WHAT IS DYSMENORRHOEA?
Dysmenorrhoea is painful menstruation; although it’s normal for most women to have mild cramps but few women experience severe pain due to which they are not able to do daily routine work.
Dysmenorrhoea or painful menses is one of the most common gynecological symptoms and is affecting many women in their reproductive age.
RISK FACTORS FOR DYSMENORRHEA
- Young age
- early menarche
- heavy menstrual flow
- nulliparity (state in which a woman has never carried a pregnancy)
TYPES OF DYSMENORRHOEA
PRIMARY (no pathology)- primary dysmenorrhoea is presence of painful menses in absence of any pathology.
Primary dysmenorrhoea is caused by excessive levels of prostaglandins (hormone that cause contraction of the uterus). it affects adolescent girls but the problem cease as they mature, particularly after a pregnancy.
Age at onset : 16–25 yrs
In primary dysmenorrhoea pain typically begins with onset of menses and last for 12-72 hours. The pain is typically most severe on the first day and diminishes gradually.
Primary dysmenorrhoea is usually seen in absence of ovulatory cycles.
It usually begins within 6 to 12 months from the onset of menarche.
The pain is confined to lower abdomen and is most intense in midline which is crampy and intermittent.
Women often complaint about pain in back and thighs as well with nausea, diarrhea, headache, fatigue, malaise.
SECONDARY (related to some underlying gynecological disorder)- Dysmenorrhea is secondary when there is an identifiable anatomic or macroscopic pelvic pathological condition.
There may be associated
- vaginal discharge
- dysperiunia (painful sexual intercourse)
- menorrhagia (heavy bleeding at menstruation).
Secondary dysmenorrhoea is seen in conditions like
- sexually transmitted infection
- pelvic inflammatory disease
- ovarian cyst
- intra uterine device.
It affects women in adulthood and most of the disorders can be treated easily.
Pain in secondary dysmenorrhoea (congestive) increases through the luteal phase (before period starts) peaking at onset of menstruation.
SYMPTOMS & CAUSES
In primary dysmenorrhoea pain typically starts with onset of menses and diminishes gradually. The pain is crampy, intermittent and confined to lower abdomen. The pain is often associated with pain in lower back, thighs, diarrhea, nausea, vomiting, malaise, headache, fatigue.
In secondary dysmenorrhoea pain is congestive and starts before menses which reaches to peak at onset of menses. There may be associated vaginal discharge, dysperiunia (painful sexual intercourse), menorrhagia (heavy bleeding at menstruation).
Primary dysmenorrhoea don’t have any underlying pathology except for high levels of prostaglandins.
For secondary dysmenorrhoea:
- Pelvic Inflammatory Disease ( Infections)
- Intrauterine polyps
- Submucosal fibroids
- Congenital uterine abnormalities
- Cervical stenosis
- Asherman syndrom
- Chronic ectopic pregnancy
- Pelvic congestion syndrome
- Ovarian cysts or neoplasms
DIAGNOSIS & TREATMENT
- History taking and physical examination along with pelvic examination would diagnose the case.
- Transvaginal ultrasound should be performed if secondary dysmenorrhoea is suspected.
Treatment of dysmenorrhea is aimed at providing symptomatic relief as well as inhibiting the underlying processes that causes symptoms.
Primary dysmenorrhea respond to
1.NSAIDs (nonsteroidal anti-inflammatory drugs, blocking production of prostaglandins) that provide analgesic (pain-killing) and anti-inflammatory effects eg: aspirin, ibuprofen and naproxen. Should be offered as first line treatment for pain relief.
2.COCs (combined oral contraceptives) are commonly used as a second line therapy when NSAIDs are ineffective, poorly tolerated or contraindicated. COCs inhibit ovulation and endometrial tissue growth, thereby decreasing prostaglandin release. Contraception is the additional benefit of COCs.
Treatment of Secondary dysmenorrhea must address the underlying disease ( cyst removal/ removal of submucosal fibroids/polyps etc ). Secondary dysmenorrhea may be resistant to NSAIDs and COCs.
Homeopathic medicines would relieve the symptoms without any side effects and would give permanent relief as well.
Pain management is very important.
Ask the patient to stay active and do regular physical exercise.
Patient should be advised to do yoga.
Advice patient to use hot water bottle for fomentation during pain.
Patient should be advised to take healthy diet.
Homoeopathic medicines like mag phos, dioscorea, sepia, pulsatilla, sabina, graphites, colocynth etc are few medicines which are very effective in treatment of dysmenorrhoea depending on the symptoms with which the patient presents.
DO’S AND DON’TS
- Regular exercise.
- Healthy diet.
- Healthy life style
- Manage anxiety/ stress
- Quit Smoking.
- Don't take Alcohol