Painful Menses

Painful Menses

FEMALE DISORDER - Painful menses

The monthly reminder representing the presence and function of the uterus (indicated asmenstruation) 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.

Homeopathic Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)