Dysmenorrhea refers to a person's abdominal spasmodic pain before and after menstruation or menstrual period, which seriously affects daily life. There are two kinds: primary and secondary. After detailed gynecological clinical examination, those who fail to find obvious abnormalities in pelvic organs are called primary dysmenorrhea, also known as functional dysmenorrhea. Secondary dysmenorrhea refers to those who have obvious pathological changes in reproductive organs, such as endometriosis, pelvic inflammatory disease and tumors. Primary pain often occurs in ovulation menstruation, so it is generally asymptomatic or only mildly uncomfortable after menarche 1 ~ 2 years. Severe spasmodic pain mostly occurs in young women after menarche in 1 ~ 2 years. If you have regular dysmenorrhea at the beginning or spasmodic dysmenorrhea after the age of 25, you should consider other abnormal conditions. Dysmenorrhea usually begins a few hours before menstrual cramps or vaginal bleeding, and it is often spasmodic colic and lasts for 1/2 ~ 2 hours. Severe abdominal pain turned into moderate paroxysmal pain after the attack, lasting about 12 ~ 24 hours. After the menstrual blood flow is smooth, it gradually disappears, and occasionally it is necessary to stay in bed for 2 to 3 days. The pain is mostly in the lower abdomen, and in severe cases, it can radiate to the lumbosacral part or the front side of the inner thigh. About 50% patients have gastrointestinal and cardiovascular symptoms. Such as nausea, vomiting (89%), diarrhea (60%), dizziness (60%), headache (45%) and fatigue (85%). Occasionally syncope and collapse. Primary dysmenorrhea often disappears spontaneously after delivery or gradually disappears with age after marriage. General treatment of primary dysmenorrhea (1): physical exercise to enhance physical fitness. Pay attention to the law of life on weekdays, combine work and rest, have proper nutrition and get enough sleep. Pay attention to the publicity and education of menstrual physiology, and eliminate the fear, anxiety and mental burden of patients through explanation and persuasion. Strengthen menstrual hygiene, avoid strenuous exercise and overwork, and prevent colds. (2) Inhibition of ovulation: If the patient is willing to control fertility, oral contraceptive tablets (compound norethindrone tablets or compound progesterone tablets) are the first choice for the treatment of primary dysmenorrhea. Oral contraceptives can relieve more than 90% of the symptoms, which may be due to the inhibition of endometrial growth, the decrease of menstrual flow and the decrease of PG below the normal level, which leads to the weakening of uterine activity. The treatment can be tried for 3 ~ 4 cycles, and if the curative effect is satisfactory, you can continue to take it; If the symptoms are not improved obviously, PGs synthesis inhibitor can be added appropriately. Because the drug should be used throughout the menstrual cycle, and the effect is only 1 ~ 2 days at the end of the cycle, unless contraception is needed at the same time, it is generally unpopular with patients. (3) Prostaglandin synthesis inhibitor (PGsI): PGSI should be selected for patients who are unwilling to use contraception. It inhibits the synthesis of PGS in endometrium, significantly reduces the amplitude and frequency of uterine contraction, but does not affect the function of pituitary-ovarian axis, nor does it cause metabolic side effects like oral contraceptives. As long as it is taken before the onset of pain, it can last for 2 ~ 3 days, which is its greatest advantage. But we need to try a stage to determine the most satisfactory drug type and the most suitable dose for everyone. The trial adjustment period can sometimes be as long as half a year. According to its chemical structure, commonly used PGSI can be divided into: ① Indole indazoles (such as indomethacin and benzazine): 25mg, 3-6 times a day or 50mg, 3 times a day; (2) Acetic acid: methyl formate (trade name ponstan), initial dosage 500mg, later period 250mg, within 6-8 hours 1 time, chloranilic acid, trade name Xiaoyan Ling, flumizinic acid, initial dosage 400mg, later period 200mg, within 6-8 hours 1 time; (3) phenylpropionic acid derivative: p-isobutyl propionic acid, trade name ibuprofen, 400mg, 4 times a day, methoxynaproxen sodium, trade name naproxen, 500mg for the first dose, 250mg for the second time, 65438+6-8 hours, 0 times; ④ Patasone: Patasone or oxybupropion, the first dose is 200mg, then 100mg, within 6-8 hours 1 time. The above four drugs are absorbed quickly and can be taken within 48 hours before menstruation. However, due to the frequent differences in the onset time of menstruation, it is generally appropriate to give drugs three days before menstruation to ensure the curative effect, and the remission rate is about 70%. If the above drugs are substituted, the effective rate can reach 9%. Gastrointestinal ulcer and allergic to the above drugs are prohibited. The side effects are mild and most of them can be tolerated. Among them, only indomethacin has a high incidence of intestinal reaction, and symptoms such as dizziness, fatigue and headache appear. It can also happen, so that many people stop taking drugs during treatment. A class of drugs such as deacidification or phenylpropionic acid derivatives, especially methoxynapropionic acid, have a long duration of action, and its sodium salt quickly reaches a high value in the blood, so it takes effect quickly and has little side effects, and is the most widely used drug in clinic at present. When the dosage of PGSI is large, serious side effects will occasionally occur, which should be paid attention to and stopped when necessary. The known side effects are: ① gastrointestinal symptoms: indigestion, heartburn, nausea, abdominal pain, constipation, vomiting, diarrhea and melena caused by gastrointestinal bleeding; ② Central nervous system symptoms: headache, dizziness, dizziness, blurred vision, hearing impairment, irritability, depression, burnout and lethargy; ③ Other symptoms: rash, edema, bronchospasm, fluid retention, liver and kidney dysfunction (elevated transaminase, jaundice, proteinuria, hematuria). (4) Beta receptor agonist: By exciting the beta receptor on the muscle cell membrane, the adenylate cyclase is activated, and then the intracellular cAMP content is increased. On the one hand, it promotes phosphorylation of sarcoplasmic reticulum membrane protein and strengthens Ca++ binding; On the other hand, it inhibits the activity of myosin light chain kinase, relaxes uterine muscles and relieves dysmenorrhea quickly, but at the same time it has the side effects of increasing heart rate and hypertension. In recent years, the clinical application of drugs that stimulate uterine β2 receptor alone has obviously reduced the side effects. Commonly used β _ 2 receptor stimulants are: hydroxyisobutyrine, with the trade names of sulbactam and m-hydroxyisobutyrine, with the trade name of terbutaline. Administration methods include oral administration, aerosol inhalation, subcutaneous injection, intramuscular injection and intravenous administration.