DYSMENORRHEA

Dysmenorrhea is a condition of pain during menstruation which interferes with daily activities or defined simply as menstrual pain or at least menstrual pain that is excessive. Contractions and relaxation of uterus is a normal phenomenon but these contractions are generally of higher strength, duration and frequency than in the rest of the menstrual cycle.

Dysmenorrhea due to some underlying disease or structural change inside or outside of uterus is termed as secondary dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, a condition in which cells from the lining of the uterus, endometrium appear and flourish outside the uterus, most commonly on the peritoneum which lines the abdominal cavity. These endometrial cells are influenced by hormonal changes in similar way as the cells inside the uterus respond. Symptoms often worsen at the time of menses.

Other causes are leiomyoma, a benign smooth muscle growth which is rarely premalignant and most commonly occur in the uterus, small intestine and esophagus, ademomyosis, ovarian cysts and pelvic congestions. A copper IUCD (intra uterine contraceptive devise) can also cause dysmenorrhea. Primary dysmenorrhea is diagnosed when none of these are detected.

The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or above the pubic region of the abdomen. The pain may felt in the right or left abdomen and may radiate to the thighs and lower back. A patient may feel different kinds of pain as throbbing, shooting, burning, nauseating, cramp like, dull or sharp pains. The pain may precede menstruation by several days for example may start at or just after ovulation which occurs around 14^th day of a regular cycle or may accompany menstruation and it usually subsides as menstruation tapers off. There may excessively blood loss with dysmenorrheal, known as menorrhagia. 

Menstrual pains may occur with nausea and vomiting, diarrhea or constipation, headache, vertigo, hypersensitivity to sound, light, smell and touch, disorientation, fainting and fatigue. Use of certain types of birth control pills can prevent the symptoms of dysmenorrhea because ovulation is prevented by birth control pills.

The diagnosis of dysmenorrhea is usually based on a medical history of menstrual pain that interferes with daily activities. Underlying cause should be investigated. Beside certain laboratory tests pap’s test and gynecologic ultrasonography are necessary. Sometime, leproscopy (Opening and looking into abdomen) may be required to diagnose the problem.

Treatment                                                                                                                                                                  Non steroidal anti-inflammatory drugs and hormonal contraceptives offer no permanent relief with their side effects. In secondary dysmenorrhea cause needs to be treated. Homeopathic treatment solves both primary and secondary dysmenorrhea. Decision of prescription of homoeopathic medicine is based on specific symptoms therefore patient need to observe type of pain and time and circumstances in which pains are aggravated.  Following are some medicines and example of modalities that is symptom variation –                                                                                                     

PAIN - Uterus - menses- before - agg.
– Alumina., Apis mel., Arund., Belladona.,  Bry., Bufo .,CALC., CALC-P., CAUL.,
Caust., Cham., Coloc., KALI-C.,  Lach., Lyc., Mag-p., Mosch., Nat-m., Nux-v.,
 Phos., PULS., Sec., SEP., Sil., Ustilago., Vibernum op., Zincum met.
– Burning – Bufo, Carb-an., Conium, Curare, Natrum-mur.
– Cramping – Cactus., CALC-P., Caust., CHAM., Mag-p., Thymol., Viber. op.
– Cutting pain – Caust., Mag-c., Murx., Natrum-carb.
– drawing pain – Juglans-reg., Thymol.
– pinching pain – Alum., Bry.
– pressing pain –jug-r.
– sore – bov.
– stitching pain – borx.
-  tearing pain – nat – m.

– during – agg .

Acon., Agar., agn., alum., Am-c., apis.,_, Arist-cl., ars-met., bamb-a., BELL., CACT., CALC., Calc-p., calc-s., caul., Cham., Cimic., Cocc., cupr., ferr., Gels., Ham., Ign., Kali-c., kali-s., Kreos., Lac-c., Lach., led., Lil-t., Lyc., Mag-m., merc., NUX-V., op., phyt., Plat., PULS., sars., sep., Stann., Sulph., symph., syph., Tarent., tritic-vg., Tub., Ust., xan., xanth.

Other methods – Transdermal nitroglycerin has been said to be effective in dysmenorrhea. Behavioral interventions are base on assumption that the physiological processes underlying dysmenorrhea are affected by environmental and psychological factors. Acupressure, spinal manipulation, topical heat and transcutaneous electric nerve stimulation, thiamine, vitamin E, acupuncture, fish oil, magnet or vitamin B 12 is used for treating dysmenorrheal.

Case - Miss A.       22 yrs.      female        student             hindu                   vegetarian

Diagnosis – Dysmenorrhea

The patient had regular menses for six days but with lower abdomen pain extending to back, aggravated 2 days before and menses, since menarche at age 14 yrs. The pain was relieved by lying on back. She has numbness in her hands on grasping anything which was relieved by motion. Her pain abdomen and head pain was aggravated on fasting. Pain in calves and ankles occurred in morning on rising. She has pain in the lumber region of her back. She got itching in inner corners of eyes.

She has desires sweets and lemon and strong aversion to milk. She perspires on forehead, in palms and soles. She prefers cold things and dislikes warmth. Has fair complexion.

26/09/11 Rx 1. Natrum mur.      30      two doses to take at 10 minutes interval.                                                            

                    2. Phytum               30      two pills thrice a day for one month,

                    3. L. S.                  200      two pills once a day.

08/11/11 No numbness in hands but knees pain and itching in eyelids was still there. Menses were almost painless this time. Hairs were graying.

                  Rx 1. Natrum mur.      30      two doses to take at 10 minutes interval.

                       2. Phytum               30      two pills thrice a day for one month,

                       3. L. S.                  200      two pills once a day.

17/12/11 Menses were painless. Pains in knees decreased. Itching eyes decreased.

                  Rx 1. Natrum mur.      30      two doses to take at 10 minutes interval.

                       2. Phytum              30      two pills thrice a day for one month.  

                       3. L. S.                  200      two pills once a day

Thereafter menses were painless and lumber pain and itching in eyes was relieved.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in