Dysmenorrhea is defined as painful menstruation of uterine origin and Is commonly divided into two categories based on the pathophysiology. Primary dysmenorrhea is painful menstruation that typically begins during adolescence with ovulatory cycles and is not due to any pelvic disease. it is distinguished from secondary dysmenorrhea, which is uncommon during adolescence and results from pelvic organ pathology. Common causes of secondary dysmenorrhea include endometriosis, uterine fibroids, Adenomyosis, obstructive vaginal or uterine congenital anamolies, and use of intrauterine contraceptive devices.

Causes of dysmenorrhea

1. Primary dysmenorrhea – affects 40-70 % of women of childbearing age. Cigarette smoking has been associated with an increased duration of dysmenorrhea with each cycle. Other risk factors for dysmenorrhea include obesity and frequent alcohol consumption. Studies have shown decreased prevalence and improvement of dysmenorrhea symptoms with exercise.

1. Secondary dysmenorrhea – has several underlying causes

• Endometriosis – occurs in 3-10% of women of reproductive age. Twenty-five percent to 35% of women with infertility have endometriosis.

• Leiomyomas – develop in women by age of 40; most are asymptomatic. Black women have an increased incidence of uterine fibroids.

• Adenomyosis – is observed most frequently in women in the fifth and sixth decades. Fifteen percent of women with Adenomyosis have associated endometriosis.

• Ovarian cyst

• Intrauterine device

• Pelvic inflammatory disease

• Miscellaneous causes – congenital abnormalities (bicornuate or septate uterus), cervical stenosis, imperforate hymen, uterine polyps, or uterine adhesions may cause secondary dysmenorrhea.

Manifestations of dysmenorrhea

The spasm or cramping of dysmenorrhea may begin few hours prior to onset of flow or begin at onset of flow. Pain usually stops after 48 hours, but may last as long as 72 hours or continue through entire period. Pain is mainly confined to the suprapubic or pelvic region, back, and lower abdomen, but may radiate to the anterior or medial thigh. A large number of patients experience one or more ancillary problems, such as headache, nausea, bloating, dizziness, lightheadedness, irritability, anxiety, vomiting, fatigue, lower back pain, constipation, diarrhea, distended abdomen, and syncope.

Diagnosis of dysmenorrhea

The diagnosis of primary dysmenorrhea is one of exclusion.  Due to the high incidence of Chlamydia and human papilloma virus infections and due to the severity of their possible complications, cervical smear and Chlamydia test are indicated in sexually active adolescents who complain of menstrual symptoms. Other laboratory tests are seldom required. If clinical evaluation raises suspicion or secondary causes of dysmenorrhea, such as endometritis or pelvic inflammatory disease, then laparoscopy should be considered.

Secondary dysmenorrhea should also be suspected if symptoms starts after the age of 25 years; if the begin with first few menstrual cycles; and if those initially typical of primary dysmenorrhea worsen in duration and intensity.

In individual cases, e.g. with suspicion of pelvic anamolies, pelvic imaging using transvaginal ultrasound or magnetic resonance imaging may be warranted.

Homeopathic treatment of dysmenorrhea

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat dysmenorrhea but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat dysmenorrhea that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of dysmenorrhea:

Calcaria carb – swelling and pain in breasts before start of menses; acts well in fat ladies; females with thyroid and pituitary dysfunction.

Cimicifuga – pain increases with establishment of menstrual flow.

Colocynth – remarkable reedy for dysmenorrhea especially when there is pain in abdomen before menses which is relieved by pressure and compelling patient to bending double; early menses; marked amelioration by the application of warm objects

Tuberculinum – menses too painful; too early, too profuse, and last for long time; pain increases as the flow starts and during menstruation.

Pulsatilla – menstruation too late and scanty, changeable and clotty; stops and restarts; pain ameliorates on consolation and in open air; weeping tendency in females

Caulophyllum – severe labor like pains in the abdomen during the menstrual cycle.

Chamomilla – violent colic consequent on profuse and painful menses, labor-like pains on sides with diarrhea.

Lachesis – menses too late, too scanty and of too short a duration with haemorrhoidal pains.  Nosebleed, bloody stools, constipation, leucorrhea and toothache.

Sabina – intense distressing pain at menses with bearing down and labor like pains; Inflammation of the uterus and ovaries.

Collinsonia – terrible dysmenorrhea with hemorrhoids or piles, violent convulsions preceded by severe pain in the region of womb; Irritation of cardiac nerves; suppressed menses return after heart trouble is over.

Borax – membranous dysmenorrhea; menses too early, too profuse and attended with colic and nausea; flow preceded by stitching pains in pectoral region. Dysmenorrhea with sterility.

Bromium – membranous dysmenorrhea, violent contractive spasms for six or twelve hours in abdomen, premature and profuse flow of bright red blood or pressive flow with much exhaustion; hard swelling in ovarian region.

Bufo – menses regular, discharging pale fluid blood with clots; epileptic aura from uterus to stomach; burning heat and stitches in ovaries.

Gelsemium – neuralgic and congestive dysmenorrhea, with sharp, labor like pains in uterus alternating with other neuralgic pains; sensation as if uterus were squeezed by hand and forced downward; menses delayed, painful and suppressed.

Hamamelis – dysmenorrhea with severe pain in lumber and hypogastric region and down legs; bruised sore feelings in abdomen; profuse discharge of dark blood in daytime.

Ignatia – dysmenorrhea from irritation of nervous system, and not from uterine congestion; weak and empty feeling in the stomach at pit of stomach before menses; much bearing down in hypogastric region during menses.