Dysmenorrhoea

Dysmenorrhoea(menstrual pain) is a gynecological disorder of females in which there is pain before the onset of menstruation and that interferes with daily routine activities. Dysmenorrhoea is also defined as the menstrual pain or excessive menstrual pain.

dysmenorrhoea

Pains of dysmenorrhoea are of different types such as sharp, throbbing, dull, nauseating, burning, and shooting pains.

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Dysmenorrhoea precedes menstruation by several days or accompanying it and it is gone by the stoppage of menstruation or on the 1st day of menstruation as the flow starts.

During the menstruation cycle of the woman the endometrium (inner layer of uterus) get thickened and get prepared for the potential pregnancy. After release of ovum if it is not fertilized and if there is no pregnancy then this thickly built up uterine inner wall is shed off.

PATHOPHYSIOLOGY
Due to destruction of the endometrial cells during menstruation there is release of molecular compounds or proteins called prostaglandins. This release of prostaglandins and other inflammatory mediators during menstruation lead to contraction of the uterus. These molecules are the major cause of primary dysmenorrhoea. These prostaglandins act on the muscles of the uterus and cause contraction.
When the muscles of the uterus contract they cease the blood supply to the tissue of the endometrium. Due to cessation of blood supply to the endometrial layer it starts breaking down and dies.
These uterine contractions continue till the old tissue layer inside the uterus is shed off.

Due to the contraction process of muscles and pressure on the uterine arteries there occur temporary oxygen deprivation to the surrounding areas of arteries and these contraction are the cause of pain or cramps during menstruation.
In secondary type of dysmenorrhoea, there is constant pain during full menstrual period days due to some underlying disease or disorders affecting the uterus.
Who are affected ?

Dysmenorrhoea is a female disorder does not occur in males.
Dysmenorrhoea affecting women between the age group of 17-25 years is primary dysmenorrhoea.
Dysmenorrhoea above the age of 30 years is related to the underlying disease of the reproductive system, especially uterus.

What Causes Dysmenorrhoea ?

Risk factors leading to dysmenorrhoea are as following
• Menarche (appearance of menses) at an early age.
• Heavy menses flow.
• Smoking.
• Positive history of family with dysmenorrhoea.
• Long menstrual period.

Causes of secondary dysmenorrhoea are as following
• Adenomyosis.
• Uterine tumors.
• Pelvic inflammatory disease.
• Intrauterine contraceptive devices.
• Endometriosis.
• Adhesions.
• Uterine polyps.
• Pelvic congestion syndrome.
• Ovarian cysts.
• Congenital malformation of the Mullerian system.
• Psychogenic pain.
• Cervical strictures or stenosis.
• Mittelschmerz.
• Allen masters syndrome.

Differential diagnosis of Dysmenorrhoea

• Ovarian cysts.
• Pelvic inflammatory disease.
• Irritable bowel disease.
• Endometriosis.
• Abortion.
• Urinary tract infection.
• Ectopic pregnancy.

Treatment of Dysmenorrhoea

In acute cases of pain analgesics are given to relieve the pain.
In cases where dysmenorrhoea is due to secondary causes like pelvic inflammatory disease, endometriosis treatment is done according to the underlying disease.

Dietary changes helps to overcome Dysmenorrhoea

• Patient should take low fat containing diet.
• Patient should take vegetarian diet.

Differential diagnosis of Dysmenorrhoea

• Abortion
• Irritable bowel syndrome
• Inflammatory bowel disease
• Ovarian cysts
• Urinary tract infection in females
• Pelvic inflammatory disease
• Adrenal insufficiency
• Ectopic pregnancy

Prognosis of Dysmenorrhoea

The prognosis of dysmenorrhoea is excellent. It can be treated with good prognosis.

Homeopathic remedies for Dysmenorrhoea

Borax veneta
• Menses are too soon, profuse with gripping pain, nausea and pain in the stomach extending to the lumbosacral region.
• Well indicated medicine for membranous dysmenorrhoea.
• There is sensation of distension in clitoris with sticking.
• There is leucorrhoea like white of eggs with sensation as if warm water was flowing.

Cactus grandiflorus
• Indicated for dysmenorrhoea with pulsating pain in the uterus and ovaries.
• Menses are early, dark, pitch like ceases on lying down.
• Constriction in the uterine region and ovaries.
• Also indicated for vaginismus.

Cimicifuga racemosa
• There occurs pain immediately before menses.
• Menses are profuse, dark coagulated offensive with backache, nervousness and are always irregular.
• Very well indicated medicine for dysmenorrhoea.
• Patient complains of ovarian neuralgia.
• Pain in the ovarian region shoots upward and down the anterior surface of thighs.
• There is pain across the pelvis, from hip to hip.
• After pains with great insensitiveness and intolerance to pain.

Coffea cruda 
• Well indicated medicine for dysmenorrhoea with large clots of black blood.
• Menses appear too early and long lasting.
• Vulva and vagina are hypersensitive.
• There is voluptuous itching of vulva.

Colocynthis
• Patient suffers from bearing down cramps during menses causing her to bend double.
• Wants abdomen supported by pressure.
• There is boring pain in the ovary.
• Patient must bend double with great restlessness.
• Round, small cystic tumors in the ovaries or broad ligaments.

Caulophyllum thalictroides
• This medicine is indicated for dysmenorrhoea with pains flying to other parts of pains in the cervix.
• Menses and leucorrhoea profuse.
• Revives labor pains furthers progress of labor.
• Indicated for habitual abortion from uterine debility.
• Spasmodic and severe pains which fly in all directions, shivering, without progress.

Magnesia phosphorica
• Well indicated medicine for menstrual colic.
• There occurs membranous dysmenorrhoea.
• Menses are too early, dark and stringy.
• There is swelling of the external parts of female reproductive system.
• Also give good results for the treatment of ovarian neuralgia.

Senecio aureus 
• Well indicated medicine for anemic dysmenorrhoea.
• There occurs functional amenorrhoea in young girls with backache.
• Premature and very profuse menses.
• Before menses there occur inflammatory conditions of throat, chest, and bladder.
• As soon as the menses commences these symptoms improve.

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