Dysmenorrhea

Dysmenorrhea is the term used to describe a painful period, normal ovulatory menstruation can be painful, but when it affects one’s routine life, for example, absence from school or the office or unable to do day-to-day activities, it has to be investigated and treated. Women of any age can experience painful periods; some women find periods are no longer painful after pregnancy and childbirth.

Dysmenorrhea is menstrual cramps that refer to the pain during menstruation, specifically in the area of the lower abdomen, which involves contraction of the uterine walls, which may lead to the blockage of blood vessels, tissue death, and hence, cause pain in the lower abdomen. Many women experience cramps just before or during the menstrual period, these cramps may also be caused by underlying condition of endometritis, uterine fibroid, or adenomyosis for which a diagnosis has to be made post the relevant investigations, these cramps are transient and are associated with the hormonal changes during menstruation. 

Dysmenorrhoea can be associated with…….

• Nausea and Vomiting
• Headache
• Digestive Problems
• Fainting
• Premenstrual Symptoms, Such as Tender Breasts

Causes and Risk Factors of Dysmenorrhoea…….

• Age – Dysmenorrhoea is more seen in women after the age of 40 Years.
• Underlying Condition – Dysmenorrhea can be either primary or secondary based on the presence of an underlying cause. Some of the underlying conditions that cause secondary dysmenorrhea are leiomyoma, adenomyosis, ovarian cysts, and pelvic congestion.
• Early Puberty –The females who hit puberty at the early age of 11 years or even younger.
• Medical Condition – Heavy bleeding during periods (Menorrhagia), and Irregular menstrual bleeding (Metrorrhagia) also contribute to dysmenorrhea.
• Skeletal Abnormalities –Some skeletal abnormalities like scoliosis also contribute to dysmenorrhea

Common Symptoms like ……

• Nausea, Vomiting, and Fainting
• Stomach Cramps or Pain, Painful Lower Abdomen or Pelvis( Mostly during the period due to narrowing of Cervix with stricture or Hormonal Problem or clots in menses also create this type of pain, also called this situation Spasmodic Dysmenorrhoea)
• Headache, Giddiness
• Extreme case of Dysmenorrhoea where the patient can see the disintegrated membrane of the uterus in Bleeding which may be due to chronic inflammation (This is rare and immediate medical attention is needed in this case, called Membranous Dysmenorrhoea)
• Constipation, Anorexia, Altered Bowel Habits like Diarrhoea or Constipation
• Frequent Urination
• Heart Palpitation and Sweating can also occur due to Anxiety and Hormonal Changes
• Heavy Bleeding Periods
• Premenstrual Symptoms like Heaviness, Fullness, and Painfulness of the Breast or Abdomen may occur before or during the period (Condition also called Congestive Dysmenorrhoea)
• Pain occurs after an unpleasant sexual activity or lack of sexual knowledge, this type of pain is usually neurological, called Psychogenic Dysmenorrhoea.

Types of Dysmenorrhoea

• Generally, there are two types of Dysmenorrhoea,
• Primary Dysmenorrhoea
• Secondary Dysmenorrhoea

Primary Dysmenorrhoea –

Normal menstruation that happens to be painful is known as primary Dysmenorrhea. In primary Dysmenorrhoea, it is thought that the muscles of the uterus contract harder than normal to excrete the thickened lining (Endometrium). These contractions may also reduce blood flow to the uterus which makes the pain worse. The hormone-like compounds that prompt these contractions are prostaglandins. The reason for the increased prostaglandins is not known. This type of Dysmenorrhea diminishes with age. It is mostly seen in the adolescent period due to low pain threshold, tension, and anxiety.

Secondary Dysmenorrhoea

It happens due to specific Medical condition as –

• Endometriosis
• Adenomyosis
• Pelvic Inflammatory Disease
• Ovarian Cysts
• Fibroid of Uterus

Ayurvedic Concept with Management

 In Ayurveda literature, Dysmenorrhoea is known as ‘Kashta-Artava’ (‘Kashta’ means Pain, ‘Artava’ means Discharge from Vagina). It’s not mentioned as a disease individually, although explained as associated symptoms with a particular medical condition.

• According to Ayurveda, ‘Apana Vayu’ (One of the 5 types of ‘Vata dosha’ or subtype of ‘Vata Dosha’, present in the body, classified as per their functions) controls Menstruation. The factor which causes Dysmenorrhoea provokes the ‘Apana Vata or Vayu’ and its disturbed the natural route of a downward direction and makes it move in reverse and upward direction. The change in direction of Vata Dosha alters the Menstrual Blood Flows.
• As another theory, Ayurveda believes it is most common in PID(Pelvic Inflammatory Disease), it stated that when there is Vitiation of Vata Dosha, instead of proper direction, The Apana Vayu work in opposite direction, so as reproductive organs are under influence of the Apana Vayu, there is colicky pain( Note- In Ayurveda, Vayu vitiation means Pain) and discharge is thrown out with difficulties and become frothy. The position of the Uterus is become distorted due to faulty position and excessive coital act. The mouth of the uterus becomes curved and it falls back which is responsible for painful menstruation and painful intercourse. When along with Vata, Pitta Dosha also vitiated there will symptoms like chronic backache, painful menses, painful intercourse, and excessive bleeding during the period, this situation correlated with PID.
• In Pranava Kerala Ayurveda Clinic, the qualified and highly experienced Doctors stated that Dysmenorrhoea may be seen in many women without any underlying disease. For diagnosis of severe condition, a detailed Medical History is obtained here and a physical examination is undertaken if any abnormality is suspected Tests suggest including an Ultrasound of the Abdomen, Imaging Tests like CAT, or MRI (Magnetic Resonance Imaging) study Abdomen.  
• Ayurvedic management is mainly based on the correction of Apana Vayu vitiation, the site of Apana Vata is the last part of the intestine. Pranava Kerala Ayurveda Clinic provides the classical treatment which is explained in Ayurvedic scripture, I.e Panchakarma (Five Action)
• Snehana –Oleation Therapy, Massage with medicated Oil or Ghee, (Shatavari Ghrit, Sesame Oil), and Hot Water Bag Fomentation (Nadi Sweda), Highly helpful in Painful conditions
• Virechana –
  Medicated Purgation Therapy, use of Laxative like Gandharva Haritaki.
• Basti – Basti is Enema Therapy, It’s the best treatment for the vitiation of Vata Dosha, like Uttar Basti with Bala Taila, Decoction Basti, Matrabasti, etc.

Pranava Kerala Ayurveda Clinic provides proper screening of patients, personalized herbal medication like herbal medicine preparation like Yograj Guggulu, Maharasnaadi Kashyaya, Dashmool Kwath, Ashokarishta, etc is the best treatment for Dysmenorrhoea and provides the knowledge of diet and lifestyle advice as per disease condition. Important precaution measures should be taken as-

• Yoga, Pranayama, Meditation, Exercise
• Tea, coffee, alcohol, aerated drinks, and non -vegetarian food should be avoided.

Increase intake of fruit, green vegetable, and salad