DYSMENORRHOEA

• Dysmennorhoea is a term describing painful menstruation that typically involves cramps caused by uterine contractions
• Painful menstruation in such a magnitude that limits daily activities
• Also known as painful periods or menstrual cramps
• Primary dysmenorrhoea- recurrent lower abdominal pain shortly before or during menstruation (in the absence of pathologic findings)
• Secondary dysmenorrhoea- recurrent lower abdominal pain shortly before or during menstruation that is due to an underlying condition

Primary

• During menstruation, Prostaglandin F2α is released from endometrial cellsà uterine smooth muscle contractionàsome degree of uterine ischemia
• Prostaglandins may also cause hypersensitization of pain terminals to physical and chemical stimuli
• Behavioural, cultural, and psychological factors influence the patient’s reaction to pain
• Risk factors – Early menarche, nulliparity, smoking, obesity, positive family history

 Secondary

Caused by pelvic pathologies like:

• Endometriosis
• Adenomyosis
• Pelvic adhesions
• Ovarian cysts
• Uterine fibroid
• PID
• Endometrial polyp
• Cervical stenosis
• Chronic pelvic infection
• Inflammatory bowel disease
• IUD

Primary:

• Seen mostly in adolescent girls
• Usually appears within 2 years of menarche, when ovulatory cycles establish
• Confined to ovulatory cycles
• Pain starts a few hours before or just with the onset of menstruation
• Pain lasts for few hours, may extend to 24 hours & very rarely up to 48 hours
• Spasmodic pain
• Confined to the lower abdomen and may radiate to back and medial aspect of thighs
• Systemic discomforts like nausea, vomiting, headache, diarrhoea, fatigue, etc. may be seen

 Secondary:

• Elderly/parous women
• Patients are usually in their thirties
• Secondary to pelvic pathology
• Dull aching pain
• Confined to the back and in front without radiation
• Pain appears 3 to 5 days before the period & relieves with the onset of bleeding
• In some cases, pain persists throughout the periods

• History 
• Physical examination
• CBC (to rule out evidence of infection)
• Urine analysis (to rule out bladder infection)
• Cervical culture to exclude STI
• ESR to detect an inflammatory process
• Non-invasive diagnostic procedure
  • Abdominal USG
  • Transvaginal USG
• Invasive diagnostic procedure
• Laparoscopic examination
• Hysteroscopy 
• D & C

• For pain relief - NSAID’s, cyclo oxygenase-2 inhibitors
• Hormonal contraceptives
• Lifestyle changes
• Exercise
• Limiting salty foods
• Weight loss
• Avoiding alcohol and tobacco
• Dietary supplements- Vit E, Omega-3 fatty acids, Vit B-6, and magnesium supplements
• Reducing stress by relaxation techniques

Ayurvedic Treatment

Internal medicines

• Saptasara Kashaya
• Sukumara Kashaya
• Maharasnadi Kashaya
• Dashamoola Kashaya
• Kumaryasava
• Abhayarishta
• Jeerakaraishta
• Erandabhrishta Hareetaki
• Sukumara Gritha
• Hinguvachadi Choorna
• Rajapravartini Vati
• Dhanwantharam Gulika –during periods to relieve pain 

Procedures

• Matra vasti - Dashamoola Taila, Tila Taila, Dhanwanthara Taila, Bala Taila, Pippalyadi Anuvasana Taila 
• Yoni Pichu & Yoni Purana - Sukumara Taila, Maha Narayana Taila, Hinguuvadi Taila 
• Local Abhyanga and Sweda using Vata hara Taila - 5 to 7 days before the expected periods
• Snigdha mridu Virechana- before the expected periods - Sukumara Eranda, Gandharvahastadi Eranda, Hingu triguna taila 
• Kashaya vasti – Madhu tailika vasti
• Uttara vasti - Sukumara Gritha, Maha Narayana Taila, Dashamoola Taila