Dysmenorrhoea

Dysmenorrhoea Overview:

When pain is associated with the menstrual period. It may be idiopathic, associated with ischaemia, prostaglanding imbalance, endometriosis, or decreased uterine resting tone.


Aetiology:

+ Spasmodic Dysmenorrhoea (Primary)

  • Sharp, cramping pain
  • Usually locallised to the area and can affect the lower back
  • May affect the digestive tract
  • Strong and frequent uterine contractions and decreased resting tone.
  • Reduction of blood flow to the uterine muscle (ischaemia)
  • Prostaglanding imbalance
  • May improve after childbirth
  • Usually occurs soon after menarch
  • Most common in younger women in their 20s
  • uterine smooth muscle ischemia

Can be the result of prostaglandin imbalance (thromboxane A2, prostacyclin, and leukotrienes) which induce abnormal uterine contractions, similarily to the stimulation of labour. These contractions reduce blood flow, leading to hypoxia (uterine), and pain.

Other causes include relative oestrogen excess, pelvic constriction, or pelvic spasm (also associated with either constipation or diarrhea).

+ Congestive Dysmenorrhoea (Secondary)

  • Heavy, dragging, dull pain
  • may radiate to the inner thighs, hips, and back
  • Pain usually starts before period starts
  • May occur with oedema
  • Blood usually darker and/or clotted
  • Common in women over 30
  • Caused by an underlying pathology
    • Chronic pelvic sepsis
    • Pelvic Inflammatory Disease (PID)
    • Endomedtriosis
    • Fibroids
    • Adhesions
    • Tumor
    • Adenomyosis
    • Polyps
    • IUD

Pain associated with this form of dysmenorhoea is usually short lived (1 or 2 days) each month. It can be caused by deficiency status, with poor blood pooling, poor uterine tone, and poor vascular tone.


Symptoms:

Sharp cramping pain

Symptom

Symptom

Symptom

Symptom

Symptom

Symptom


Diagnostic Considerations:

  • If menorrhagia suggests uterine cause
  • If abdo symptoms suggests extrauterine cause (note any distention or ascites=
  • ovarian neoplasm until proven otherwise)
  • Fever chills discharge suggest infection
  • Coexisting infertility suggests endometriosis

Therapeutic Aims
(Spasmodic Dysmenorrhoea):

1. Relax Uterine Smooth Muscle

...

  • Uterine antispasmodics (Viburnum opulus, Dioscorea villosa)
  • Uterine tonics ()
  • Prostaglandin Inhibitors (Zingiber officinale, Tanacetum vulgare, Curcuma longa)
  • Warming Pelvic Circulatory Stimulants (Zingiber officinale, Cinnamomum zeylanicum)

2. Regulate Female Hormones

...

  • Hepatics ()
  • ...

3. Treat Spasmodic Constipation (If Indicated)

...

  • Bulking Laxatives ()
  • ...

4. Treat Pain Symptomatically

...

  • Anodynes (Cordyalis ambigua, Anemone pulsatilla, Piscidia erythrina, Lactuca virosa, Valeriana officinalis, Verbena officinalis)
  • ...

5. Treatment For This Type Of Dysmenorrhoea Should Be Long Term

...

  • ...

Therapeutic Aims:
Congestive Dysmenorrhoea

1. Regulate Female Sex Hormones

...

  • Isoflavones
  • Hepatics ()
  • Vitex agnus-castus

2. Increase Uterine Tone

Especially if heavy, pooling, or flooding periods are present.

  • Uterine Tonics (Caulophyllum thallictroides, Tubus idaeus, Mitchella repens, Angelica sinensis Paeonia laactiflora)
  • Uterine Astringents (Achillea millefolium (Yarrow), Alchemilla vulgaris (Ladies Mantle), Hydrastis canadensis, Capsella bursa-pastoris (Shepherds purse), Lamium album (White deadnettle), Trillium erectum (Beth root)

3. Improve Uterine Circulation

...

  • Emmenagogues (Artemisia vulagris)
  • Venous Decongestants (Calendula officinalis, Iris versicolor, Thuja occidentalis, Trifolium pratense, Viola odorata)
  • Circulatory tonics (Achillea millefolium, Aesculus hippocastinum, Ginkgo biloba)

4. Treat Pain Symptomatically

...

  • Anodynes ()
  • ...

5. Treatment For This Type Of Dysmenorrhoea Should be Short Term.

...

  • ...
 

Differential Diagnosis:

Endometriosis. 

 

Cautions:

Caution advised in any situation where pain is unilateral or radiating, associated with pregnancy, new symptoms accompanied by vomiting, nausea, diarrhea and faintness, or if pain worsens at the end of period.

 

Herbs For Dysmenorrhoea:

  • Caulophyllum thallictroides,
  • Tubus idaeus,
  • Mitchella repens,
  • Angelica sinensis
  • Paeonia laactiflora
  • Calendula officinalis,
  • Iris versicolor,
  • Thuja occidentalis,
  • Trifolium pratense,
  • Viola odorata
 

Spasmodic Dysmenorrhoea Formula

Herb Name Ratio Amount in mL
Cordyalis ambigua 1:2 25 mL
Dioscorea villosa 1:2 30 mL
Viburnum opulus 1:2 35 mL
Zingiber officinalis 1:2 10 mL
Total 100 mL

Congestive Dysmenorrhoea Formula

Herb Name Ratio Amount in mL
Vitex agnus-castus 1:2 20 mL
Aesculus hippocastanum 1:2 25 mL
Dioscorea villosa 1:2 30 mL
Angelica sinensis 1:2 25 mL
Total 100 mL

Author:

Justin Cooke

The Sunlight Experiment

Updated: October 2017


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References:

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