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A DIFFERENTIATED APPROACH TO THE TREATMENT OF JU^NILE DYSMЕNORHEA IN ADOLESCENT GIRLS Asrankulova D.B.1, Musazoda D.M.2 Email: Asrankulova 17162@scientifictext.ru
1Asrankulova Diloram Baktiyarovna - Doctor of Medical Sciences, Professor, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY № 1 ; 2Musazoda Durdona Murotalievna - graduate Student, DIRECTION: OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: dysmenorrhea in adolescents is a cyclical pelvic pain and a complex of systemic disorders that arise in puberty and are associated with menstruation. It is manifested by acute pain sensations in the lower abdomen, preceding or coinciding in time with the onset of menstruation, various vegetative-vascular, neurovegetative, metabolic-endocrine, psychoemotional disorders.
It is diagnosed by determining the content of sex hormones and magnesium, a diagnostic test with NSAIDs, ultrasound of the pelvic organs. For treatment, prostaglandin synthetase inhibitors, progestins, magnesium preparations, COCs in combination with lifestyle correction and physiotherapy are used. Keywords: juvenile dysmenorrhea, adolescence.
ДИФФЕРЕНЦИРОВАННЫЙ ПОДХОД К ЛЕЧЕНИЮ ЮВЕНИЛЬНОЙ ДИСМЕНОРЕИ У ДЕВУШЕК-ПОДРОСТКОВ Асранкулова Д.Б.1, Мусазода Д.М.2
1Асранкулова Дилорам Бактияровна - доктор медицинских наук, профессор, кафедра акушерства и гинекологии № 1; 2Мусазода Дурдона Муроталиевна - студент магистратуры, направление: акушерство и гинекология, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: дисменорея у подростков — это циклическая тазовая боль и комплекс системных расстройств, возникающих в пубертате и связанных с менструациями. Проявляется острыми болевыми ощущениями в низу живота, предшествующими или совпадающими по времени с началом месячных, разнообразными вегетативно-сосудистыми, нейровегетативными, обменно-эндокринными, психоэмоциональными нарушениями.
Диагностируется путем определения содержания половых гормонов и магния, диагностической пробы с НПВС, УЗИ органов малого таза. Для лечения используют ингибиторы простагландинсинтетазы, прогестины, препараты магния, КОК в комбинации с коррекцией образа жизни и физиотерапией. Ключевые слова: ювенильная дисменорея, подростковый возраст.
UDC 618.14-005-055.25:612.661+519.23
Relevance. Adolescence is a period of transition from childhood to adulthood, characterized by leaps in physical, physiological, endocrine, emotional and mental growth, with the transition from complete dependence to relative independence. It should be noted that reproductive health is established in childhood and adolescence [3].
One of the main physiological changes occurring in adolescent girls is menarche, which is often associated with the problem of irregular menstruation, abnormal uterine bleeding during puberty (AMC) and primary dysmenorrhea (PD) PD is one of the important tasks of pediatric gynecology. According to domestic and foreign authors, the frequency of PD in adolescent girls ranges from 8% to 90%, and in 15% of cases PD has a severe course, leading to disruption of social and daily activity, up to the loss of working capacity, due to which this pathology is a serious medical and social problem [1].
The main theory of the occurrence of PD is considered to be prostaglandin, and today the first-line drugs are non-steroidal anti-inflammatory drugs (NSAIDs), the prescription of which is pathogenetically justified at any age and has a high level of evidence [2, 4].
But NSAID therapy does not always lead to a decrease in the frequency of PD, but only has a symptomatic effect in the form of temporary relief of pain, and in severe PD, in most cases, there is no analgesic effect at all. Pain is often not the only manifestation of this disease [1]. Sometimes, in the absence of painful sensations, neurovegetative, psychoemotional and metabolic endocrine symptoms prevail, reflecting the low adaptive ability of the whole organism, which is often due to the presence of a premorbid background. It is important to take into account that already existing deviations in the state of health can lead to a severe course of PD in adolescent girls.
In the course of numerous studies, it has been shown that endothelial dysfunction occurs in DST, which is also described in PD, leading to various disorders on the part of all organs and systems. DST does not have a definite clinical symptom complex and is widespread in the population [2]. This pathology may not manifest itself for a long time and proceed in a mild form, but any provoking agent can be the cause of manifestation and even lead to death. These factors can include stress, exercise, pregnancy, childbirth, infection, injury, and more.
As a result of studying the scientific literature, we found no information on the relationship between the expression of the collagen catabolism marker (free hydroxyproline in the blood serum) and the severity of PD in adolescent girls; the relationship between indicators of endothelial dysfunction (matrix metalloproteinase-2, -9), present in CTD, and the presence of PD, its severity in adolescent girls; indicators of the immune system in adolescent girls with PD and DST before and after treatment [3, 4].
Thus, the study of PD in adolescent girls in combination with CTD will reveal new aspects in the etiology and pathogenesis of this pathology and develop a new pathogenetically substantiated differential approach to treatment tactics.
Purpose of the study. Improving the efficiency of early diagnosis and developing a differentiated approach to the treatment of adolescent girls suffering from primary dysmenorrhea, taking into account etiopathogenetic factors.
Materials and methods of research. To solve the problems and achieve the goal of the study, as well as to exclude the influence on the results of the work of factors that are not subject to study, the criteria for selecting patients for the study were established. The criteria for inclusion in the study were: age from 15 to 17 years 11 months 29 days, the diagnosis of primary dysmenorrhea, which was established based on the results of anamnesis, examination, gynecological examination, non-invasive methods of excluding organic pathology of the organs of the reproductive system, and informed consent.
Research results. Adolescent girls with primary dysmenorrhea, having signs of connective tissue dysplasia, are significantly more likely to suffer from combined chronic somatic pathology - mitral valve prolapse, chronic autoimmune thyroiditis, biliary dyskinesia, pathology of the organ of vision and other extragenital diseases (77.1%) and functional reproductive disorders systems - abnormal uterine bleeding (72%), functional ovarian cysts (56%).
Mothers of adolescent girls with primary dysmenorrhea with signs of connective tissue dysplasia are significantly more likely to suffer from varicose veins of the lower extremities (56%).
In adolescent girls with primary dysmenorrhea and connective tissue dysplasia, the most common symptoms were cutaneous and articular signs (47.5%), visual impairments (44%) and minor anomalies of the heart (38%).
In patients with primary dysmenorrhea and connective tissue dysplasia, the pain syndrome is significantly more pronounced than in adolescents without connective tissue dysplasia (general rank pain index 28 ± 5.3 and 21.3 ± 4.5, total number of selected descriptors 12.0 ± 4.3 and 9.0 ± 3.5, respectively, p <0.05).
The first episode of primary dysmenorrhea with DST coincides with menarche in 88% of cases.
The relationship between the severity of the course of primary dysmenorrhea, the presence of signs of connective tissue dysplasia and the content of magnesium in the blood serum has not been identified. In primary dysmenorrhea, the concentration of matrix metalloproteinases 2 and 9 changes, which indicates endothelial dysfunction. 6.
Decrease in free hydroxyproline, on average, 2.8 times, matrix metalloproteinase 2 - 3.4 times, tumor necrosis factor a - 2.1 times, the content of antibodies to cardiolipin - 3.5 times and an increase in matrix metalloproteinase 9 on average 4.2 times (p <0.05) confirms the high efficiency of treatment of primary dysmenorrhea with non-steroidal anti-inflammatory drugs in combination with a vitamin-mineral complex containing calcium and vitamin D. The proposed algorithm for the treatment of patients with primary dysmenorrhea makes it possible to transfer a severe form of primary dysmenorrhea to moderate and mild in every 3rd observation. 8. The presence of connective tissue dysplasia in adolescence is not an indication for prescribing drugs that affect collagen formation, since they do not increase the effectiveness of treatment.
Conclusion: To enhance the therapeutic effect, the treatment regimen is supplemented with agents containing magnesium. Pathogenetically justified is the use of drugs based on the sacred vitex, which have a dopaminergic effect, eliminating the imbalance between estrogen and progesterone. Antispasmodics can be recommended as symptomatic agents. To eliminate systemic symptoms, sedative phytopreparations are used, in more severe cases, tranquilizers. When dysmenorrhea is combined with other disorders of menstrual function, hormone therapy with the appointment of estrogen-progestogenic drugs is possible. Treatment of adolescents with secondary dysmenorrhea, in which NSAIDs are often ineffective, is carried out according to standard treatment protocols for the underlying disease. An accurate determination of the causes of dysmenorrhea and the correct therapeutic tactics can completely eliminate or significantly reduce menstrual pain in most adolescents. In 80.5% of girls with functional dysmenorrhea taking NSAIDs, the condition returns to normal within 3-4 months. Hormone therapy is effective in 90% of cases. For prophylactic purposes, patients with early menarche and having a hereditary burden of dysmenorrhea are recommended to regularly observe an adolescent gynecologist, observe a rest regimen, exclude excessive loads, and quit smoking.
References / Список литературы
1. Gynecology of adolescents: a guide for doctors / Gurkin Yu.A., 2000.
2. The effectiveness of the treatment of dysmenorrhea in adolescent girls / Saduakasova Sh.M., Zhatkanbaeva G.Zh., Nesipbaeva G.M. // Bulletin of KazNMU, 2014. № 4.
3. Pathogenetic mechanisms and optimization of treatment of primary dysmenorrhea in girls and adolescent girls: Abstract of the thesis / Mosolov K.V., 2005.
4. Dysmenorrhea of adolescents: etiology, pathogenesis and correction of magnesium deficiency / Veropotvelyan PN, Veropotvelyan NP, Nikitenko MK, Rusak NS. // Female doctor, 2010. № 5.
