Dysmenorrhea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination.
What is it?
Dysmenorrhea is the pain or discomfort ("cramps") during or just before a menstrual period. Dysmenorrhoea can be either primary,with the onset of menarche, or secondary, developing later. There may be cramping lower abdominal pains, which often radiate to the back, or down the inner aspect of the thigh. These may be accompanied by faintness or gastrointestinal symptoms, including loose stools or nausea.
Primary dysmenorrhea
Menstrual symptoms vary widely amongst individuals, but some suffer more severely than others. Primary dysmenorrhoea occurs almost exclusively in ovulatory cycles.It is severe, disabling cramps without underlying illness. Symptoms may include backache, leg pain, nausea, vomiting, diarrhea, headache, and dizziness. This kind of dysmenorrhea usually affects young woman within two years of the onset of menstruation and lasts one or two days each month. Primary dysmenorrhea may affect up to 75 percent of women at some time, and 5-6 percent may have incapacitating pain. The frequency of cases increases up to age 20 and then decreases with age.
Causes:-• Prostaglandin production
• Increased myometrial contractility
• Decreased endometrial blood flow
• Leukotrienes
« Vasopressin
Secondary dysmenorrhea
This develops after menarche and there may be identifiable underlying patholog. It is cramps caused by another medical problem(s) such as endometriosis (abnormalities in the lining of the uterus), adenomyosis (nonmalignant growth of the endometrium into the muscular layer of the uterus), pelvic inflammatory disease, uterine fibroids, cervical narrowing, uterine malposition, pelvic tumors or an IUD (intra-uterine device). This condition usually occurs in older women.
Treatment is dependent on the cause. Investigation may include thorough examination, ultrasound scan and laparoscopy. Although psychological factors are quoted as being involved in both primary and secondary dysmenorrhoea, the evidence for physical factors is strong. Recurring, debilitating pain may well cause depression and anxiety, rather than depression initiating the pain.
Causes:-
IdiopathicEndometriosis
Adenomyosis
Pelvic inflammatory disease
• Pelvic venous congestion
Cervical stenosis
Intrauterine device
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Why does it pain on menustration?
When the menstrual cycle begins, prostaglandins (chemical substances that are made by cells in the lining of the uterus) are released by the endometrial cells as they are shed from the uterine lining, causing the uterine muscles to contract. If excessive prostaglandin is present, the normal contraction response can become a strong and painful spasm. As it spasms, the blood flow is cut off temporarily, depriving the uterine muscle of oxygen and thus causing a "cramp." The cramps themselves help push out the menstrual discharge.
Excessive prostaglandin release is also responsible for contraction of the smooth muscle in the intestinal tract; hence the diarrhea, nausea and vomiting. Headache and dizziness may also be the result of high prostaglandin levels.
Investigations of Dysmenorrhea
A medical history and pelvic exam alone may provide enough information for the doctor to determine whether the cramps are caused by primary dysmenorrhea. In primary dysmenorrhea, the pelvic exam is normal between menses. Examination during menses may produce discomfort but no abnormal findings.
In secondary dysmenorrhea, there may be findings on physical exam. Additional tests may include radiologic studies (including ultrasound) and laparoscopy (involves inserting a tiny, flexible lighted tube through a small incision just below the navel to view the internal abdominal and pelvic organs).
Self Care
For relief of painful menstrual cramps and their associated discomforts, start with a hot bath. The water helps relax the uterus and other tensions that may be contributing to the problem.
Place a heating pad on your abdomen. The flow of heat can provide soothing, temporary pain relief.
Exercise regularly. Aerobic exercise such as walking, swimming, running, bicycling, and aerobic dance may diminish cramping symptoms. For some women, exercise may inhibit prostaglandins or help release endorphins, the brain's natural painkillers.
HOMEOPATHY IN DYSMENORRHEA
As homeopathy treats man in disease (not disease in man) the remedy differs for every case. After a complete case taking a constitutional medicine is prescribed. Still there are many common medicines which are frequently prescribed for dysmenorrhea. I have pictured some common medicines below which should be taken as per your doctor advice.
It’s been found fantastic results in homeopathic treatment for dysmenorrhea.
Most commonly indicated medicines
Belladonna: Symptoms that are very intense and come and go suddenly, accompanied by a feeling of heat, often indicate a need for this remedy. The menstrual flow is typically bright red, profuse, and may have begun too early. Pain and cramping are worse from jarring and from touch, yet applying steady pressure often brings relief. Walking or bending over can make things worse, and sitting may be the most tolerable position. A woman who needs this remedy may feel restless and flushed, with pulsing or pounding sensations, and eyes that are sensitive to light.
Bovista: Women needing this remedy tend to have problems with puffiness and edema during times of menstrual stress, and can feel very awkward and clumsy. Pain may be felt in the pelvic region, often with soreness near the pubic bone. Menstrual flow increases at night (and may even be absent during the day). Diarrhea occurring at the time of the menstrual period is a strong indication for this remedy.
Caulophyllum: Women with a history of weak uterine tone and irregular periods may find some relief in this remedy. Intense discomfort during periods, with drawing pains in the thighs and legs as well as the pelvic area, are strong indications. The woman may experience a heavy flow of blood or other discharge. Stiffness or arthritis, especially in the finger-joints, may be seen in a person who needs this remedy.
Chamomilla: This remedy is indicated when the person’s mood and nerves are so sensitive that pains seem almost unbearable. Anger and irritability may be extreme (or pain and cramping may come on after the woman has been angry). The menstrual flow can be heavy, and the blood may look dark or clotted. Pain often extends from the pelvic area into the thighs, and may be worse at night. Heating pads or exposure to wind can aggravate the symptoms. Vigorous walking or moving around in other ways may help relieve the pain.
Cimicifuga (also called Actaea Racemosa): Cramping and pain that get worse as the flow increases, back and neck pain with muscle tension, and sharp pains like shocks that shoot upward, down the thighs, or across the pelvis, are all indications for this remedy. The woman is likely to be nervous, enthusiastic, and talkative by nature, yet feel pessimistic and fearful when unwell.
Cocculus: This remedy is indicated when a woman has cramping or pressing pain in the pelvic or abdominal region, along with weakness or dizziness. She may be inclined toward headaches or nausea, and parts of her body can feel numb or hollow. Feeling worse from standing up or from any kind of exertion and feeling better from lying down and sleeping are typical. (Cocculus is often indicated when a person has not been sleeping well and then feels weak or ill.)
Colocynthis: Sharp, cutting, tearing pains that make the person double over bring this remedy to mind. Cramping may be felt throughout the pelvic area or be focused near the ovaries. The woman feels restless from the pain, but lying down and keeping hard pressure and warmth on the area improve things. This remedy is often indicated if problems are worsened by emotional upsets, especially after feeling anger or suppressing it.
Lachesis: Women who have intense discomfort and tension before the menstrual period begins and feel much better when the flow is established may benefit from this remedy. Symptoms include a bearing-down sensation in the pelvis, flushes of heat, headache, and an inability to tolerate the touch of clothing around the waist or neck. A person who needs this remedy may feel “like a pressure cooker”: intense and passionate, needing an outlet both physically and emotionally.
Lilium tigrinum: Indications for this remedy include great premenstrual irritability (making other people “walk on eggs”) and cramping pain with a bearing-down feeling during periods. The woman may feel as if her uterus is pushing out, and may need to sit a lot or cross her legs. She is likely to feel worse from strong emotions or excitement and be better from fresh air.
Magnesia phosphorica: Painful cramps and pain in the pelvic region that are relieved by pressure and warmth often respond to this remedy. Periods may start too early, often with a dark or stringy discharge, and pain is usually worse on the right side of the body. The woman is sensitive and inclined toward “nerve pain”—feeling worse from being cold and also worse at night.
Nux vomica: This remedy may be indicated when a woman has irregular menstrual periods with constricting pains that can extend to the rectum or the area above the tailbone. The woman tends to be impatient, irritable, and easily offended. Chilliness and constipation are also common. Mental strain, anger, physical exertion, stimulants, strong foods, and alcohol are likely to make things worse. Warmth and rest often help.
Pulsatilla: Delayed or suppressed menstrual flow accompanied by nausea or faintness suggests the use of this remedy. Getting too warm or being in a stuffy room make things worse. Cramping pain with a bearing-down feeling, either with scanty flow or thick, dark, clotted discharge, can also occur—symptoms that are changeable often point to Pulsatilla. The woman’s moods are changeable as well, and a desire for attention and sympathy, along with a sensitive (even tearful) emotional state are typical. This remedy is indicated during many conditions involving hormonal changes and is often helpful to girls who have recently started having periods.
Sepia: Indications for this remedy include painful, late, or suppressed menstruation, sometimes with a feeling that the pelvic floor is weak or as if the uterus is sagging. The woman may feel irritable, dragged out, and sad—losing interest temporarily in marital and family interactions, wanting to be left alone. Dampness, perspiring, and doing housework may aggravate the symptoms. Warmth and exercise, especially dancing, often brighten the woman’s outlook and restore some energy.
Veratrum album: Menstrual periods with a very heavy flow and cramping, along with feeling of exhaustion, chilliness, and even vomiting and diarrhea, are indications for this remedy. The periods may start too early and go on too long. Discomfort is often worse at night and also in wet, cold weather. Warm drinks, exercise, or moving the bowels may make things worse. Small meals, cold drinks, and wrapping up in warm clothes or covers will tend to bring relief.
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