Primary Dysmenorrhea Diagnosis and Therapy
Primary Dysmenorrhea Diagnosis and Therapy
复制标题
原发性痛经的诊断与治疗
DOI：
10.1097/aog.0000000000004096
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发表时间：
2020-11-01
影响因子：
7.2
通讯作者：
Archer, Johanna S.
中科院分区：
文献类型：
--
作者：
Ferries-Rowe, Elizabeth;Corey, Elizabeth;Archer, Johanna S.
原发性痛经定义为月经周期中无明确原因的疼痛。它是女性盆腔疼痛最常见的原因之一。痛经会对女性的生活质量产生负面影响，并干扰日常活动。原发性痛经的病理生理学可能是环氧合酶途径产生增加的前列腺素，特别是前列腺素（PGs）的结果。前列腺素增加导致子宫收缩，限制血流，并导致产生刺激疼痛受体的厌氧代谢物。有典型原发性痛经病史的妇女可以开始经验性治疗，而无需额外的检查。共同决策是有效管理痛经的关键，以最大限度地提高患者的依从性和满意度。在讨论了它们的风险和益处之后，非常有效的经验性疗法是非甾体激素类药物和避孕激素疗法。原发性痛经的其他治疗方法可以单独使用，也可以与其他方法联合使用，但支持其使用的文献并不令人信服。如果患者在遵守其医疗方案后没有报告月经学改善，医生应开始对继发性痛经进行评估。
Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen.