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經痛：修订间差异

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第107行： 第107行：
* [[Laparoscopy]] may be required.<ref name=ACOG2015/>
* [[Laparoscopy]] may be required.<ref name=ACOG2015/>
{{trans F}}
{{trans F}}
⚫
==流行病学==
⚫
经痛在妇女中的患病率约为25%<ref name=holder>[http://emedicine.medscape.com/article/795677-overview eMedicine > Dysmenorrhea] By Andre Holder, Laurel D Edmundson and Mert Erogul. Updated: Dec 31, 2009</ref>，在20岁左右最为多发，通常随着年龄增长减少。据一份调查，经痛在青少年女性中的患病率为67.2%<ref name="sharma">{{cite journal |author=Sharma P, Malhotra C, Taneja DK, Saha R |title=Problems related to menstruation amongst adolescent girls |journal=Indian J Pediatr |volume=75 |issue=2 |pages=125–9 |year=2008 |pmid=18334791 |doi= 10.1007/s12098-008-0018-5|url=}}</ref>，另一份调查结果是90%<ref name=holder/>。不同种族的患病率和发病率没有显著差异。<ref name=holder/>
⚫
一般认为[[怀孕]]可以解除痛经，然而这不是必然的。调查表明，有原发性经痛的未产妇在40岁后症状明显减少。<ref name= Juang>{{cite journal |author=Juang CM, Yen MS, Horng HC, Cheng CY, Yuan CC, Chang CM |title=Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study |journal=J Chin Med Assoc |volume=69 |issue=10 |pages=484–8 |year=2006 |pmid=17098673 |doi= 10.1016/S1726-4901(09)70313-2}}</ref>据[[问卷调查]]，在遭受过[[性虐待]]的女性中，包括痛经在内的月经问题更为普遍。<ref name=vink>{{cite journal |author=Vink CW, Labots-Vogelesang SM, Lagro-Janssen AL |title=[Menstruation disorders more frequent in women with a history of sexual abuse] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=150 |issue=34 |pages=1886–90 |year=2006 |pmid=16970013 |doi= |url=}}</ref>

⚫
一份来自[[挪威]]的调查显示，在该国20岁至35岁的女性中，有一成四会因經痛症状之重而在家休假。<ref name="mozon">{{cite web | title=Mozon: Sykemelder seg på grunn av menssmerter | publisher= Mozon | date=2004-10-25 | url=http://www.mozon.no/php/art.php?id=349090 | accessdate=2007-02-02}}</ref>对[[青春期]]女性而言，經痛是缺课的首要原因。<ref name=french>{{cite journal |author=French L |title=Dysmenorrhea in adolescents: diagnosis and treatment |journal=Paediatr Drugs |volume=10 |issue=1 |pages=1–7 |year=2008 |pmid=18162003 |doi= 10.2165/00148581-200810010-00001|url=}}</ref>


== 治療 ==
== 治療 ==
第127行： 第122行：
====治療====
====治療====
續發性經痛與原發性經痛不同，一些非類固醇類的止痛藥或口服避孕藥在治療疼痛的效果不如原發性經痛來的好，治療主要還是要針對造成疼痛的病因加以處理，如果藥物治療無效，也可以考慮薦骨前神經切除術，效果可以達到50%至75%。
續發性經痛與原發性經痛不同，一些非類固醇類的止痛藥或口服避孕藥在治療疼痛的效果不如原發性經痛來的好，治療主要還是要針對造成疼痛的病因加以處理，如果藥物治療無效，也可以考慮薦骨前神經切除術，效果可以達到50%至75%。
{{trans H}}
==Management==

===NSAIDs===
[[Non-steroidal anti-inflammatory drugs]] (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.<ref name=":marjoribanks2015">{{Cite journal|last=Marjoribanks|first=Jane|last2=Ayeleke|first2=Reuben Olugbenga|last3=Farquhar|first3=Cindy|last4=Proctor|first4=Michelle|date=2015-07-30|year=|title=Nonsteroidal anti-inflammatory drugs for dysmenorrhoea|url=|journal=The Cochrane Database of Systematic Reviews|volume=|issue=7|pages=CD001751|doi=10.1002/14651858.CD001751.pub3|issn=1469-493X|pmid=26224322|via=}}</ref> They can have [[adverse effect|side effect]]s of nausea, [[dyspepsia]], [[peptic ulcer]], and diarrhea.<ref name=Rossi2006>Rossi S, editor. [[Australian Medicines Handbook]] 2006. Adelaide: Australian Medicines Handbook; 2006. {{ISBN|0-9757919-2-3}}</ref><ref name=":marjoribanks2015" /> People who are unable to take the more common NSAIDs may be prescribed a [[COX-2 inhibitor]].<ref name="chantler">{{cite journal |vauthors=Chantler I, Mitchell D, Fuller A | title = The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrheic pain | journal = Clin J Pain | volume = 24 | issue = 1 | pages = 39–44 | year = 2008 | pmid = 18180635 | doi = 10.1097/AJP.0b013e318156dafc | url = }}</ref>

===Hormonal birth control===
Use of [[hormonal birth control]] may improve symptoms of primary dysmenorrhea.<ref name="Archer 2006">{{cite journal | author = Archer DF | title = Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives | journal = Contraception | volume = 74 | issue = 5 | pages = 359–66 | date = November 2006 | pmid = 17046376 | doi = 10.1016/j.contraception.2006.06.003 | url = }}</ref><ref name="Harel 2006">{{cite journal | author = Harel Z | title = Dysmenorrhea in adolescents and young adults: etiology and management | journal = J Pediatr Adolesc Gynecol | volume = 19 | issue = 6 | pages = 363–71 | date = December 2006 | pmid = 17174824 | doi = 10.1016/j.jpag.2006.09.001 | url = }}</ref> A 2009 systematic review however found limited evidence that the birth control pill, containing low doses or medium doses of oestrogen, reduces pain associated with dysmenorrhea.<ref name=Wong2009/> In addition, no differences between different birth control pill preparations were found.<ref name=Wong2009>{{cite journal|last1=Wong|first1=CL|last2=Farquhar|first2=C|last3=Roberts|first3=H|last4=Proctor|first4=M|title=Oral contraceptive pill for primary dysmenorrhoea.|journal=The Cochrane database of systematic reviews|date=7 October 2009|issue=4|pages=CD002120|pmid=19821293}}</ref>

[[Norplant]]<ref>{{cite journal | author = Power J, French R, Cowan F | title = Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy | journal = Cochrane Database Syst Rev | volume = | issue = 3 | pages = CD001326 | year = 2007 | pmid = 17636668 | doi = 10.1002/14651858.CD001326.pub2 | url = | editor1-last = Power | editor1-first = Jo }}</ref> and [[Depo-provera]]<ref name="glasier">{{cite book |last=[[Anna Glasier|Glasier]] |first=Anna |editors=DeGroot, Leslie J.; Jameson, J. Larry (eds.) |title=Endocrinology |edition=5th |year=2006 |publisher=Elsevier Saunders |location=Philadelphia |isbn=0-7216-0376-9 |pages=2993–3003 |chapter=Contraception}}</ref><ref name="loose">{{cite book |author1=Loose, Davis S. |author2=Stancel, George M. |editor1=Brunton, Laurence L. |editor2=Lazo, John S. |editor3=Parker, Keith L. |year=2006 |chapter=Estrogens and Progestins |title=Goodman & Gilman's The Pharmacological Basis of Therapeutics |edition=11th |pages=1541–1571 |location=New York |publisher=McGraw-Hill |isbn=0-07-142280-3}}</ref> are also effective, since these methods often induce [[amenorrhea]]. The [[intrauterine system]] (Mirena IUD) may be useful in reducing symptoms.<ref name="gupta">{{cite journal |vauthors=Gupta HP, Singh U, Sinha S | title = Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device | journal = J Indian Med Assoc | volume = 105 | issue = 7 | pages = 380, 382–5 | year = 2007 | pmid = 18178990 | doi = | url = }}</ref>

===Other===
A review indicated the effectiveness of [[transdermal]] [[nitroglycerin]].<ref name=morgan>{{cite journal |vauthors=Morgan PJ, Kung R, Tarshis J | title = Nitroglycerin as a uterine relaxant: a systematic review | journal = J Obstet Gynaecol Can | volume = 24 | issue = 5 | pages = 403–9 | year = 2002 | pmid = 12196860 | doi = | url = }}</ref>

===Alternative medicine===
There is insufficient evidence to recommend the use of any herbal or dietary supplements for treating dysmenorrhea, including, [[melatonin]], [[vitamin E]], [[fennel]], [[dill]], [[chamomile]], [[cinnamon]], [[Rosa × damascena|damask rose]], [[rhubarb]], guava, and uzara.<ref name=AFP2014/><ref name=Patt2016>{{Cite journal|last=Pattanittum|first=Porjai|last2=Kunyanone|first2=Naowarat|last3=Brown|first3=Julie|last4=Sangkomkamhang|first4=Ussanee S.|last5=Barnes|first5=Joanne|last6=Seyfoddin|first6=Vahid|last7=Marjoribanks|first7=Jane|date=2016-03-22|year=|title=Dietary supplements for dysmenorrhoea|url=|journal=The Cochrane Database of Systematic Reviews|volume=3|pages=CD002124|doi=10.1002/14651858.CD002124.pub2|issn=1469-493X|pmid=27000311|via=}}</ref> Further research is recommended to follow up on weak evidence of benefit for: [[fenugreek]], [[ginger]], [[valerian (herb)|valerian]], [[zataria]], [[Zinc sulfate|zinc sulphate]], [[fish oil]], and [[Thiamine|vitamin B1]].<!-- <ref name=Patt2016/> --> A 2016 review found that evidence of safety is insufficient for all dietary supplements.<ref name=Patt2016/>

There is some conflicting evidence in the scientific literature, including:

One review found [[thiamine]] and [[vitamin E]] to be likely effective.<ref name="BMJ11" /> It found the effects of [[fish oil]] and [[vitamin B12]] to be unknown.<ref name="BMJ11">{{cite journal |vauthors=Latthe PM, Champaneria R, Khan KS | title = Dysmenorrhoea | journal = Clinical evidence | volume = 2011 | date = Feb 21, 2011 | pmid = 21718556 | pmc = 3275141 }}</ref>

Reviews found tentative evidence that [[ginger]] powder may be effective for primary dysmenorrhea.<ref>{{Cite journal|title = Efficacy of Ginger for Alleviating the Symptoms of Primary Dysmenorrhea: A Systematic Review and Meta-analysis of Randomized Clinical Trials|journal = Pain Medicine (Malden, Mass.)|date = 2015-12-01|issn = 1526-4637|pmid = 26177393|pages = 2243–2255|volume = 16|issue = 12|doi = 10.1111/pme.12853|first = James W.|last = Daily|first2 = Xin|last2 = Zhang|first3 = Da Sol|last3 = Kim|first4 = Sunmin|last4 = Park}}</ref><ref>{{Cite journal|last=Chen|first=Chen X.|last2=Barrett|first2=Bruce|last3=Kwekkeboom|first3=Kristine L.|date=2016-05-05|title=Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis|url=http://dx.doi.org/10.1155/2016/6295737|journal=Evidence-Based Complementary and Alternative Medicine|language=en|volume=2016|pages=1–10|doi=10.1155/2016/6295737|issn=1741-427X|pmc=4871956|pmid=27274753}}</ref>

Another review found Vitamin B1 to be effective.{{Citation needed|date=February 2017}} [[Magnesium]] supplementation are a promising possible treatment.{{Citation needed|date=February 2017}}

A 2008 review found promising evidence for [[Chinese herbal medicine]] for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.<ref>{{cite journal | author = Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA | title = Chinese herbal medicine for primary dysmenorrhoea | journal = Cochrane Database Syst Rev | volume = | issue = 2 | pages = CD005288 | year = 2008 | pmid = 18425916 | doi = 10.1002/14651858.CD005288.pub3 | editor1-last = Zhu | editor1-first = Xiaoshu }}</ref>

====Procedures====
[[Acupuncture]]: A 2016 Cochrane review found that the [[Randomized controlled trial|randomized controlled trials]] (RCTs) of acupuncture treatments for dysmenorrhea are of low quality and concluded that it is unknown if acupuncture or [[acupressure]] is effective for treating symptoms of primary dysmenorrhea.<ref name=":smith2016">{{Cite journal|last=Smith|first=Caroline A.|last2=Armour|first2=Mike|last3=Zhu|first3=Xiaoshu|last4=Li|first4=Xun|last5=Lu|first5=Zhi Yong|last6=Song|first6=Jing|date=2016-04-18|year=|title=Acupuncture for dysmenorrhoea|url=|journal=The Cochrane Database of Systematic Reviews|volume=4|pages=CD007854|doi=10.1002/14651858.CD007854.pub3|issn=1469-493X|pmid=27087494|via=}}</ref> There are also concerns of [[bias]] in study design and in publication, insufficient reporting (few looked at [[Adverse effect|adverse effects]]), and that they were inconsistent.<ref name=":smith2016" /> There are conflicting reports in the literature, including one review which found that acupressure, topical heat, [[transcutaneous electrical nerve stimulation]], and behavioral interventions are likely effective.<ref name=BMJ11/> It found the effect of acupuncture and [[magnets]] to be unknown.<ref name=BMJ11/>

A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.<ref>{{cite journal | author = Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM | title = Behavioural interventions for primary and secondary dysmenorrhoea | journal = Cochrane Database Syst Rev | issue = 3 | pages = CD002248 | year = 2007 | pmid = 17636702 | doi = 10.1002/14651858.CD002248.pub3 | editor1-last = Proctor | editor1-first = Michelle }}</ref>

Spinal manipulation does not appear to be helpful.<ref name=BMJ11/> Although claims have been made for [[chiropractic]] care, under the theory that treating [[subluxation]]s in the [[Vertebral column|spine]] may decrease symptoms,<ref>{{cite book |title= The Chiropractic Profession: Its Education, Practice, Research and Future Directions |author= Chapman-Smith D |year=2000 |chapter= Scope of practice|isbn=1-892734-02-8 |publisher=NCMIC |location= West Des Moines, IA}}{{page needed|date=January 2013}}</ref> a 2006 systematic review found that overall no evidence suggests that [[spinal manipulation]] is effective for treatment of primary and secondary dysmenorrhea.<ref>{{cite journal | author = Proctor ML, Hing W, Johnson TC, Murphy PA | title = Spinal manipulation for primary and secondary dysmenorrhoea | journal = Cochrane Database Syst Rev | volume = 3 | issue = 3 | pages = CD002119 | year = 2006 | pmid = 16855988 | doi = 10.1002/14651858.CD002119.pub3 | editor1-last = Proctor | editor1-first = Michelle }}</ref>
{{trans F}}
⚫
==流行病学==
⚫
经痛在妇女中的患病率约为25%<ref name=holder>[http://emedicine.medscape.com/article/795677-overview eMedicine > Dysmenorrhea] By Andre Holder, Laurel D Edmundson and Mert Erogul. Updated: Dec 31, 2009</ref>，在20岁左右最为多发，通常随着年龄增长减少。据一份调查，经痛在青少年女性中的患病率为67.2%<ref name="sharma">{{cite journal |author=Sharma P, Malhotra C, Taneja DK, Saha R |title=Problems related to menstruation amongst adolescent girls |journal=Indian J Pediatr |volume=75 |issue=2 |pages=125–9 |year=2008 |pmid=18334791 |doi= 10.1007/s12098-008-0018-5|url=}}</ref>，另一份调查结果是90%<ref name=holder/>。不同种族的患病率和发病率没有显著差异。<ref name=holder/>
⚫
一般认为[[怀孕]]可以解除痛经，然而这不是必然的。调查表明，有原发性经痛的未产妇在40岁后症状明显减少。<ref name= Juang>{{cite journal |author=Juang CM, Yen MS, Horng HC, Cheng CY, Yuan CC, Chang CM |title=Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study |journal=J Chin Med Assoc |volume=69 |issue=10 |pages=484–8 |year=2006 |pmid=17098673 |doi= 10.1016/S1726-4901(09)70313-2}}</ref>据[[问卷调查]]，在遭受过[[性虐待]]的女性中，包括痛经在内的月经问题更为普遍。<ref name=vink>{{cite journal |author=Vink CW, Labots-Vogelesang SM, Lagro-Janssen AL |title=[Menstruation disorders more frequent in women with a history of sexual abuse] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=150 |issue=34 |pages=1886–90 |year=2006 |pmid=16970013 |doi= |url=}}</ref>

⚫
一份来自[[挪威]]的调查显示，在该国20岁至35岁的女性中，有一成四会因經痛症状之重而在家休假。<ref name="mozon">{{cite web | title=Mozon: Sykemelder seg på grunn av menssmerter | publisher= Mozon | date=2004-10-25 | url=http://www.mozon.no/php/art.php?id=349090 | accessdate=2007-02-02}}</ref>对[[青春期]]女性而言，經痛是缺课的首要原因。<ref name=french>{{cite journal |author=French L |title=Dysmenorrhea in adolescents: diagnosis and treatment |journal=Paediatr Drugs |volume=10 |issue=1 |pages=1–7 |year=2008 |pmid=18162003 |doi= 10.2165/00148581-200810010-00001|url=}}</ref>


==参考资料==
==参考资料==

2017年8月30日 (三) 04:01的版本

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經痛
Dysmenorrhea
同义词Dysmenorrhoea, painful periods, menstrual cramps, 陣痛期, 月經絞痛
症状月經期的時候感到疼痛，可能伴隨腹瀉和噁心
[1][2]
起病年龄通常第一次出現在初潮出現後一年內[1]
病程少於三天 [1]
病因未知但不重大、子宮肌瘤、子宫腺肌病、子宮內膜異位症[3]
診斷方法骨盆檢查、超聲波[1]
鑑別診斷異位妊娠、骨盆腔發炎、間質性膀胱炎、慢性骨盆痛（英语：chronic pelvic pain）[1]
治療熱敷、藥物治療[3]
藥物非類固醇消炎止痛藥 例如：ibuprofen、賀爾蒙的生育控制法（英语：hormonal birth control）、IUD with progestogen（英语：IUD with progestogen）（NSAIDs 比如說： ibuprofen、賀爾蒙避孕（英语：hormonal birth control）, IUD with progestogen（英语：IUD with progestogen））[1][3]
预后常隨著年紀增加而減輕[2]
患病率未進入更年期的女性中的 20% ~ 90% [1]
分类和外部资源
醫學專科婦科學
ICD-11GA34.3
ICD-10N94.4、​N94.6
DiseasesDB10634
MedlinePlus003150
eMedicine253812
[编辑此条目的维基数据]

經痛（英語：Dysmenorrhea，或稱為：dysmenorrhoea），又稱陣痛期（英語：painful periods）、月經絞痛（英語：menstrual cramps、menstrual pain），是女性月經來潮期間出現的疼痛[1][2]。經痛通常在月經來的時候開始。 典型的症狀大約持續不到三天。經痛通常出現在骨盆或下腹部；其他的症狀可能包括背痛、腹瀉與噁心[1]。

對於年輕婦女，經痛可能在沒有任何原發疾病的影響下發生。可是較年長的婦女若有經痛困擾，大多和子宮肌瘤、子宮肌腺瘤或是子宮內膜異位症有關[3]。較常見於患有月經量過多（經血過多）（英语：Menorrhagia）、經期不規律、初經發生在十二歲前又或是體重過輕的婦女[1]。會建議有規律性生活（sexually active）的女性接受骨盆腔檢查。超音波掃描可幫助醫師做出正確的診斷[4]。在進行診斷時，應優先排除子宮外孕、骨盆腔發炎、間質性膀胱炎與慢性骨盆疼痛症候群等疾病的可能性[1]。

平常有運動習慣以及在很年輕就生育的女性較少有經痛的困擾[1]。使用加熱墊（熱敷）也是減緩經痛的方式之一[3]。非類固醇抗發炎藥物像是布洛芬、賀爾蒙避孕藥（英语：Hormonal contraception）還有子宮內避孕器都是能幫助患者減輕疼痛的醫療方法[3][1]。補充維他命B或鎂亦有幫助[2]。對於瑜伽、針灸和按摩是否能夠抑制經痛的研究還不夠完整[1]，但若確定患有某種可能導致經痛的宿疾，手術是減輕經痛的一種可能有用的方法[2]。

處於生育年齡的婦女，估計約有20-90%曾有經痛的經驗[1]，它可說是最常見的月經失調疾病[2]，大多開始在初經開始的一年內[1] 。在沒有其他可能疾病的影響下，經期疼痛的情況會隨著年齡增加而改善，也會在懷孕後趨緩[2]。

症狀

經痛的主要疼痛點集中在下腹或骨盆[1]次要的疼痛點為腹部的左側或右側。經痛的疼痛感可能會擴散至大腿和下背。[1]

經痛常伴隨噁心、呕吐、腹瀉 或 便秘、頭痛、頭暈、disorientation（英语：disorientation）、對於聲音、光、嗅覺、和碰觸感到敏感、昏厥、和疲倦。

經痛及共伴症狀通常於排卵（ovulation）後就會立即出現，且可能持續到該次月經結束。 這是因為經痛與排卵引起的體內激素改變高度相關。 避孕藥有助於預防經痛的出現因為避孕藥能阻止排卵。

原發性經痛

經痛發生在於女性開始出現規則性月經時，其經痛大都是發生在月經的前一、二天，經痛的表現為痙攣、絞痛。多數的經痛在月經的第二至三天會自動緩解，而且大部份的女性也會在年齡稍長或是生過孩子會自然的減輕經痛或是消失經痛。

疼痛通常發生在月經開始之前的幾個小時或月經開始以後，而且會持續1至3天，恥骨上會有痙攣性的疼痛，有時會伴隨著腰酸，疼痛也可能牽連到大腿，噁心、嘔吐、腹瀉的情況也很常見，嚴重的病人甚至可能暈倒，按壓肚子、按摩腹部或改變姿勢會減少經痛的症狀，這與其他因為化學刺激或是感染造成的腹膜炎不同。

續發性經痛

經痛出現在女性有一段時間沒有經痛的月經之後，或是本來月經來潮的不舒服症狀漸漸的轉變成為明顯的腹痛。其表現的疼痛比較多樣性，有時表現在痙攣、絞痛，有時表現在鈍痛、脹痛甚至出現劇烈的刺痛。痛的性質並不會隨時年紀而減輕，反而會出現更惡化。

疼痛通常在月經來潮前的1~2週就開始，而且會持續到出血停止之後幾天才慢慢緩解，病因相當的多，子宮內膜異位是最常見的原因，其次是子宮的腺肌症或是子宮內避孕器造成的疼痛等等。

成因

經痛可以分成兩型，分別為第一型（Primary）及第二型（Secondary）。第二型經痛代表經痛的背後存有其他潛在的問題。第一型經痛則是經痛的背後沒有其他潛在的問題。 「第二型經痛」最常見的病因為子宮內膜異位症，大概佔了所有經痛的青少女的70%。子宮內膜異位症可以利用腹腔镜（英语：laparoscopy）直接以肉眼觀察發現。 [5]

其他導致第二型經痛的原因包括leiomyoma（英语：leiomyoma）[6] 、卵巢囊腫、子宫腺肌病[7] 、和骨盆阻塞（pelvic congestion）[8]。 長短腳（英语：Unequal leg length#Effect on Menstrual pain）被假定為經痛加劇的原因之一或被誤以為是經痛，因為長短腳會導致骨盆不正，長期會引起下背痛。 [9]其他骨骼問題，例如：脊椎側彎也會導致長短腳。

原發性經痛

造成原發性經痛的原因是因為子宮內膜的前列腺素產生過度旺盛，造成子宮強烈收縮及缺血。前列腺素在成熟的子宮內膜也就是黃體期的子宮內膜特別容易產生，這也是為什麼有排卵的週期比較會痛的原因。

續發性經痛

通常發生在初經以後幾年才開始，主因是骨盆腔有 病變造成經痛的情形。

機轉

在一位女性的月經週期過程中， 子宮內膜先是增厚以備可能的懷孕。卵巢排卵後，如果「卵细胞沒有受精（英语：Human fertilization）」及/或「子宮沒有懷孕」，則新增的子宮組織（即先前為懷孕做準備所新生的子宮內膜組織）將因為用不到而脫落 ，而前列腺素這個分子化合物會因為子宮內膜的脫落被釋放出來。 [10] 前列腺素以及其他子宮發炎介質的釋出會讓子宮產生收縮。因而，這些物質被認為是導致第一型經痛的主要因素。 [11]

子宮收縮時，連帶限制了到達子宮內膜（endometrium）的血液輸送，從而導致子宮內膜的壞死與剝落。子宮的收縮會一直持續以擠壓、排擠那些老死的內膜組織經由子宮頸和阴道排出。這類的收縮會影響周圍正常組織的氧氣供應，引起疼痛或絞痛。

常出現經痛（第一型經痛）的婦女，相較其他婦女，其子宮肌有較為頻繁和強烈的收縮。[12]

一個比較「有經痛（dysmenorrheic）」和「沒有經痛的（eumenorrheic (normal)）」婦女們子宮的核磁共振成像的研究顯示，有經痛的婦女們的子宮可視特徵（visible features of the uterus），在月經開始後的一到三天與疼痛的程度高度相關，且明顯與沒有經痛的婦女們不同。 [13]

診斷

已隱藏部分未翻譯内容，歡迎參與翻譯。

The diagnosis of dysmenorrhea is usually made simply on a medical history of menstrual pain that interferes with daily activities. However, there is no universally accepted gold standard technique for quantifying the severity of menstrual pains.[14] Yet, there are quantification models, called menstrual symptometrics, that can be used to estimate the severity of menstrual pains as well as correlate them with pain in other parts of the body, menstrual bleeding and degree of interference with daily activities.[14]

Further work-up

Once a diagnosis of dysmenorrhea is made, further workup is required to search for any secondary underlying cause of it, in order to be able to treat it specifically and to avoid the aggravation of a perhaps serious underlying cause.

Further work-up includes a specific medical history of symptoms and menstrual cycles and a pelvic exam.[2] Based on results from these, additional exams and tests may be motivated, such as:

治療

原發性經痛

診斷

要排除掉其他可能造成經痛的病因，同時醫師會詳細了解病人的過去病史、月經狀況，經痛的發生是不是週期性的而且十分規律，在做內診時，原發性經痛的人子宮、卵巢或者是其他臟器都是完全正常的。

治療

非類固醇類的止痛藥(前列腺素抑制劑)，對於原發性經痛的療效 可以達到80%以上，許多女生害怕服用止痛藥，怕成癮，或是怕藥物愈來愈沒效，其實一個月服用幾次藥，並不需要擔心這些問題，但是這些藥物要在經痛發生前或剛剛發生時就開始服用，每六到八小时就要服用一次效果才會比較好，在藥物的選擇時，至少要嘗試過三種以上的藥物，而且要經過四至六個月的治療週期才能夠確定藥物 的效果，部分對藥物有過敏或有胃潰瘍的人必須選擇其他的替代藥物服用，如果妳剛好也有避孕的需要，不排斥，也沒有服用避孕藥的禁忌時，避孕藥不失為一個良好的選擇，大約有超過90%的原發性經痛病人在服用避孕藥後疼痛可以得到緩解，如果上面的治療都沒辦法發揮效果時，一些類固醇或者是較強的麻醉止痛藥可以選擇性的使用，但是 醫師也會評估患者的精神狀態或心理因素的影響。除了這些治療之外，針灸或者是經皮的電刺激治療，目前也有越來越多的人認為可以發揮效果。

續發性經痛

診斷

超音波、內診、血液檢查、腹腔鏡都是可能需要的工具，目的也就是找到可能造成疼痛的病因。

治療

續發性經痛與原發性經痛不同，一些非類固醇類的止痛藥或口服避孕藥在治療疼痛的效果不如原發性經痛來的好，治療主要還是要針對造成疼痛的病因加以處理，如果藥物治療無效，也可以考慮薦骨前神經切除術，效果可以達到50%至75%。

已隱藏部分未翻譯内容，歡迎參與翻譯。

Management

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.[15] They can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.[16][15] People who are unable to take the more common NSAIDs may be prescribed a COX-2 inhibitor.[17]

Hormonal birth control

Use of hormonal birth control may improve symptoms of primary dysmenorrhea.[18][19] A 2009 systematic review however found limited evidence that the birth control pill, containing low doses or medium doses of oestrogen, reduces pain associated with dysmenorrhea.[20] In addition, no differences between different birth control pill preparations were found.[20]

Norplant[21] and Depo-provera[22][23] are also effective, since these methods often induce amenorrhea. The intrauterine system (Mirena IUD) may be useful in reducing symptoms.[24]

Other

A review indicated the effectiveness of transdermal nitroglycerin.[25]

Alternative medicine

There is insufficient evidence to recommend the use of any herbal or dietary supplements for treating dysmenorrhea, including, melatonin, vitamin E, fennel, dill, chamomile, cinnamon, damask rose, rhubarb, guava, and uzara.[1][26] Further research is recommended to follow up on weak evidence of benefit for: fenugreek, ginger, valerian, zataria, zinc sulphate, fish oil, and vitamin B1. A 2016 review found that evidence of safety is insufficient for all dietary supplements.[26]

There is some conflicting evidence in the scientific literature, including:

One review found thiamine and vitamin E to be likely effective.[27] It found the effects of fish oil and vitamin B12 to be unknown.[27]

Reviews found tentative evidence that ginger powder may be effective for primary dysmenorrhea.[28][29]

Another review found Vitamin B1 to be effective.[來源請求] Magnesium supplementation are a promising possible treatment.[來源請求]

A 2008 review found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.[30]

Procedures

Acupuncture: A 2016 Cochrane review found that the randomized controlled trials (RCTs) of acupuncture treatments for dysmenorrhea are of low quality and concluded that it is unknown if acupuncture or acupressure is effective for treating symptoms of primary dysmenorrhea.[31] There are also concerns of bias in study design and in publication, insufficient reporting (few looked at adverse effects), and that they were inconsistent.[31] There are conflicting reports in the literature, including one review which found that acupressure, topical heat, transcutaneous electrical nerve stimulation, and behavioral interventions are likely effective.[27] It found the effect of acupuncture and magnets to be unknown.[27]

A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.[32]

Spinal manipulation does not appear to be helpful.[27] Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms,[33] a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.[34]

流行病学

经痛在妇女中的患病率约为25%[35]，在20岁左右最为多发，通常随着年龄增长减少。据一份调查，经痛在青少年女性中的患病率为67.2%[36]，另一份调查结果是90%[35]。不同种族的患病率和发病率没有显著差异。[35] 一般认为怀孕可以解除痛经，然而这不是必然的。调查表明，有原发性经痛的未产妇在40岁后症状明显减少。[37]据问卷调查，在遭受过性虐待的女性中，包括痛经在内的月经问题更为普遍。[38]

一份来自挪威的调查显示，在该国20岁至35岁的女性中，有一成四会因經痛症状之重而在家休假。[39]对青春期女性而言，經痛是缺课的首要原因。[40]

参考资料

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參見

女性盆腔和生殖器疾病（N70–N99，614–629）
女性内生殖器
子宫附件
卵巢疾病（英语：Ovarian disease）
输卵管
子宫
子宫内膜
子宫肌层
子宫旁组织
子宫颈
其他
阴道
其他
女性外生殖器
外阴
阴蒂包皮或阴蒂
描述
疾病
治療
事件及分期
階段
追蹤
體徵
系統
抑制
失调
相關事件
文化和宗教（英语：Culture and menstruation）
描述
疾病
治療
检索自“https://zh.wikipedia.org/w/index.php?title=經痛&oldid=45967188”