The monthly reminder
representing the presence and function of the uterus (indicated as menstruation)
usually get started by the age of 12. From that time, perfection of rhythm or
regularisation of menses is slowly attained before the age of 16-18. Its
start-up and regularisation varies with racial, nutritional, environmental,
emotional and physical activities. Dysmenorrhoea is a medical term for painful
menstruation or menses or periods. Pain during menses is the most disturbing and
frequent gynaecological complaint of young women during her periods, affecting
day-to-day activities in this busy world. It may be due to cramps and congestion
of the uterus or ovaries. Usually, it occurs just before and during menses. It
mostly gets cured after marriage or sexual activity or pregnancy. Sometimes it
may persist even after that or start later in life. Pain may be mild to severe
which varies from person to person in location and occurrence. Sometimes pain
may be very excruciating in the lower abdomen, accompanied by anxiety, fear,
fainting, vomiting, loose stools and the person may collapse with a mild degree
of shock. More than 40 per cent of girls fear menses in relation to discomfort
and pain.
Dysmenorrhoea is a very common,
acute complaint which should be evaluated medically. But in most of the cases,
proper medical attention is not given due to home therapy and advice from older
women. Also, in most of the cases, its pain is wrongly diagnosed as appendicitis
and the innocent, normal appendix gets assaulted by surgery. Likewise, some
intestinal problems are maltreated or left untreated thinking it is pain related
to periods. Unless complicated, (in emergency conditions like chocolate cysts of
ovary, fallopian tubal pregnancy, etc., where hospitalisation and immediate
medical attention is needed) it is a normally completely curable condition. Pain
during periods won’t injured the ovary or uterus.
Types of dysmenorrhoea
It may be classified as
1) Primary and spasmodic
dysmenorrhoea
2) Secondary dysmenorrhoea
Primary dysmenorrhoea is
the very common type of painful periods. It occurs mostly during and around
puberty. Here the cause is obscure and there won’t be any disease and it is
characterised by a sudden cramp which is felt as spasmodic or colicky sensation.
It is found that these types of patients usually have high levels of
prostaglandins which produce constriction of the muscles of the uterus. As
constriction occurs, the blood supply is further lessened due to compressed
blood vessels, which further intensify the pain.
Secondary dysmenorrhoea
can occur at any age in the fertile periods of women (from puberty to
menopause). It mostly occurs in adult female due to pelvic diseases which cause
pelvic congestion. Secondary dysmenorrhoea is characterised by pain in the
affected area and side. It is always relieved by menstrual flow.
Pelvic diseases include
Fibroid tumours (excessive
growth of the uterine muscle tissue)
Adenomyosis - where ectopic endometrium bleeds into a closed area forming cysts.
These cysts enlarge during periods due to internal bleeding and causes pain due
to expansion. These types of patients often get better during pregnancy due to
absence of menses. In this case the patient also feels pain during sexual
intercourse.
Cervical stenosis - narrowing of cervical canal with cramps due to infection or
hormonal or trauma or congenital narrowing.
Dysmenorrhoea can also be
classified as
1) Congestive dysmenorrhoea -
due to congestion of pelvis (due to premenstrual syndrome, pelvic diseases,
etc.)
2) Spasmodic dysmenorrhoea - occurs mostly during periods due to narrowing of
cervix with stricture or hormonal problem. Clots in menses also cause this type
of pain.
3) Membranous dysmenorrhoea – extreme case of dysmenorrhoea where patient can
see the disintegrated membranes of uterus in bleeding which may be due to
chronic inflammation. Immediate medical attention is needed in this case.
4) Psychogenic dysmenorrhoea – usually occurs after an unpleasant sexual
activity or painful coition or fear of sex with lack of sexual knowledge. This
type of pain is mostly neurological.
The causes of dynsmenorrhoea
are
-
Increased blood supply –
which causes congestion of uterus or ovary or pelvis as in the case of
inflammatory diseases such as salphingo-oophoritis, parametritis and pelvic
adhesions
-
Decreased blood supply –
which causes cramps of uterus or ovaries
-
Heavy blood loss - due to
excessive bleeding which in turn reduces the blood supply of the affected
part which in turn causes cramps and pain.
-
Obstruction -may be due to
cervical stenosis or because of abnormal position of uterus or clots or due
to cramps.
Also causes may be classified
with
-
Uterus- due to abnormal
position (acquired retroverted uterus) Fibroid uterus, endometrial polyp,
any abnormalities (like cervical stenosis, endometriosis)
-
Ovaries - due to chocolate
cysts of ovaries or any other cystic swelling in ovaries. When it is due to
ovaries, it usually occurs during ovulation period (14th day or middle of
menses) initially and lasts till the end of the menses.
-
Pelvic inflammatory
diseases with leucorrhoea (white discharges) will usually cause adhesions
and abnormalities while healing. And finally foreign substance, IUCD (intra
uterine contraceptive device) used for contraception may also be the cause
of pain and excess bleeding during periods. If it is the case, it should be
removed.
Symptoms of dysmenorrhoea
Pain - It is often described as labour-like pain with some bearing down
sensation in the lower abdomen which may extend to back and legs (mostly felt in
front of the thighs). But it varies in nature of pain, places of occurrence and
timing. The nature of the pain may be cutting or gripping or colicky or a
constant dull ache. Pain usually commences just before the start of menses and
it is more on the first day and tapers in the subsequent days. But some may have
pain only on the first day and some throughout the periods. Pain will also be
more while passing clots. It mostly accompanies with
-
Headache
-
Nausea, vomiting and
fainting
-
Altered bowel habits like
diarrhoea or constipation
-
Frequent urination
-
Premenstrual symptoms like
heaviness, fullness and painfulness of breasts or/and abdomen may occur before
and during the periods
-
Heart palpitation and sweating
can also occur due to anxiety and hormonal changes.
Heavy bleeding periods
Effects of dysmenorrhoea
- Due to continued dysmenorrhoea, most women get dejected with sexual life since
these type of patients also get pain during and after sexual intercourse, due to
cramps in the pelvic genital organs.
Diagnosis - In the era
of ultrasound scan, diagnosis can be easily made. It mainly helps to rule
out the emergency condition like ectopic pregnancy or appendix mass or chocolate
cysts of ovaries, etc. Also examination and history of pain for a patient gives
added points for diagnosis. The occurrence and point of the pain also help in
the diagnosis. In case of difficulty in diagnosis, it is mostly found to be
hormonal.
-
If the painful periods are
late and bleeding is heavy - rule out ectopic pregnancy
-
If the pain is more just
before periods – rule out pelvic diseases
-
If the pain is more in the
middle of the periods – rule out ovarian complications.
The nature of the pain also
helps in diagnosing the type of dysmenorrhoea and its causes. Constant lower
abdomen pain and backache denotes congestive dysmenorrhoea. Cramping pains often
denote spasmodic dysmenorrhoea. Hysteroscopy and laparoscopy also give an idea
of the patient’s condition. Blood tests and culture and sensitivity tests are
to be done to rule out sexually transmitted diseases such as gonorrhoea,
syphilis, etc.
Prevention of dysmenorrhoea
Avoid
-
Stress and strain
-
Sedentary life
Take
-
Nutritious diet, especially
food rich in vitamins A, B, C and E, and magnesium and zinc
-
Balanced diet, low in
carbohydrates to maintain healthy weight
-
Plenty of fluids - water,
juices to avoid dehydration
-
Regular exercises like
walking, jogging or swimming
Management of pain at home
Take
-
Rest in a relaxed manner in
well-aerated room in a comfortable position (bending double position usually
relaxes the abdomen and thus eases the pain)
-
Warm drinks which usually
clear dizziness and headache
-
Light diet to manage nausea
and abdominal disturbances
-
Warmth application over the
painful area which mostly soothes it
Treatment of dysmenorrhoea
- Patients are mainly treated for pain and related symptoms with pain killers,
anti spasmodic and anti inflammatory drugs. Since there is no specific medicine
available for dysmenorrhoea in Allopathy, most of the prescription concentrates
on temporary management and symptomatic relief. If the patient also has peptic
ulcer, they have to suffer it or otherwise they have to suffer with ulcer
complaints, since pain killers often aggravates peptic ulcer.
-
For congestion - Artificial
menstruation is induced with hormonal drugs since menses releases the
congestion and thus pain
-
For inflammation and cramps
- Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are often
used. These drugs inhibit prostoglandins which acts as a precursor for
congestion and pain
-
Oral contraceptive pills
are also often used to reduce the pain. It acts hormonally. It prevents
ovulation (the release of an egg) and so the preparatory works in
endometrium for lodging a fertile egg doesn’t appear. So there won’t be
any congestion or pain. Hence, a woman, who does not ovulate, will not
experience any spasmodic cramps. This type of treatment induces anovulatory
cycles which may cause infertility.
Surgery - In extreme
painful cases, it is performed as a last resort for removing ovarian cysts,
endometriotic cysts, polyps, adhesions and fibroids. In case of heavy bleeding
with bulky uterus and fibroids, hysterectomy (removal of uterus with or without
ovaries) is performed. Also, sometimes surgeons perform presacral sympathectomy
i.e., cutting away the sensory nerves of the uterus and ovaries to block the
conduction of the pain to the brain, but these operations are very rarely
performed in very extreme cases. Here the patient won’t feel pain but will
have all other symptoms.
Homoeopathic approach to
dysmenorrhoea - Even though nobody thinks of Homeopath in an acute condition
of dysmenorrhoea, miraculous cure can be seen in the case of dysmenorrhoea.
Treatment with Homeopathic medicines often reveals miracles. Homeopathy can cure
the condition rather than control it temporarily. Each system has its own
advantage and scope and Homeopathy is no exception. Within its limit, its
performance is often wonderful. It treats the patient in whole (mental and
physical state of symptoms).
One of the most common reasons
why people seek Homeopathic care is the cure will be permanent and the treatment
has no side-effects. Instantly killing pain with a painkillers tablet is like
putting off the light when you don’t want to see things. Surely, the day will
come to light up when you cannot switch off the pain. Likewise, during painful
periods, most women use painkillers which often suppress pain without treating
the condition. So, the disease continues to grow and return later in full blast.
Painkillers will also cause
ulceration and other complaints if taken often. In Homeopathy, peptic ulcer
patients are also in safer hands, since they won’t get any ulceration or any
other side-effects. So, patients who suffer from peptic ulcer and those who are
sensitive to painkillers or antibiotics or any other drugs can take Homeopathic
medicines without any adverse reactions. Homoeopathy is the fingerpost on the
crossroads of healing which directs the way to safe and permanent cure.
Homoeopathy works towards
nature. In Homoeopathy, medicines are given for normal ovulation and
menstruation in a natural way rather than for inducing artificial menstruation
or suppressing normal ovulation. So, it goes with nature to treat the condition
for getting normal, regular cycle of ovulation and subsequently menses.
Homoeopathy medicines not only relieve the pain but also treat the condition
permanently.
Homeopathic medicines commonly
used for dysmenorrhoea are Belladonna, Bryonia, Borax, Apis mel, Colocynthis,
Cimicifuga, Caulophyllum, Cocculus, Pulsastilla, Kreosote, Sabina, Secale cor,
Mag phos, Viburnum Opulus, Xanthoxylum, Calcarea Phos, Calcarea carbonica,
Staphysagria, etc. These medicines should be taken under the advice and
diagnosis of a qualified Homoeopath.
| Place |
Hospital |
Address |
Phone |
Visiting
Hours |
| Chennai |
Kumaran
Hospital (P) Ltd., |
869, E.V.R. Periyar Road,
(Poonthamalle High Road),
Next to Sangam Theatre
Kilpauk,
Chennai - 600 010. |
044 - 26411860
(5 Lines)
|
Every Month
2nd Saturday &
Sunday |
| Place |
Hospital |
Address |
Phone |
Tele
Fax |
| Madurai |
Laxmi Homeo
Clinic |
24 E New Mahalipatti Road,
Madurai - 625 001. |
0452 -
2338833
Mobile: 0-98431-91011 |
0452-2330196 |
|