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Menstrual cramps (dysmenorrhea)

อาการปวดประจำเดือน คือ อาการปวดท้องน้อยสัมพันธ์กับรอบเดือน โดยมีอาการปวดท้องก่อนมีประจำเดือน 1-2 วัน และ/หรือระหว่างมีประจำเดือนในช่วงวันแรกๆ อาการปวดท้องประจำเดือน (dysmenorrhea) มีตั้งแต่อาการปวดหน่วงหรือปวดเกร็งเล็กน้อย ไปจนถึงอาการปวดขั้นรุนแรง เช่น ปวดหลังลงด้านล่าง คลื่นไส้อาเจียน เหงื่อออก ท้องเสียหรือท้องผูก ท้องอืด เวียนศีรษะและปวดศีรษะ เป็นต้น

Cause
Every 28 days (on average), if a woman’s egg is not fertilized, the uterine lining will be shed as menstruation. Menstrual cramps are caused by a hormone-like substance called prostaglandin, which occurs in the uterine lining in between menstrual cycles. Prostaglandin causes the uterus to contract, just as it would during labor. Furthermore, it can cause nausea and diarrhea. The more prostaglandin is produced, the more severe the symptoms, including uterine contractions, which increases the pain felt.
Menstrual cramps can be divided into two types:
  • Primary dysmenorrhea is the most common type of menstrual cramps. It is caused by the excessive production of prostaglandin in the uterine lining.
  • Secondary dysmenorrhea occurs due to a problem with the uterus or other reproductive organs, such as:
    • Endometriosis, where the uterine lining grows outside the uterus, but still sheds normally during a menstrual cycle, leading to bleeding, severe abdominal pain, and even infertility.
    • Adenomyosis, where the uterine lining breaks through the muscle wall of the uterus, leading to severe pain and/or a longer, heavier period.
    • Uterine fibroids are non-cancerous growths that can be very small to very big. Large uterine fibroids can lead to excessive menstrual bleeding or spotting that lasts weeks, along with menstrual cramps or chronic lower back pain.
    • Pelvic inflammatory disease is an infection in the pelvis, usually caused by a sexually transmitted infection. If untreated, it can lead to inflammation and abdominal pain in between menstrual cycles.
    • Cervical stenosis occurs due to the cervix being too narrow, slowing the flowing of menstrual blood. If the opening (os) is closed, fluid will build up in the uterus, causing severe and chronic abdominal pain.
    • Scarring from previous abdominal surgery.
    • Conditions associated with the intestines.
  1. Pain and/or pressure in the lower abdomen that might be severe enough to cause fainting.
  2. Nausea.
  3. Vomiting.
  4. Diarrhea.
  5. Headache, dizziness, back pain.
  1. Medical history and physical examination.
  2. Internal (vaginal) examination.
  3. Ultrasound.
  4. Laparoscopy to inspect the pelvic organs.
Treatment of menstrual cramps will depend on their severity and the cause of the pain. Pain caused by the cramping of the uterus may be managed with pain medication or birth control pills to prevent ovulation and reduce the amount of bleeding.
If you experience menstrual cramps, you can try the following home treatments:
  • Place a hot water bottle or electric heading pad on your abdomen and back.
  • Take a warm bath.
  • Use relaxation techniques, such as yoga or meditation.
  • Take NSAIDs (non-steroidal anti-inflammatory drugs). Medication should be taken before symptoms begin or right as they do. Pain medication has side effects so take them only when needed.
  • Get enough rest.
  • Exercise regularly.
  • Eat plenty of fruit and vegetables, limit fat, salt, caffeinated beverages, alcohol, and sweets.

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