Primary Dysmnorhea In Adolescents and Therapeutic Approaches

Abstract

Dysmenorrhea is one of the most common gynecologic problems among adolescent and young adult females. Usually ıt ıs categorised into two types as primary and secondary dysmenorrhea. Primary dysmenorrhea is defined as recurrent, crampy pain occurring with menses in the absence of identifiable pelvic pathology. The prevalence of primary dysmenorrhea varies between 16% and 93%. Several studies suggest that severe menstrual pain is associated with absentenism from school or work and limitation of other daily activities. Studies indicate that increase in the activity of leukotriene and prostaglandin pathways in endometrium and uterin contractility contributes to the pathphysiology. Early menarch, long menstrual periods, heavy menstruation, smoking and family history are among the risk factors. Multidimensional pain scoring system and visual analog scale are used for grading the severity of the pain related with dismenorrhea. But these relies on the patient’s self reporting. Parity and advanced age are related with reduction of the prevalence of dismenorrhea. Nonsteroidal antiinflammatory drugs and hormonal contraceptives take place in medical treatment. Majority of the patiens response to these therapies. There are several options for nonsteroidal antiinflammatory drugs and there is no evidence that one is better than others. For hormonal contraception, oral contraceptive pills, contraceptive patchs, rings and intrauterine systems could be options. Hence, patients should be warned about advers effects of medical treatment. Complementary and alternative thereapies might be advised for the patients who don’t want medical treatment or couldn’t tolerate the advers effects of medical treatment. It was shown that alternative therapies such as heat therapy, exercise, transcutaneus electrical nerve stimulation, vitamine B1, B6, D, E, omega 3 and magnesium replacement are effective in dismenorrhea. Acupuncture, as a traditional treatment method from the past, also took place in treatment of primary dismenorrhea. But further studies are needed about effectiveness of complementary and alternative medicine.

Keywords

• Adolescent,primary dismenorrhea,complementary and alternative treatment

Adölesanlarda Primer Dismenore Ve Tedavi Yaklaşımları

Abstract

Dismenore adölesanlarda ve genç kadınlarda en sık görülen jinekolojik problemlerden biridir. Genellikle primer ve sekonder olmak üzere iki tipte kategorize edilir. Primer dismenore mens döneminde ortaya çıkan tanımlanabilen herhangi bir pelvik patoloji olmadan rekürren, kramp şeklinde ortaya çıkan karın ağrılarıdır. Prevalansı %8,8 den %94 e kadar değişkenlik göstermektedir. Birçok çalışma şiddetli menstüel ağrının iş veya okuldan uzak kalmaya ve günlük aktivitelerde kısıtlanmaya yol açtığını göstermektedir. Patofizyolojiye endometriumdaki prostaglandin ve lökotrien yolaklarındaki aktivite ve uterin kontraksiyonlardaki artışın katkıda bulunduğu çalışmalarda belirtilmektedir. Erken menarş, uzun menstrüel periyotlar, yoğun menstrüel kanama, sigara kullanma ve aile öyküsü primer dismenorenin risk faktörleri arasında bulunmaktadır. Dismenoreyle ilişkili ağrını şiddetini derecelendirmede çok boyutlu ağrı skorlama sistemi ve görsel analog skala kullanılmaktadır. Ancak bunlar hastanın kendi ifadesine dayanmaktadır. Parite ve yaşın ilerlemesi dismenore sıklığında azalma ile ilişkilendirilmiştir. Medikal tedavide nonsteroidal anitiinflamatuar ilaçlar ve hormonal kontraseptifler yer almaktadır. Hastaların birçoğu bu tedavilere yanıt vermektedir. Primer dismenore tedavisi için birçok nonsteroidal anitiinflamatuar ilaç seçeneği vardır ve bunların birbirinden daha iyi olduğunu gösteren bir kanıt yoktur. Hormonal kontrasepsiyon için oral kontraseptifler, kontraseprif yamalar, halkalar ve rahim içi sistemler seçenek olabilir. Ancak hastalar medikal tedavilerin yan etkileri konusunda uyarılmalıdır. Medikal tedaviyi istemeyen veya yan etkilerinden dolayı tolere edemeyen hastalar için tamamlayıcı ve alternatif tedaviler önerilebilir. Sıcak tedavisi, egzersiz, transkutanöz elektrikli sinir uyarımı, B1, B6, D, E, vitaminleri omega 3 ve magnezyum replasmanı gibi alternatiflerin dismenorede etkili olduğu gösterilmiştir. Eskiden beri geleneksel tedavi yöntemi olarak birçok alanda kullanılan akupunktur kendine primer dismenore tedavisinde de yer bulmuştur. Ancak tamamalyıcı ve alternatif tedavilerin etkinliği konusunda daha fazla çalışmaya ihtiyaç vardır.

Keywords

• Adölesan,primer dismenore,tamamlayıcı ve alternatif tedaviler

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