Abstract: Dysmenorrhoea is the most common gynecologic complaint and the leading cause of recurrent short-term school or work absenteeism among female adolescents and young adults. It is defined as difficult menstrual flow or painful menstruation of uterine origin and commonly divided into two categories based on the pathophysiology which is primary and secondary. Primary dysmenorrhea typically begins during adolescence ith 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. This is an article about dysmenorrhoea focusing on classification, etiology, clinical type and homoeopathic medicines related to various rubrics in different repertories by cross repertorisation.
Keywords: Dysmenorrhoea – primary & secondary, Homoeopathy, Cross-repertorisation, Therapeutic medicines.
Introduction: Normal menstrual cycles are often associated with difficult and painful menstruation known as dysmenorrhoea. The term dysmenorrhoea is derived from the Greek words Dys- meaning difficult/ painful/ abnormal, meno- meaning month, and rrhea meaning flow.(1) It may affect more than 50% of menstruating women, and its reported prevalence has been highly variable (e.g. 45-95%). Optimal management of this symptom depends on an understanding of the underlying cause.(2)
Classification: There are two types of dysmenorrhoea:
- A) Primary/ Idiopathic/ True dysmenorrhoea: The pain is of uterine origin and directly linked to menstruation but with no visible pelvic Pain usually occurs on the first day (Spasmodic dysmenorrhoea).(3) It typically occurs in the first few years after menarche and affects as many as 50% of postpubertal females. (2)
- B) Secondary dysmenorrhoea: Pain which is associated with uterine / pelvic pathology(3), as is seen in women with endometriosis or chronic pelvic inflammatory It is most often observed in women aged 30-45 years(2). It may continue throughout the flow/ congestive, i.e. worse premenstrually and relieved during flow. (3)
Risk factors for primary dysmenorrhoea include the following:
- Early age at menarche (< 12 years)
- Heavy or prolonged menstrual flow
- Positive family history
Risk factors for secondary dysmenorrhoea include the following :
Excess prostaglandin production or hypertonic uterine contractions secondary to cervical obstruction, intrauterine mass or pressure of foreign body. A definitive cause can be found. The most common causes are:
- Imperforate hymen
- Transverse vaginal septum
- Cervical stenosis
- Uterine anomalies
- Intrauterine synechiae
- Endometrial polyps
- Intrauterine devices
- Uterine leiomyomas
- Pelvic congestion syndrome(3)
- Leiomyomata (fibroids)
- Tubo-ovarian abscess
- Ovarian torsion
Clinical features of primary dysmenorrhea include the following:
- Pain begins a few hours or just after the onset of menstrual period and may last up to 48-72
- Suprapubic cramping lumbosacral backache, pain radiating down to anterior aspect of
- Colicky in (3)
- Normal vital
- No abdominal
- Normal pelvic (3)
The following may indicate secondary dysmenorrhea :
- Dysmenorrhoea beginning in the 20s or 30s, after previous relatively painless cycles
- Heavy menstrual flow or irregular bleeding
- Dysmenorrhoea occurring during the first or second cycles after menarche
- Pelvic abnormality with physical examination
- Poor response to nonsteroidal anti- inflammatory drugs (NSAIDs) or oral contraceptives (OCs)
- Vaginal discharge.(2)
Selection of repertory for repertorization mainly depends on the type of the case. A physician generally limits himself to one repertory while working out a case. Cross- repertorization using more than one repertory is for selection of the simillimum or to confirm the result obtained from the use of one repertory. Here, cross repertorisation of the rubrics related to dysmenorrhoea from various repertories is done to identify likely homoeopathic medicines. (4) The rubrics regarding dysmenorrhea from different repertories are as follows:-
DYSMENORRHOEA, Remedies in general (766): Apiol., Bell., Borx., Cact., Caul., Cham., Cimic., Cocc., Coff., Coloc., Gels., Gnaph., Guaj., Ham., Kali- perm., Macrot., Mag-c., Mag-p., Puls., Sec., Senec., Verat., Vib., Xan., Zinc. (5)
Dysmenia, or Dysmenorrhoea.(57): Aco., Aga., Alet., Ana., Atp., Aran., Art.v., Asr., Asc.s., Ber., Brac., Bro., Cast., Caul., Cer.o., Cham., Ch.s., Chl. h., Coll., Col., Cro., Crt. h., Cur., Dio., Gel., Gna., Gos., Gph., Gui., Haem., Hdm., Hlon., Hyo., Ign., Inu., Iris., Jab., Jn. c., K. ca., K. fc., K. n., Klm., Lc. c., Lc. f., Lp. s., Lau., Lo. i., Lyc., Mac., Mag. m., Mag. p., Mag. s., Man., Med., Mli., Mrl., Mil., Mit., Mom., Mur., Naj., Na. c., Nic., Nx. m., Opi., Pet., Phyt., Plat., Pb., Pod., Plg., Pop. c., Pul., Rap., Rhs., Sbl., Sbi., Sang., Sap., Sars., Se. a., Sep., Sul., Syph., Tan., Trn., Ter., Ther., Thu., Thyr., Tur., Ust., Ver., Ve. v., Vb. o., Vb. p., Wye., Xan. (6)
GENITALIA- FEMALE- MENSES- painful, dysmenorrhoea: acon., am-c., ars., Bell., berb., bor., Cact., calc., Calc-p., caul., caust., Cham., cic., Cimic., cocc., coff., coloc., con., croc., cycl., dios., dulc., gel., graph., helon., ign., kali-ar., Kali-c., kali-i., kali-p., kali-s., lac-c., lach., lap-a., lil-t., lyc., med., meli., merc., merl., nat-c., nux-v., phos., plat., Psor., puls. , rhus-t., sabin., sec., senec., sep., sulph., tub., verat., xan. (7)
DYSMENORRHOEA, painful menses (765): AM-C., BELL., CACT., CACL-P., CHAM., CIMIC., COCC., COLOC., CYCL.,ERIG., IGN., KALI-C., MAG-P., MILL., NUX-V., PSOR., PULS., SABIN., SEP., SULPH., UST., VERAT-V., VIB., XAN. (8)
MENSES – Painful, dysmenorrhoea(263): Bell; Cact; Calc; Calc-p; Caul; CHAM., Cimi; Cocl; Con; Cup; Dios; Grap; Kali-c; Lyc; Med; Nux-m; Plat; PUL; Psor; Sep; SUL; Tub; Ver-a; VIB; Xanth; Zin-val. (9)
Female genitalia/ sex- Menses- painful: ( pain; Pain- uterus – menses – during – agg.) (1132): Am-c, Bell, Cact, Calc-p, Cham, Cimic, Cocc, Erig, Kali-c, Mag-p, Mill, Psor, Ust, Verat-v, Vib, Xan. (10)
Based on the above given rubrics of dysmenorrhea from different repertories.
- Chamomilla 6 (15)
- Xantoxylum Fraxineum 6 (12)
- Cimicifuga Racemosa 5 (14)
- Viburnum Opulus 5 (12)
- Belladonna 5 (12)
- Kalium Carbonicum 5 (11)
- Pulsatilla Pratensis 5 (11)
- Cocculus Indicus 4 (10)
- .Magnesia Phosphorica 4 (10)
Therapeutics of Dysmenorrhoea:
Chamomilla – Dysmenorrhoea from anger or emotions. membranous dysmenorrhea, especially at puberty. Profuse discharge of clotted , dark blood with labor like pains. Menstrual cramps with a lot of pain and irritability. Patient intolerant of pain. Yellow, acrid leucorrhea. (11)(12)
Xantoxylum Fraxineum – Menses too early and painful. neuralgic dysmenorrhoea with neuralgic headaches, ovarian neuralgia with pain in the loins and lower abdomen; worse, left side, extending down the thigh , along the genito-crural nerves . Pain in the back and down the legs. Menses thick, almost black. After- pains. Leucorrhoea at time of menses.(11)(12)
Cimicifuga Racemosa – Menses profuse, dark, coagulated, offensive with backache, nervousness , irregular in time and amount, more flow, more pain menses suppressed from menses. Hysteric or epileptic spasms at the time of menses. Great debility between menses. Pain across the pelvis, from hip to hip. After- pains with great sensitiveness and intolerance to pain. Infra-mammary pains, worse left side. Pain in the ovarian region ; shoots upward and down the anterior surface of thighs. Pain immediately before menses.(11)(12)
Viburnum Opulus– Sudden pain in the region of uterus before menstruation and much backache during menses. offensive in odor, with crampy pains, cramps extend down the thighs. Bearing down pains before menses. Ovarian region feels heavy and congested (ovaritis ) aching in sacrum and pubes, with pain in anterior muscles of thighs; spasmodic and membranous dysmenorrhea. Leucorrhea excoriating. Smarting and itching of genitals. Faints on attempting to sit up. (11)(12)
Belladonna- Menses bright red, too early , too profuse . Menses and lochia very offensive and hot. Cutting pain from hip to hip. Ovarian pain with appearance of menses. Flow of blood between periods. Dragging around loins. badly smelling haemorrhages, hot gushes of blood. Diminished lochia. (11)
Kalium Carbonicum – Menses early , profuse, or too late pale and scanty, with soreness around the genitals; pain from the back passes down, through the gluteal muscles, with cutting in the abdomen. Pain through the left labium, extending through the abdomen to the chest. Difficult first menses. Complaints after parturition. Uterine hemorrhage; constant oozing after copious flow, with violent backache (dysmenorrhea ), relieved by sitting and pressure. (11)
Pulsatilla – Dysmenorrhoea beginning in puberty. Dysmenorrhoea, with chilliness, paleness of face, stretching and yawing. During menses, fainting, nausea and vomiting, sour slimy taste. Chilliness, nausea with a downward pressure and pain, tardy menses. Flow intermits. Diarrhea during or after menses. Uterine cramps, compelling her to bend double.(11)(12)
Cocculus Indicus – Dysmenorrhoea, with profuse dark menses. Menses too early, clotted, with spasmodic colic. Painful pressing in the uterine region, followed by hemorrhoids. Purulent, gushing leucorrhea between menses; very weakening. Can scarcely speak. So weak during menstruation, she is scarcely able to stand. (11)(12)
Magnesia Phosphorica – Menstrual colic , pain precedes flow, membranous dysmenorrhea. Menses too early, dark, stringy. Swelling of external parts. Ovarian neuralgia. Vaginismus. < on right side, > by external application of heat.(11)
Conclusion: The above medicines are used frequently in daily practice for dysmenorrhoea with good results. These are only the top most remedies found through cross repertorisation, but other homoeopathic medicines can also be used for significant relief in dysmenorrhoea.
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