Dysmenorrhea is defined as the pain and cramping experienced during periods in females.
Each month the ovaries normally prepare one egg for fertilization by the sperm to produce a fetus. This involves the production of the hormones estrogen and progesterone which make the lining of the uterus or the endometrium thicker in preparation for implantation. This anticipation of pregnancy is created by the remains of the follicle that forms the egg or ovum known as the corpus luteum which produces progesterone in large quantities. It is the same corpus luteum that in case of implantation continues to produce progesterone to support the pregnancy in the first trimester or till the placenta takes over its function.
This is brought on by two pituitary hormones known as FSH or Follicular Stimulating Hormone which causes the selection and maturation of the assigned follicle in that cycle and Luteinizing hormone which causes the follicle’s rupture to release the egg at a menstrual event known as the LH surge. These two hormones act upon the ovaries which in turn produce the hormones progesterone and estrogen mentioned before. Given below is an illustration for easy explanation of the process:
in case of no fertilization, the egg is absorbed by the body along with its corpus luteum. This causes the stoppage of the production of progesterone which leads to break down of the lining of the endometrial which in turn results in menstruation.
Along with the disintegration of the endometrium, there is a release of Prostaglandins which are produced as a result of tissue injury, they make the myometrium or the muscles of the uterus contract to expel out the lining but also lead to symptoms of dysmenorrhea such as cramps, uneasiness, bloating, pain as well as diarrhea in some.
Now that we understand the mechanism of Dysmenorrhea, let us have a look at the types of dysmenorrhea based on the causation.
Types of Dysmenorrhea
Based on Cause:
There are two types of dysmenorrhea- Primary and Secondary. While Primary Dysmenorrhea has no detectable organic cause for the pain, it Is the most common cause of dysmenorrhea and is due to the increased activity of prostaglandins.
Secondary dysmenorrhea on the other hand is caused by pelvic conditions such as endometriosis, fibroids, polyps, Pelvic inflammatory disease, cervical stenosis or prolapse etc.
Based on Symptoms:
It can be Spasmodic/ Membranous or Congestive- Spasmodic is usually more severe as the flow increases while congestive is better due to the release of endometrial tissue.
Symptoms of Dysmenorrhea include the following before or during the menstrual cycle:
- Pain and cramping in the lower abdomen
- Pain in the lower back
- Pain extending to the thighs and legs
- Nausea and vomiting
- Fatigue and weakness
Although nearly 50% of women suffer from primary dysmenorrhea, severe pain that causes debility and interferes with the daily routine should be checked on by a Gynecologist.
Diagnosis can be done by an ultrasound and some blood tests to rule out conditions that could be causing the same. Sometimes an MRI may also be required. If the pain does not resolve even after medicinal management or is severe in nature, a diagnostic hysteroscopy or exploratory laparoscopy may be required.
Management of dysmenorrhea:
Management of pain from periods includes
- Hot fomentation using a heating pad or hot water bottle
- Use of analgesics or pain killers
- Drinking more water and staying hydrated
- Anti-inflammatory foods such as fruits, green vegetables, nuts and seeds.
- Decreasing packaged foods and animal products as they contain less fiber which does not assist estrogens disposal from the body causing more pain
Homoeopathic medicines for Dysmenorrhea:
Homoeopathic management for period pains is effective and safe to be used on a regular basis too. Some of the best Homoeopathic remedies for period cramps are:
- Magnesium Phosphoricum: This biochemic remedy is the first choice for many for period pains as it is very effective for pain and cramping. It is a great antispasmodic remedy and helps in case of cramping of muscles with radiating pains. Pains are relieved by warmth menstrual colic, membranous dysmenorrhea (ie, discharge of menstrual blood in membranes or pieces), flatulent colic and bloated sensation, has to loosen the clothing.
- Cactus grandiflorus: It acts well on the circular muscle fibers making it an effective remedy for constricting pains and a band like sensation. It is marked by hemorrhages, constrictions, periodicity and spasmodic pains. It is hence suitable for dysmenorrhea with pulsating pain in the uterus, menses dark, early and cease on lying down.
- Colocynthis: Pain in abdomen that forces one to bend double is its characteristic feature, wants abdomen to be supported by pressure, bearing down cramps, agonizing and cutting pains in the abdomen. Colic with cramps in the calves. It is suitable to women with copious menses and sedentary habits. B Jain Pharmaceutical’s Biocombination No. 15 is a useful remedy for painful menses.
- Cimicifuga racemose: It is a good remedy for muscular and cramps, characterized by agitation. It is suited to females with scanty menstrual flow, dark and clotted. Menstrual flow may be offensive and accompanied by backache. Irregular periods, pain across the pelvis from hip to hip.
- Lachesis mutus: It is a very helpful remedy for females facing menstrual troubles at the time of menopause or in the pre-menopausal states. Menses are short and feeble but pains are better as the flow increases, making it a very useful remedy for congestive dysmenorrhea. Left sided pains are characteristic along with pain worse by pressure. Pain in lower back as well especially on rising from a sitting posture. Pain is also better by application of warmth and this remedy should preferably be given at the beginning or close of the menses.
- Zincum metallicum: It is a good remedy for pain on the left side with inability to stay still. Menses are late, suppressed with more flow at night time. Pain is worse before the menses and complaints get better ta the time of flow. All complaints are accompanied by restlessness, depression, coldness, spinal tenderness and restless feet. There may also be a dry cough before and during the menses.
- Caulophyllum thalictroides: It is primarily a woman’s remedy and is helpful in case of spasmodic pains which fly in all directions, accompanied by shivering. Dysmenorrhea with pains flying to other parts of the body, profuse menses. There is also discoloration of the skin in women with menstrual and uterine disorders. Omeo She Drops are a specialty product consisting of Caulophyllum, Cimicifuga, Magnesium Phos and Viburnum opulus that can help greatly with painful menses associated with backache, nausea and vomiting.
- Sepia officinalis: It is suitable to women who also suffer from dyspareunia and have a general increased sensitiveness in the genitourinary area. Menses are too late, scanty, irregular or early and profuse with sharp clutching pains. Violent stitching pains are felt from the uterus to the umbilicus. Pains are better by exercise.
- Fraxinus americana: It is an excellent remedy in its tincture form for uterine fibroids, enlargement of the uterus and dysmenorrhea with cramps in the feet that get worse in the afternoon and at night.
- Sabina: It is an excellent remedy for profuse and bright menses with pain extending down to the thighs. It is a good remedy for women with profuse menses and a tendency to abort easily. Pain extends from the sacrum to the pubis and from below upwards. Bleeding is partly clotted and worse from least motion. Pain between the sacrum and pubis from one bone to another. Pain in anterior part of the thighs.
Omeo Uteroplus medicated Syrup is an excellent blend of suitable mother tinctures like Aletris farinosa, Janosia ashoka, Helonias dioica and Thlapsi bursa pastoris that help with conditions such as excessive bleeding, painful menses and debility.
Homoeopathic medicine in India is usually used by patients to get relief from menstrual pain and cramps, however, if the pain persists or is intolerable then it is advised to consult a Gynecologist at the earliest.
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Dr. Priyanka Motwani
Dr. Priyanka Motwani has completed her BHMS from the prestigious Nehru Homeopathic Medical College and Hospital, Delhi and holds a Post Graduate Program in Lean Six Sigma from Isenberg School of Management, The University of Massachusetts, Amherst. She is currently the R&D Head at BJain Pharmaceuticals and has a zeal to learn more and more each day.