Patient's question:
I have been having my period since I was 12 years old, and it has been almost 20 years. Every time I have my period, I experience abdominal pain and a heavy feeling in my lower abdomen. Sometimes I also feel dizzy and want to vomit. I have taken many medications, but they haven't helped. Now, the pain even starts earlier. My menstrual cycle is 7 days, but it often comes 4-6 days earlier. What should I do, doctor?Doctor's answer:
Hello, for primary dysmenorrhea, the following treatments can be applied:(1) General treatment: Engage in physical exercise to enhance physical fitness. Maintain a regular lifestyle, balance work and rest, and ensure adequate nutrition and sufficient sleep. Emphasize education about the physiological aspects of menstruation, and through explanation and persuasion, alleviate patients' fear, anxiety, and mental burden. Strengthen menstrual hygiene, avoid strenuous exercise, excessive fatigue, and prevent exposure to cold.
(2) Ovulation suppression: If the patient is willing to control fertility, oral contraceptives (combined norethisterone tablets or combined medroxyprogesterone tablets) are the first-line medication for treating primary dysmenorrhea. The use of oral contraceptives can relieve symptoms in more than 90% of cases, possibly due to the inhibition of endometrial growth, reduced menstrual flow, and a decrease in PG levels to below normal, leading to weakened uterine activity. Treatment can be started with 3–4 cycles. If the effect is satisfactory, the medication can be continued. If symptoms do not improve significantly, appropriate additional PGs synthesis inhibitors can be used. Since medication needs to be taken throughout the entire menstrual cycle, and the effect occurs only on the last 1–2 days of the cycle, it is generally unpopular with patients unless contraception is also required.
(3) Prostaglandin synthesis inhibitors (PGSI): For patients unwilling to use contraception, PGSI is a suitable choice. It inhibits the synthesis of PGs in the endometrium, significantly reducing the amplitude and frequency of uterine contractions, without affecting the hypothalamic-pituitary-ovarian axis function or causing metabolic side effects like those of oral contraceptives. The major advantage is that it can be taken starting before the onset of pain and continued for 2–3 days. However, it is necessary to try a period to determine the most effective medication for each individual and the most...