ABSTRACT
Dysmenorrhea means uterine pain accompanying menstruation. It occurs around the time that menstruation begins and the symptoms typically last less than three days and the pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea and nausea etc. Dysmenorrhea occurs less often in those who exercise regularly. Dysmenorrhea is the most common menstrual disorder in females of reproductive age. Usually, the pain of dysmenorrhea improves with age or following having a child. Homoeopathic medicines such as Colocynthis, Belladonna, Chamomilla, Cimicifuga, Cocculus, Magnesia phosphorica, Bovista, Caulophyllum thalictroides, pulsatilla nigricans,Sepia etc. helps a lot in managing the cases of dysmenorrhea.
Keywords: Dysmenorrhea, homoeopathy, pain management, painful menstruation
INTRODUCTION
Dysmenorrhea is a Greek term that means “painful monthly bleeding.”[1] Dysmenorrhea can be classified as primary and secondary dysmenorrhea. Primary dysmenorrhea is a lower abdominal pain happening during the menstrual cycle, which is not associated with other diseases or pathology.[2] In contrast, secondary dysmenorrhea is usually associated with other pathology inside or outside the uterus.[3] Dysmenorrhea is a common complaint among women during their reproductive age. Dysmenorrhea is associated with significant emotional, psychological, and functional health impacts.[4]
ETIOLOGY
Many theories have explained the causes of dysmenorrhea. This includes psychological, biochemical, and anatomical etiologies. The anatomical theory included abnormal uterine positions and abnormalities in shape or the length of the cervix [5] However, the biochemical theory has proven to be stronger than others according to several homogenous studies.[6]
Associated risk factors are:
- Age
- Smoking
- Attempts to lose weight
- Higher body mass index
- Depression/anxiety
- Earlier age at menarche
- Nulliparity
- longer and heavier menstrual flow
- Family history of dysmenorrhea
- Disruption of social networks [7]
TYPES OF DYSMENORRHEA:
- Primary dysmenorrhea:[8]
Painful menstruation with no identifiable pelvic pathology. In primary dysmenorrhea there is no disease of the uterus or other pelvic organs.
Causes of Pain
The mechanism of initiation of uterine pain in primary dysmenorrhea is difficult to establish, but the following are too often related:
- Mostly confined to adolescents
- Almost always confined to ovulatory cycles
- The pain is usually cured following pregnancy andvaginal delivery
- The pain is related to dysrhythmic uterine contractions and uterine hypoxia.
- Psychosomatic factors of tension and anxiety during adolescence.
- Abnormal anatomical and functional aspect of myometrium.
- Uterine myometrial hyperactivity has been observed in cases with primary dysmenorrhea.
2)Secondary dysmenorrhea:
In secondary dysmenorrhea, painful menstruation due to pelvic or uterine pathology, like uterine fibroids, endometriosis, adenomyosis, Pelvic inflammatory disease, Cervical stenosis etc.
Causes of pain:
The pain may be related to increasing tension in the pelvic tissues due to premenstrual pelvic congestion or increased vascularity in the pelvic organs.
Investigation:
- Transvaginal sonography: Can detect most pelvic pathology (Leiomyoma, adenomyosis)
- Saline infusion sonography (submucous fibroid,polyps).
- Laparoscopy (endometriosis, PID): Useful for both diagnostic and therapeutic purposes.
- Hysteroscopy is useful for both diagnostic and therapeutic purposes.
Homeopathic management of dysmenorrhea [9]:
1. Cimicifuga –This remedy predominantly suits spasmodic dysmenorrhea. Patients complain of pain in the lower abdomen which usually starts on the first day of menstruation. Painspersist until the flow ceases. The victims are usually young unmarried females. Many times, the uterus is not developed properly. Bearing down sensation with pressing pains in the intrauterine region. Pains are shifting from one hip to another.Menses are suppressed or scanty and are offensive. Withbackache. Nervousness During menstruation. Menstrual blood is blackish and partly clothed. The flow does not ameliorate the pain.The muscular pains are associated with uterine disturbances.
2.Caulophyllum –This medicine is also suitable for dysmenorrhea where the patient has a lack of tonicity of the womb. Before and during menstruation, there are spasmodic pains and patients complain that they fly in all directions.
3.Chamomilla-Cutting colic in abdomen and thighs; irritable and snappish;during: profuse discharge of large clotted blood, severe labor like pain in the uterus; tearing pains down the thighs, gripping and pinching the uterus, followed by discharge of clots.Too early, too profuse, withdark, coagulated, sometimes offensive blood.
4.Viburnum Opulus-Spasmodic dysmenorrhea, when the menses are too late,scanty and lasting for few hours.Bearing down pains in the uterine region.Tearing and shooting pain in ovarian region.Colicky pain in pelvic region .Uterine complaints associated with cramps in the thighs ,extending to calf.
5.Pulsatilla Nigricans –Delayed first menstruation. Mild,Gentle,Weeping disposition, fair complexion. Derangements at puberty,menses,suppressed from getting the feet wet, to-late, scanty, slimy,painful,irregular,intermittent flow with evening chilliness, with intense pain,changeable,comes suddenly and goes gradually,great restlessness and tossing about flows more during day. Diarrhea during menses. Pain in loins, nausea,vomiting,vertigo,tenesmus of anus and bladder and many other sufferings before,during and after menses.
6.Belladonna –Congestive enlargement of uterus or ovaries,bearing down pain.Dragging pains in loins ,severe throbbing in sacrum.
7.Colocynthis-Boring pain in the ovary. Must draw up double,with great restlessness. Round, small cystic tumors in ovaries. Wants abdomen supported by pressure. Bearing down cramps, causing her to bend double.
8.Sepia-–Pelvic organs relaxed. Bearing-down sensation as if everything would escape through vulva ; must cross limbs to prevent protrusion, or press against vulva. Menses Too late and scanty, irregular; early and profuse; sharp clutching pains. Violent stitches upward in the vagina, from uterus to umbilicus. Prolapse of uterus and vagina. Morning sickness.
REFERENCES
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2.Burnett M, Lemyre M. No. 345-Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2017 Jul;39(7):585-595. [PubMed]
3.French L. Dysmenorrhea. Am Fam Physician. 2005 Jan 15;71(2):285-91. [PubMed]
4.Chauhan M, Kala J. Relation between dysmenorrhea and body mass index in adolescents with rural versus urban variation. J Obstet Gynaecol India. 2012 Aug;62(4):442-5. [PMC free article] [PubMed]
5.Zebitay AG, Verit FF, Sakar MN, Keskin S, Cetin O, Ulusoy AI. Importance of cervical length in dysmenorrhoea aetiology. J Obstet Gynaecol. 2016 May;36(4):540-3. [PubMed]
6.Dawood MY. Current concepts in the etiology and treatment of primary dysmenorrhea. Acta Obstet Gynecol Scand Suppl. 1986; 138:7-10. [PubMed]
7.Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 2014; 36:104-13. [PubMed]
8.DC Dutta. Textbook of Gynecology .8th Edition. Jaypee Brothers Medical Publishers;2017..
9.Boericke W.New Manual Of Homoeopathic Materia Medica. New Delhi: B.Jain Publishers(P)Ltd;2011.
About the Author:
Dr Dharmendra Kumar Saini, Assistant Professor, Department of Practice of Medicine, University College of Homoeopathy, Jodhpur, Rajasthan
