Dysmenorrhea refers to painful menstruation that interferes with daily activities. It is classified into primary dysmenorrhea (without pelvic pathology) and secondary dysmenorrhea (associated with an underlying disease).
Types of Dysmenorrhea
1. Primary Dysmenorrhea
- Occurs in the absence of pelvic pathology.
- Caused by an imbalance in the autonomic nervous control of uterine muscles.
- Increased myometrial contractions due to prostaglandins, endothelins, and leukotrienes.
Clinical Features:
- Pain starts with menstruation and lasts for 1-2 days.
- Spasmodic lower abdominal pain, radiating to the back and thighs.
- Systemic symptoms:
- Nausea, vomiting
- Dizziness, fatigue
- Headache, chills
- Cold sweats, fainting
Treatment:
- Lifestyle modifications:
- Regular exercise
- Bowel regulation using laxatives
- Medications:
- NSAIDs (Mefenamic acid, Ibuprofen) - Prostaglandin synthesis inhibitors
- Combined Oral Contraceptive Pills (COCs) for 3–4 cycles
- Surgical options:
- Cervical dilatation (for cervical stenosis relief)
- Presacral neurectomy (in severe cases)
2. Secondary Dysmenorrhea
- Occurs due to an underlying pelvic pathology.
- Common causes:
- Chronic pelvic infection
- Pelvic inflammatory disease (PID)
- Endometriosis
- Adenomyosis
- Uterine fibroids
- Endometrial polyps
Clinical Features:
- Dull, continuous pelvic pain (may not radiate).
- Pain persists beyond menstruation.
- Associated with irregular or heavy menstrual bleeding.
Diagnosis:
- Abdominal & vaginal examination
- Ultrasound & laparoscopy (if required)
Treatment:
- General health improvement (diet, vitamin supplements)
- Pain relief with NSAIDs and antispasmodics
- Surgical interventions (if required):
- Endometriosis or fibroid removal
- Hysterectomy (in severe cases)
Keynote Symptoms of Dysmenorrhea
- Severe lower abdominal pain before or during menstruation
- Pain radiating to the back and thighs
- Nausea, vomiting, and dizziness
- Headache, fatigue, and mood swings
- Menstrual flow may be scanty, heavy, clotted, or irregular
1. Colocynthis
Indications:
- Intense cramping pain relieved by pressure or bending forward
- Pain worsens with anger or emotional stress
Keynote Symptoms:
- Pain is cutting, gripping, and severe.
- Relief from hard pressure on the abdomen.
- Worse from eating or emotional stress.
- Frequent urging to pass stools.
- Pain appears suddenly and disappears suddenly.
2. Cimicifuga (Actaea Racemosa)
Indications:
- Severe neuralgic pain extending from pelvis to thighs and back
- Irritability, depression, and emotional instability during menses
Keynote Symptoms:
- Menses are profuse and dark.
- Pain worsens with movement.
- Extreme sensitivity to pain.
- Fear and anxiety, especially of impending danger.
- Symptoms worsen in cold and damp weather.
3. Belladonna
Indications:
- Sudden, violent menstrual pain with a sensation of heaviness in the pelvis
- Painful, profuse, and bright red menstrual flow
Keynote Symptoms:
- Sudden onset of pain.
- Heat and congestion in the pelvic region.
- Severe throbbing pain, worse from jarring motion.
- Face becomes red and flushed.
- Symptoms worse in the afternoon and from cold air.
4. Nux Vomica
Indications:
- Irritable, oversensitive women with severe menstrual cramps
- Spasmodic pain, worse in the morning and after eating
Keynote Symptoms:
- Irritable and impatient nature.
- Pain with ineffectual urging for stools.
- Worse from cold, mental exertion, and stimulants (coffee, alcohol).
- Menses may be scanty and painful.
- Sensation of pressure in the lower abdomen.
