For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities for a few days every month.
For cclinical purposes dysmenorrhoea is ofter classified in to two broad categories: primary and secondary.
Primary dysmenorrhea is defined as painful menstrual cramps in the absence of any visible pelvic pathology that could account for it.
Secondary dysmenorrhea, the painful menstruation is accompanied by visible pelvic pathology that accounts for the pain. Such a classification allows practical differentiation in the management approach, which is based on the causal mechanism.
Usually appearing within 6"12 months after the menarche, primary dysmenorrhea occurs almost invariably in ovulatory cycles.
About 88% of adolescents with dysmenorrhea experience their first painful menstruation within the first 2 years after menarche.
Dysmenorrhea occurring more than 2 years after the menarche is more likely to be secondary dysmenorrhea, and the underlying cause should be vigorously sought.
Primary dysmenorrhea usually begins a few hours before or just after the onset of menstruation. The cramps are most severe on the first or second day of menstruation.
Characteristically, the pains are spasmodic in nature and strongest over the lower abdomen, but they may also radiate to the back and the inner aspects of the thigh, and they are often described as labor-like pains.
The cramp is commonly accompanied by one or more systemic symptoms, including :
• Nausea And Vomiting (89%)
• Fatigue (85%)
• Diarrhea (60%)
• Lower Backache (60%)
• And Headache (45%)
Nervousness, dizziness, and in some severe cases, syncope and collapse can be associated with primary dysmenorrhea. Lasting a few hours to 1 day, the symptoms seldom persist for more than 2"3 days.
Primary dysmenorrhea should be diagnosed by its positive clinical features and not through exclusion of other causes of dysmenorrhea. The hallmarks of primary dysmenorrhea are:
1. Initial onset of primary dysmenorrhea. The condition should have begun within a few months and at the very most within 2 years of menarche. Despite such fairly rigid criteria, a diagnosis of endometriosis can be extremely difficult to exclude because endometriosis-related dysmenorrhea has a remarkable resemblance to primary dysmenorrhea. Typically, the dysmenorrhea of endometriosis in adolescents begins at 2.9 years after menarche.14
2. Duration of the cramps. The cramps seldom last more than 48"72 hours. Usually the pain lasts only 24 hours or less. The pain also starts a few hours before, or more frequently, only after the onset of the menstrual flow. Dysmenorrhea, which starts before the onset of menstrual flow and extends into several days throughout the flow, is less likely to be primary dysmenorrhea.
3. Character of the pain. This is described as cramping or labor-like pain.
4. Pelvic examination. No abnormal findings that could account for the primary dysmenorrhea should be found during the examination (including rectovaginal).
CAUSES OF PRIMARY DYSMENORRHOEA
Primary dysmenorrhea refers to women with no pathological cause for these symptoms. It almost always first occurs in women younger than 20 and the patient usually reports pain as soon as she establishes ovulatory cycles. The best estimate of prevalence of primary dysmenorrhea is 75%. Although the pathogenesis of primary dysmenorrhea is unknown, there is a close association between an elevated prostaglandin F2a level in the secretory endometrium and symptoms of dysmenorrhea including uterine hypercontractility, severe cramping, and other prostaglandin-induced symptoms.
The causes of secondary dysmenorrhea include endometriosis, presence of an intrauterine device, pelvic inflammatory disease and infection, adenomyosis, uterine myomas, polyps and adhesions, congenital malformation of the müllerian system, cervical stricture or stenosis, ovarian cyst, pelvic congestion syndrome, and Allen "Masters syndrome. The appearance of painful menstrual cramps years after the menarche may be a sign of secondary dysmenorrhea, frequently caused by endometriosis. In women with anovulatory cycles, the menstrual pain is likely to be secondary dysmenorrhea.
Homeopathic treatment for painful periods:
A number of homeopathic medicines can help control the pain as well as actually prevent the menstrual cramps.
Homeopathy is an effective natural treatment with no side effects.
Some homeopathic medicines have a local action (they alleviate the cramps only) and provide fast pain relief.
They are used during painful periods only. Others are called constitutional (chronic) medicines and target the root cause of dysmenorrhea. Constitutional medicines are a deep acting treatment that eliminates not only the menstrual cramps but also brings whole body balance.
One of the best homeopathic medicines for painful menses relieved by warmth
In cases where pain is relieved by application of external warmth, Mag Phos is one of the best homeopathic medicines for painful menses. The pains are also better by application of pressure eg backache is relieved by pressure. The menses are dark, stringy and too early. The right side is more affected. The pain increases at night and from cold.
The congestive forms of dysmenorrhea would call for Belladonna. There is pain preceding the flow and a sensation of heaviness as if everything would protrude from the vulva, relieved by sitting up straight. The pains come on suddenly and cease suddenly; the flow is offensive and clotted. The dysmenorrhea is intensely painful, the vagina is hot and dry and the pains are cutting through the pelvis in a horizontal direction, not around the body, as in Platinum and Sepia. Veratrum viride has also been used with benefit in congestive dysmenorrhea, in plethoric women, accompanied by strangury and preceded by intense cerebral congestion, also spasmodic dysmenorrhea at or near the climacteric.These are conditions in which the old school knows only Opium, yet these remedies are far superior to that drug, often curing permanently while Opium is only palliative.
Spasmodic dysmenorrhoea. Before flow she is suddenly seized with terrible colicky pains in womb and lower part of abdomen, which continues sometimes for hours. Cramps in legs. This remedy is similar to cimicifuga and caulophyllum.
Cimicifuga : medicines for painful menses with crampy pains
Cimicifuga:- Severe pain in back, occiput and vertex. Pains through hips and down thighs of a neuralgic character. Labor-like pain with heavy pressing downward (Cham.) Hysterical spasms. Tenderness of hypogastrium and cramps. Low spirited and sensitive. Blood scanty or profuse and coagulated.
Pains that are crampy in nature yield well to Cimicifuga. The cramps increase as the flow increases.The pains are in the lower abdomen and shoot upward or down the thighs. For nervous women, it is one of the best homeopathic medicines for painful menses,
The dysmenorrhea of Caulophyllum is essentially spasmodic in character; the pains are bearing down in character.It produces a continued spasm of the uterus simulating first stage of labor; the flow is mostly normal in quantity. The spasmodic intermittent pains which call for Caulophyllum are in the groins, a useful remedy in these spasmodic cases if given between the periods. to various part of the body. Magnesia muriatica is also a remedy which may be studied in uterine spasm. Gelsemium is similar in many respects to Caulophyllum. It is very useful remedy in neuralgic and congestive dysmenorrhea when there is such bearing down. The pains are spasmodic and labor-like, with passages of large quantities of pale urine. It is one of the best given low in hot water. It will surely relieve the pains at the start.
Pain extends across hypogastrium to groin and down leg. Menses dark, thick, and smell like lochia (Kreosot.) Severe neuralgic pain in uterus. Slightest jar aggravates. Great palpitation. Distressing urination and bearing down of uterus.
Pulsatilla:- Delayed menses. Discharge thick and dark, flowing by fits and starts (Kreosote). Pains violent, causing anguished tossing about with weeping (Cimicif.) Chilliness and paleness of face. All symptoms worse in warm room. Mild and tearful disposition.
Preceding menses, excoriating leucorrhoea. Menses scanty and premature, feeling as if every thing would protrude through vulva, must cross legs to prevent it (Bell.) All gone sensation at pit of stomach (Ignatia.) Colicky pains and bearing down. Sallow complexion, yellow saddle across the bridge of the nose.
Menses preceded by sore throat, which continues until end of flow and is worse at night. Blood thick, dark and pitch-like, difficult to remove from linen. During pain there is no flow. Flow at night. During menses weakness, (Gels.) chilliness, headache, pale face, and pain in small of back.
Dr. Atul Rajgurav, M.D. (Hom.)
Department of Homoeopathic Pharmacy
Dr. D.Y. Patil Homoeopathic Medical College, Pune