zh,均表现为下腹部疼痛,伴腰痛55例,疼痛剧烈伴恶心、呕吐20例。均排除盆腔器质性疾病。就诊前92例既往有药物治疗史。二、治疗…     

痛经的镇痛疗法

痛经为常见病,分为原发性和继发性。原发性痛经是青少年期疾病,青春期后约50％女孩发生,30岁后发生率下降。病因主要为月经期子宫内膜产生和释放前列腺素(PG)增加,引起异常的子宫活动而疼痛;也可由于白三烯生物合成增加或加压素水平升高,引起子宫肌肉强烈收缩而致。继发性痛经是指由于生殖器官某些器质性病变引起的痛经,可发生于不同年龄。痛经治疗根据以下原则及步骤进行。     

痛经的经验性治疗

<正>痛经的发生原因复杂,影响因素多样,患病率约为16.8%~81.0%[1],是女性的常见疾病。不同患者痛经的严重程度存在差异,20%的女性可能因为严重的痛经而影响生活和工作。痛经可从月经初潮时即出现,也可在初潮后逐渐发展而来。根据病因不同,痛经可分为原发性痛经与继发性痛经两类,前者是指无盆腔器质性病变的痛经,其发生多与前列腺素合成与释放异常、子宫收缩异常及神经、精神因素相     

原发性闭经的治疗决策

<正>原发性闭经病因非常复杂,常由于下丘脑-垂体-卵巢轴器质性病变或功能失调,也可由其他内分泌腺体疾病,如甲状腺、肾上腺疾病干扰下丘脑-垂体-卵巢轴功能所致;另外,性分化异常疾病及生殖道发育异常或器质性病变也可引起闭经。原发性闭经的治疗决策包括:治疗时机的决策、治疗方案和治疗     

美国妇产科医师协会第760号委员会意见青春期痛经和子宫内膜异位症

正痛经或者经期疼痛是青春期女性及年轻女性最常见的经期症状。大部分青春期女性经历的痛经为原发性痛经,原发性痛经是指不伴有盆腔疾病的经期疼痛。当患者的病史提示原发性痛经,应给予经验性治疗。当患者的痛经经3～6个月的治疗没有改善,其妇产科医生应查找其他可能的病因并选择其他治疗方案。继发性痛经是指与病理改变有关的月经期痛。子宫内膜异位症是青春期继发性痛经的主要原因。当患者接受激素及非甾体消炎药治疗后仍存在长期明显的痛经,通过病史、体格检查及盆腔超声检查均无阳性发现,应考虑子宫内膜异位症。子宫内膜异位症在青春期女性及成年女性中的表现是不同的。在青春期女性中子宫内膜异位症病症表现为早期红色病变,如果妇产科医生对青春期子宫内     

痛经

痛经是重要的临床疾患,约殃及50%的妇女。原发性痛经发生于无盆腔病变者,而继发性痛经常伴发于盆腔炎、子宫内膜异位症或粘膜下纤维瘤等病理情况。在弄清原发性痛经系子宫过强收缩致使子宫缺血之前,总认为原发性痛经是妇女神经过敏。从1965年以来,Pickles 等许多学者的研究发现原发性痛经患者的子宫内膜、经血和子宫内膜冲洗液中 PGF_(2α)和 PGE_2都增加,而且 PGF_(2α)/PGE_2的比率比对照组增高,提示 PG 与原发性痛经有关。后     

痛经的机理与治疗进展

痛经是最常遇到的主诉症状之一,一般分为原发性和继发性两种,现将其机理与治疗方面的进展情况作一简单介绍。原发性痛经许多妇女往往由于月经的痛性痉挛而影响工作与学习,甚至限制了活动,只能卧床休息,以热水袋或止痛片等也未能完全解痛,原发性痛经的病因和发病机理,至今未     

子宫内膜异位症发病机制的研究进展

子宫内膜异位症(EMs)是妇科中的疑难病,会引起患者痛经、慢性盆腔痛、月经异常以及不孕等临床症状。研究发现EMs的发病有明显的遗传背景,并且在激素及其受体、炎症免疫、侵袭黏附、血管生成等相关因素共同作用下,患者盆腔内形成异常微环境而发病。但由于EMs的发病机制复杂,其确切的发病机制仍不清楚。目前针对EMs发病相关的关键靶点进行治疗,能改善治疗效果,但无法根治该病。本文对EMs的内分泌、炎症免疫、遗传、血管生成和侵袭黏附等因素的发病机制的研究进展和针对关键靶点进行治疗的临床应用进行综述。     

原发性痛经

原发性痛经为常见妇科病。在美国,约52%妇女患痛经,其中10%每月有1～3天失去劳动力。痛经是年轻妇女缺席工作与缺课的最大原因,估计每年浪费的工作小时达一亿四千万以上。近年来,国外学者对本病的发病机理作了较深入的研究,特别是前列腺素(Prostaglandin,PG)的作用。并应用前列腺素抑制剂治疗原发性痛经。一、原发性痛经的病理生理 (一)子宫肌活动:将导管经宫颈插入宫腔,利用导管的微转换器可测定子宫内压     

Dysmenorrhö bei Jugendlichen

Primary dysmenorrhea is especially frequent in adolescents until 20 years of age, and is usually without pelvic pathology. Secondary dysmenorrhea is acquired later, and in adolescents is most often due to endometriosis or reproductive tract anomalies. Therefore, a timely evaluation of the etiology of secondary dysmenorrhea plays an important role in preventive health care. Endometriosis in adolescents is mostly minimal or mild. For this reason, initial conservative treatment with NSAID and/or oral contraceptives is justified. If the symptoms do not respond to medical therapy within 3–6 months, further diagnostic measures are indicated. The therapeutic goal is the early recognition of pelvic pathology and maximum reduction of dysmenorrhea and pelvic pain, primarily based on long-term medical treatment.     

Dysmenorrhea

Affecting over 50% of menstruating women, dysmenorrhea results in absenteeism and economic loss. In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology. In secondary dysmenorrhea gross pelvic pathology in present. With primary dysmenorrhea, the pain is suprapubic, spasmodic, lasts for 48–72 h and is most severe during the first or second day of menstruation. Characteristically, dysmenorrhea starts at or shortly after menarche. The pathophysiology in primary dysmenorrhea is due to increased and/or abnormal uterine activity because of the excessive production and release of uterine prostaglandins. Treatment with many non-steroidal anti-inflammatory drugs (NSAIDs) that are prostaglandin synthetase inhibitors will produce relief from dysmenorrhea and a concomitant decrease in menstrual fluid prostaglandins. For those desiring oral contraception or who cannot use NSAIDs, the oral contraceptive pill will relieve dysmenorrhea by suppressing endometrial growth, thus resulting in a decrease in the menstrual flow as well as in menstrual fluid prostaglandins. Laparoscopy is needed if a pelvic abnormality is detected on examination or if medical treatment for up to 6 months is unsuccessful.In secondary dysmenorrhea, relief is obtained when the pelvic pathology is treated. Dysmenorrhea and menorrhagia due to intrauterine contraceptive devices are controlled with NSAIDs.     

Dysmenorrhea in adolescents and young adults: etiology and management

Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary (functional), and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents and young adults with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and potent leukotrienes play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAID) are the most common pharmacologic treatment for dysmenorrhea. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for 3 menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for 3 menstrual cycles. Adolescents and young adults with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The care provider's role is to explain about pathophysiology of dysmenorrhea to every adolescent and young adult female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient.     

Are combined oral contraceptives appropriate therapy for primary dysmenorrhea?

Current theories concerning the etiology of dysmenorrhea are reviewed, and the use of the combined oral contraceptive pill solely for dysmenorrhea is evaluated in light of the recent approval of antiprostaglandin agents for therapeutic use in relieving menstrual pain. Primary dysmenorrhea refers to menstrual cramping and discomfort in women free from underlying pathology and does not encompass symptoms occurring prior to the menses. There are many theories explaining the 2 types of dysmenorrhea, but none seems to offer a complete rationale. Current research appears to point toward a complex interaction of steroid hermones and prostaglandins. It is now accepted that although psychosocial factors are active in a woman's response to menstrual pain, they are not the cause. Oral contraceptives cannot be considered innocuous but have the potential for serious harm if casually prescribed and used. If a woman wants contraception concomitantly with seeking relief from severe dysmenorrhea, and if following a history and a physical she is found to be free of any pelvic pathology or contraindications for the oral contraceptive (OC), then OCs may be regarded as appropriate. There is now another choice of treatment available for dysmenorrhea -- ibuprofen -- if a woman does not need contraception or does not choose to use OC. The overall approach to care of a woman presenting with dysmenorrhea needs to be holistic. Now that there is an effective alternative in ibuprofen, continuous OC use solely for dysmenorrhea needs to be seriously questioned.     

Dysmenorrhea in pediatric and adolescent gynaecology

Dysmenorrhea is the most common problem in pediatric and adolescent gynaecology and it reaches approximately 20-90% of adolescents and young adult females. Dysmenorrhea in adolescent girls is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Secondary dysmenorrhea, associated with some pelvic pathology, constitutes approximately 10% of the cases and its most frequent reasons are: endometriosis, pelvic inflammatory disease, congenital mullerian anomalies and ovarian cysts. Prostaglandins and leukotriens play a significant role in etiopathogenesis of the primary dysmenorrhea. The therapy of the primary dysmenorrheal in adolescent girls involves: nonsteroidal anti-inflammatory drugs for at least 3 months, combined with oral contraceptives for at least 3-6 menstrual cycles, as well as dietary supplementation, other alternative therapies (vitamins, herbal remedies, acupuncture, TENS) and surgical treatment Secondary causes of dysmenorrhea should be considered in adolescents with dysmenorrhea who do not respond to the treatment. The role of the pediatric and adolescent gynaecologist is to diagnose the reason of symptoms, educate the patient, review effective treatment options as well as to restore normal daily functioning.     

Female urinary incontinence during pregnancy and after delivery: Clinical impact and contributing factors

Urinary incontinence (UI) is a common condition affecting adult women of all ages and it could have a negative influence on quality of life. The etiology of UI is multifactorial, but some of the most important risk factors are obesity and ageing, as well as adverse obstetric events. Pregnancy and delivery per se have been implicated in the etiology of UI. Although several studies have demonstrated a direct association between UI and vaginal delivery in short, medium and long-term, the role of childbirth on the risk of UI remains controversial. The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birth weights have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce significantly the incidence of UI. The role of pelvic floor muscle training (PFMT) in the prevention and treatment of UI is still unclear. However, PFMT seems to be useful when supervised training is conducted and it could be incorporated as a routine part of women’s exercise programmes during pregnancy and after childbirth.     

Mental health and primary dysmenorrhea: a systematic review

Several factors including demographic, reproductive, lifestyle, psychological and social factors can affect incidence and severity of primary dysmenorrhea. This study aimed to systematically review the psychological risk factors associated with primary dysmenorrhea. Embase, ISI web of knowledge, ProQuest, Science Direct, Scopus and PubMed central were searched using keywords related to risk factors and primary dysmenorrhea. Observational studies, published in English after 2000, focusing solely on psychological factors affecting primary dysmenorrhea were included. The search process retrieved 11,928 potential related articles. Thirty three articles met inclusion criteria and were assessed for final synthesis. The STROBE checklist was used to quality assessment of studies. Results of study showed that few studies had investigated relationship between dysmenorrhea and most psychological disorders. Most studies have investigated the relationship between dysmenorrhea and depression, anxiety, stress, alcohol abuse and somatic disorders. So, further studies are needed to investigate relation between most psychological disorders with primary dysmenorrhea. Significant relationship between some mental health components such as depression, anxiety and stress with primary dysmenorrhea shows the importance of psychological assessment before the choice of therapeutic methods. Also, the feasibility of designing and evaluating the effectiveness of the use of psychotherapy interventions for the treatment of primary dysmenorrhea as alternative therapies can be considered.     

青春期子宫内膜异位症的发病特点研究进展

青春期子宫内膜异位症（EMs）是EMs的一种特殊类型,与育龄期妇女相似,可引起痛经、慢性盆腔痛、不孕等症状。该病发病原因不明确,发病机制复杂多样,目前学说认为与经血逆流、遗传、血源播散等因素相关。其中逆流经血中包含子宫内膜样干细胞的观点近年来引发热议,即子宫内膜样干细胞通过经血逆流入腹腔,发生异位种植、侵袭、生长,从而导致EMs。目前诊断EMs的金标准为腹腔镜手术及病理检查,但由于发病时间早,且易于复发,是妇科的一个棘手问题。综述青春期EMs的流行病学资料、发病机制、相关高危因素及临床特点,继续深入研究有助于加强对青春期EMs的预防,做到早诊断,早治疗,减少日后EMs并发症的发生。     

Dysmenorrhea

Dysmenorrhea affects over 50% of menstruating women and causes extensive personal and public health problems, a high degree of absenteeism and severe economic loss. In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology, while in secondary dysmenorrhea gross pathology is present in the pelvic structures. With primary dysmenorrhea the pain is suprapubic and spasmodic, and associated symptoms may be present. Characteristically dysmenorrhea starts at or shortly after menarche. The pain lasts for 48-72 hours during the menstrual flow and is most severe during the first or second day of menstruation. It is now clear that in many women with primary dysmenorrhea the pathophysiology is due to increased and/or abnormal uterine activity because of the excessive production and release of uterine prostaglandins. Treatment with many of the prostaglandin synthetase inhibitors (nonsteroidal antiinflammatory drugs) will produce significant relief from dysmenorrhea and a concomitant decrease in menstrual fluid prostaglandins. For dysmenorrheic women who desire oral contraception, this agent will relieve the dysmenorrhea by suppressing endometrial growth, thus resulting in a decrease in the menstrual flow as well as in menstrual fluid prostaglandins. For those not requiring oral contraception the drug of choice for primary dysmenorrhea remains a prostaglandin inhibitor. Laparoscopy need be resorted to only if a pelvic abnormality is detected on examination or if treatment with prostaglandin inhibitors for up to six months is not significantly effective. In secondary dysmenorrhea, relief is obtained when the pelvic pathology--such as ovarian cysts, uterine fibroids, adhesions, cervical stenosis, congenital malformation of the uterus and endometriosis--is treated. In women using IUDs the dysmenorrhea is readily controlled with prostaglandin inhibitors since the underlying pathophysiology is excessive prostaglandin production and release.     

Adenomyosis: review of the literature

Adenomyosis usually occurs in women in their reproductive years, predominantly in those with menorrhagia and dysmenorrhea. The etiology and pathophysiology remain unclear; however, recent advancements in diagnostic methods and new investigations of treatment options have changed how clinicians manage adenomyosis. A review was performed using PubMed and cross-references of reviews, case reports, and prospective and retrospective studies published from 1958 to 2010 to provide an overview of the etiology, diagnosis, prevalence, risk factors, clinical signs and symptoms, and treatments of adenomyosis.