DYSMENORRHOEA (Painful menstruation)

It is a medical condition characterized by severe uterine pain during menstruation. The pain is so severe as to limit normal activities or require medication.

Types

There are two types of Dysmenorrhoea:

1. Primary dysmenorrhoea refers to menstrual pain that occurs in otherwise healthy women. This type of pain is not related to any specific problems with the uterus or other pelvic organs.

1. Membranous dysmenorrhoea

2. Secondary: Secondary dysmenorrhoea is menstrual pain that is attributed to some underlying disease process or structural abnormality either within or outside the uterus.

1. Ovarian dysmenorrhoea

1. Primary Dysmenorrhoea

It is one where there is no identifiable pelvic pathology is present. The incidence of sufficient magnitude with incapacitation is about 5-10%. It occurs in the first few years after menarche and affects up to 50% of post pubescent females.

Causes

The pain caused by excessive secretion of prostaglandins. Prostaglandins are the hormones secreted by the cells in the uterus. These hormones are responsible for the contraction of uterine muscles. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experienced during menstruation.

It has also been attributed to behavioral and psychological factors. The incidence is higher amongst affluent introspective and neurotic women. Those having a low threshold for pain and predisposed to undue fears and anxiety are most susceptible. Although these factors have not been convincingly demonstrated to be causative, they should be considered if medical treatment fails.

Some abnormal anatomical and functional aspects of uterus like stenosis of internal os, unequal development of mullerian ducts causes unequal contraction of uterine muscles, inappropriate law of polarity and imbalance autonomic nervous control.

Clinical features

1. It predominantly belongs to adolescent girls and usually appears within 2 years of menarche.
2. The pain begins with the onset of menstruation (or just shortly before) and persists throughout the first 1-2 days, with a usual duration of 48-72 hours.
3. The pain is described as spasmodic, cramping and superimposed over a background of constant lower abdominal pain, which radiates to the back or anterior and/or medial thigh. Affected women experience sharp, intermittent spasms of pain, usually centred in the hypogastrium or suprapubic area.
4. Other symptoms may include nausea and vomiting, diarrhea, headache, fainting, and fatigue.
5. Symptoms of dysmenorrhoea often begin immediately following ovulation and can last until the end of menstruation.

Investigation:

1. No tests are specific to the diagnosis of primary dysmenorrhoea. Diagnosis is made based on clinical findings.
2. The following can be performed to exclude organic causes of dysmenorrhoea:

1. Cervical culture to exclude sexually transmitted diseases
2. Complete blood count
3. WBC count to exclude infection
4. Human chorionic gonadotropin level to exclude ectopic pregnancy
5. Cancer antigen 125 (CA-125) assay: This has limited clinical value in evaluating women with dysmenorrhoea because of its relatively low negative predictive value.
6. Urine analysis
7. Erythrocyte sedimentation rate (While nonspecific, erythrocyte sedimentation rate can help the physician to identify the patient with subacute salpingitis.)
8. Stool guaiac

Treatment

Most of the conventional modes of treatment aim to palliate the pain rather than curing the cause behind it.

Homeopathy being an individualistic science tries to find an individual remedy for each case. Different females suffering from dysmenorrhoea present with different symptoms regarding the character, localization, extension and severity of pain.
The character of blood, its color, presence or absence of clots, the underlying cause like fibroids, cysts, endometriosis and so on, differentiate one case from another. Most importantly the disposition and mental state of each person is different. Hence a Homeopathic remedy is selected by considering the physical, mental and emotional state of each person in order to select a remedy - that remedy can cure dysmenorrhoea (pain during periods) safely and effectively.

2. Secondary dysmenorrhoea

Secondary dysmenorrhoea is defined as menstrual pain resulting from anatomic and/or macroscopic pelvic pathology.

Causes:

A number of factors may be involved in the pathogenesis of secondary dysmenorrhoea. The following pelvic pathologies can lead to the condition: 

• Endometriosis and Adenomyosis
• Pelvic inflammatory disease
• Ovarian cysts and tumors
• Cervical stenosis or occlusion
• Fibroids
• Uterine polyps
• Intrauterine adhesions
• Congenital malformations (eg, bicornuate uterus, subseptate uterus)
• Intrauterine contraceptive device
• Transverse vaginal septum
• Pelvic congestion syndrome
• Allen-Masters syndrome

Clinical Features:

1. This condition is most often observed in women aged 30-45 years.
2. The patient may have onset of pain a week or more prior to the onset of menses, and pain may continue for a few days after cessation of flow or it may be relieved by the onset of flow. The onset and intensity of pain is also depending upon the pathology present.
3. This is usually associated with abdominal bloating, flatulent distension of upper colon, constipation, and feeling of fullness and heaviness of breasts, pelvic heaviness, and back pain.
4. Patients presenting with secondary dysmenorrhoea may have unique and specific findings on physical examination that correspond to their particular pathologies like fibroids, endometriosis, pelvic inflammatory diseases, pelvic adhesions, adenomyosis, ovarian cysts etc.

Treatment

The treatment aims at the cause rather than the symptoms. The type of treatment is depending on the severity, age, and parity of patient.
It may also necessitate surgical interventions.

1. a. Membranous dysmenorrhoea

This is one variety of primary dysmenorrhoea but is rare. There is shedding of big endometrial casts during periods. It is probably due to deficiency in the tryptic ferment normally secreted in the endometrium. The treatment is same as that of primary dysmenorrhoea.

2. a. Ovarian dysmenorrhoea

The pain is felt for 2 or 3 days before menses in one or both lower quadrants in the areas innervated by the tenth thoracic to the first lumbar segments. The pain is ascribed to ovarian nerve degeneration or sclerocystic condition of the ovary/ies.

Homoeopathy

Homeopathy being an individualistic science tries to find an individual remedy for each case. Different females suffering from dysmenorrhoea present with different symptoms regarding the character, localization, extension and severity of pain.
The character of blood, its color, presence or absence of clots, the underlying cause like fibroids, cysts, endometriosis and so on, differentiate one case from another. Most importantly the disposition and mental state of each person is different. Hence a Homeopathic remedy is selected by considering the physical, mental and emotional state of each person in order to select a remedy - that remedy can cure dysmenorrhoea (pain during periods) safely and effectively.

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