Patient's question:
Medical Description: Detailed medical condition and purpose of consultation: Menstrual cramps started after the first menstrual period, very severe. Later, some medication was taken, and the cramps stopped. Currently, the period is almost normal, but the flow is slightly less, and there are still cramps, but they are not particularly severe. Is it still necessary to see a doctor? Is some degree of cramping normal?Medical History: History of hyperthyroidism
Doctor's answer:
Primary dysmenorrhea(1) General treatment: Engage in physical exercise to enhance physical fitness. Pay attention to a regular lifestyle, balance work and rest, and ensure adequate nutrition and sufficient sleep. Emphasize education on the physiology of menstruation, and alleviate patients' fear, anxiety, and mental burden through explanation and persuasion. 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 megestrol tablets) are the first-line drugs 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 of medication. If the effect is satisfactory, the patient can continue taking the medication. 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 only occurs on the last 1–2 days of the cycle, it is generally unpopular with patients unless contraception is also needed.
(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 for 2–3 days before the onset of pain. However, it is necessary to try different types of medication for a period to determine the most effective drug and the most suitable dosage for each individual. The trial and adjustment phase may sometimes last up to half a year.