Patient's question:
I am 24 years old this year. Since the start of my menstruation, I have always experienced menstrual cramps, sometimes to the point where I can't bear it. My periods are not very regular; sometimes they come 4 days early, and sometimes they are delayed by 4 days. When I went to the hospital for a check-up, they said everything was fine, which puzzles me. Could you please help me understand this? Thank you.Doctor's answer:
Hello: After identifying potential causes of dysmenorrhea through medical history and systemic and local examinations, the following treatments are recommended:（）General Management
Conduct necessary health education to alleviate anxiety, tension, and fear, and reduce mental stress. Timely treatment of chronic systemic diseases is essential. Individuals with developmental disorders or weak constitutions should correct these conditions. Begin physical exercise to enhance physical fitness. Avoid strenuous exercise and excessive fatigue during menstruation, prevent exposure to cold, and pay attention to menstrual hygiene.
（）Prostaglandin Synthetase Inhibitors
To reduce prostaglandin release, take 25mg of indomethacin, 0.3g of acetylsalicylic acid, or 250mg of mefenamic acid orally 3–5 days before menstruation. Dosage: 2–4 times daily. These medications may be highly effective.
（）Acupuncture and Moxibustion Therapy
During dysmenorrhea episodes, the primary acupoints are Qihai, Hegu, and Sanyinjiao. The supplementary acupoints are Guanyuan, Zongzi, and Zusanli. First, stimulate the primary acupoints with strong intensity, retain the needles for 10–15 minutes. If the pain persists, add supplementary acupoints or moxibustion on Qihai and Guanyuan.
（）Hormonal Therapy
1. Ovulation Suppression
Since dysmenorrhea primarily occurs in ovulatory cycles, oral contraceptives (Type I or II) can be used to suppress ovulation. Dosage and administration follow standard contraceptive methods, which may alleviate symptoms. Alternatively, take 5–10mg of medroxyprogesterone daily, 2.5–5mg of norethisterone, or 4–8mg of megestrol daily, starting on the 5th day of the menstrual cycle and continuing for 20–22 days for 3 cycles. This method is suitable for endometriosis and older individuals.
2. Estrogen
Often used for individuals with underdeveloped uteri. Take 1mg of diethylstilbestrol orally once nightly.