It is a medical condition characterized by
severe uterine pain during menstruation. The pain is so severe as to
limit normal activities, or require medication.
There are two types of Dysmenorrhoea:
1.Primary dysmenorrhoea refers to menstrual pain that occurs in
otherwise healthy women. This type of pain is not related to any
specific problems with the uterus or other pelvic organs.
2.Secondary Secondary dysmenorrhoea is menstrual pain that is
attributed to some underlying disease process or structural abnormality
either within or outside the uterus.
3.Membranous dysmenorrhoea
4.Ovarian dysmenorrhoea
Primary Dysmenorrhoea
It is one where there is no identifiable pelvic pathology is present.
The incidence of sufficient magnitude with incapacitation is about
5-10%. It occurs in the first few years after menarche and affects up
to 50% of post pubescent females.
Causes:
The pain caused by excessive secretion of prostaglandins.
Prostaglandins are the hormones secreted by the cells in the uterus.
These hormones are responsible for the contraction of uterine muscles.
When the uterine muscles contract, they constrict the blood supply to
the tissue of the endometrium, which, in turn, breaks down and dies.
These uterine contractions continue as they squeeze the old, dead
endometrial tissue through the cervix and out of the body through the
vagina. These contractions, and the resulting temporary oxygen
deprivation to nearby tissues, are responsible for the pain or "cramps"
experienced during menstruation.
It has also been attributed to behavioral and psychological factors.
The incidence is higher amongst affluent introspective and neurotic
women. Those having a low threshold for pain and predisposed to undue
fears and anxiety are most susceptible. Although these factors have not
been convincingly demonstrated to be causative, they should be
considered if medical treatment fails.
Some abnormal anatomical and functional aspects of uterus like stenosis
of internal os, unequal development of mullerian ducts causes unequal
contraction of uterine muscles, inappropriate law of polarity and
imbalance autonomic nervous control.
Clinical features:
1.It is predominantly belongs to adolescents girls, usually appears
within 2 years of menarche.
2.The pain begins with the onset of menstruation (or just shortly
before) and persists throughout the first 1-2 days, usual duration of
48-72 hours.
3.The pain is described as spasmodic, cramping and superimposed over a
background of constant lower abdominal pain, which radiates to the back
or anterior and/or medial thigh. Affected women experience sharp,
intermittent spasms of pain, usually centred in the hypogastrium or
suprapubic area.
4.Other symptoms may include nausea and vomiting, diarrhea, headache,
fainting, and fatigue.
5.Symptoms of dysmenorrhoea often begin immediately following ovulation
and can last until the end of menstruation.
Investigation:
1.No tests are specific to the diagnosis of primary dysmenorrhoea.
Diagnosis is made based on clinical findings.
2.The following can be performed to exclude organic causes of
dysmenorrhoea:
a.Cervical culture to exclude sexually transmitted diseases
b.Complete blood count
c.WBC count to exclude infection
d.Human chorionic gonadotropin level to exclude ectopic pregnancy
e.Cancer antigen 125 (CA-125) assay: This has limited clinical value in
evaluating women with dysmenorrhoea because of its relatively low
negative predictive value.
f.Urine analysis
g.Erythrocyte sedimentation rate (While nonspecific, erythrocyte
sedimentation rate can help the physician to identify the patient with
subacute salpingitis.)
h.Stool guaiac
Treatment:
Most of the conventional modes of treatment aim to palliate the pain
rather than curing the cause behind it.
Homoeopathy- Homeopathy being an individualistic science tries to find
an individual remedy for each case. Different females suffering from
dysmenorrhoea present with different symptoms regarding the character,
localization, extension and severity of pain.
The character of blood, its color, presence or absence of clots, the
underlying cause like fibroids, cysts, endometriosis etc differentiate
one case from another. Most importantly the disposition and mental
state of each person is different. Hence a Homeopathic remedy is
selected by considering the physical, mental and emotional state of
each person in order to cure safely and effectively.
Secondary dysmenorrhoea
Secondary dysmenorrhoea is defined as menstrual pain resulting from
anatomic and/or macroscopic pelvic pathology.
Causes:
A number of factors may be involved in the pathogenesis of secondary
dysmenorrhoea. The following pelvic pathologies can lead to the
condition:
Clinical Features:
1.This condition is most often observed in women aged 30-45 years.
2.The patient may have onset of pain a week or more prior to the onset
of menses, and pain may continue for a few days after cessation of flow
or it may be relieved by the onset of flow. The onset and intensity of
pain is also depending upon the pathology present.
3.This is usually associated with abdominal bloating, flatulent
distension of upper colon, constipation, and feeling of fullness and
heaviness of breasts, pelvic heaviness, and back pain.
4.Patients presenting with secondary dysmenorrhoea may have unique and
specific findings on physical examination that correspond to their
particular pathologies like fibroids, endometriosis, pelvic
inflammatory diseases, pelvic adhesions, adenomyosis, ovarian cysts etc.
Treatment:
The treatment aims at the cause rather than the symptoms. The type of
treatment is depending on the severity, age, and parity of patient.
It may also necessitate surgical interventions.
Membranous dysmenorrhoea
This is one variety of primary dysmenorrhoea but is rare. There I
shedding of big endometrial casts during periods. It is probably due to
deficiency in the tryptic ferment normally secreted in the endometrium.
The treatment is same as that of primary dysmenorrhoea.
Ovarian dysmenorrhoea
The pain is felt for 2 or 3 days before menses in one or both lower
quadrants in the areas innervated by the tenth thoracic to the first
lumbar segments. The pain is ascribed to ovarian nerve degeneration
or sclerocystic condition of the ovary/ies.