Dysmenorrhea Also Known as Painful Periods

Dysmenorrhea, also known as painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms may include back pain, diarrhea, or nausea. Estimates of the percentage of women of reproductive age affected vary from 20% to 90%. It is the most common menstrual disorder. Typically, it starts within a year of the first menstrual period. When there is no underlying cause, often the pain improves with age or following having a child. Although there are home remedies, Ayurveda treatments for dysmenorrhea, Siddha remedies of Swami Hardas Life System are the best remedies, which contain no medicines and need no money. 

What is Dysmenorrhea?

It is the medical term for painful menstrual periods which are caused by uterine contractions. Primary dysmenorrhea refers to recurrent pain, while secondary dysmenorrhea results from reproductive system disorders. Both can be treated.

Dysmenorrhea symptoms

Pain in the lower abdomen or pelvis

The main symptom of dysmenorrhea is pain concentrated in the lower abdomen or pelvis. It is also commonly felt on the right or left side of the abdomen. It may radiate to the thighs and lower back.

Nausea and vomiting

Symptoms often co-occurring with menstrual pain include:

• Nausea and vomiting, 
• Diarrhea,
• Headache,
• Dizziness,
• Disorientation,
• Fainting, and
• Fatigue. 

Symptoms of dysmenorrhea often begin immediately after ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. In particular, prostaglandins induce abdominal contractions that can cause pain and gastrointestinal symptoms. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea because they stop ovulation from occurring.

Heavy menstrual bleeding

Dysmenorrhea is associated with increased pain sensitivity and heavy menstrual bleeding.

Can continue until menopause

For many women, primary dysmenorrhea gradually subsides in the late second generation. Pregnancy has also been demonstrated to lessen the severity of dysmenorrhea when menstruation resumes. However, dysmenorrhea can continue until menopause. 5–15% of women with dysmenorrhea experience symptoms severe enough to interfere with daily activities.

Dysmenorrhea Causes

Primary dysmenorrhea

Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Primary dysmenorrhea occurs without an associated underlying condition, while secondary dysmenorrhea has a specific underlying cause, typically a condition that affects the uterus or other reproductive organs.

Painful menstrual cramps that result from an excess of prostaglandin release are referred to as primary dysmenorrhea. Primary dysmenorrhea usually begins within a year or two of menarche, typically with the onset of ovulatory cycles.

Secondary dysmenorrhea

Secondary dysmenorrhea is the diagnosis given when menstruation pain is a secondary cause of another disorder. Conditions causing secondary dysmenorrhea include endometriosis, uterine fibroids, and uterine adenomyosis. Rarely, congenital malformations, intrauterine devices, certain cancers, and pelvic infections cause secondary dysmenorrhea.

If the pain occurs between menstrual periods, lasts longer than the first few days of the period, or is not adequately relieved by the use of non-steroidal anti-inflammatory drugs (NSAIDs) or hormonal contraceptives, this could be a sign of secondary causes of dysmenorrhea.

When laparoscopy is used for diagnosis, the most common cause of dysmenorrhea is endometriosis, in approximately 70% of adolescents.

Other causes

Other causes of secondary dysmenorrhea include leiomyoma, adenomyosis, ovarian cysts, pelvic congestion, and cavitated and accessory uterine mass.

Dysmenorrhea Risk factors

Stress, and depression

Genetic factors, stress, and depression are risk factors for dysmenorrhea. Risk factors for primary dysmenorrhea include early age at menarche, long or heavy menstrual periods, smoking, and a family history of dysmenorrhea.

Familial predisposition

Dysmenorrhea is a highly polygenic and heritable condition.  There is strong evidence of familial predisposition and genetic factors increase susceptibility to Dysmenorrhea. There have been multiple polymorphisms and genetic variants in both metabolic genes and genes responsible for immunity which have been associated with the disorder. 

Differences in genotypes

Three distinct possible phenotypes have been identified for dysmenorrhea:

• Multiple severe symptoms,
• Mild localized pain, and
• Severe localized pain.

While there are likely differences in genotypes underlying each phenotype, the specific correlating genotypes have not yet been identified. These phenotypes are prevalent at different levels in different population demographics, suggesting different allelic frequencies across populations.

CYP2D6 and GSTM1

Polymorphisms in the ESR1  gene have been commonly associated with severe Dysmenorrhea. Variant genotypes in the metabolic genes such as CYP2D6 and GSTM1  have been similarly correlated with an increased risk of severe menstrual pain, but not with moderate or occasional phenotypes.

Genetic mutations

The occurrence and frequency of Secondary Dysmenorrhea (SD) have been associated with different alleles and genotypes of those with underlying pathologies, which can affect the pelvic region or other areas of the body. Individuals with disorders may have genetic mutations related to their diagnoses which produce Dysmenorrhea as a symptom of their primary diagnosis.

It has been found that those with Fibromyalgia who have the ESR1 gene variation Xbal and possess the Xbal AA genotype are more susceptible to experiencing mild to severe menstrual pain resulting from their primary pathology. Commonly, genetic mutations which are a hallmark of or associated with specific disorders can produce Dysmenorrhea as a symptom that accompanies the primary disorder.

Single Nucleotide Polymorphisms

In contrast with Secondary Dysmenorrhea, Primary Dysmenorrhea (PD) has no underlying pathology. Genetic mutation and variations have therefore been thought to underlie this disorder and contribute to the pathogenesis of PD. There are multiple Single Nucleotide Polymorphisms (SNP)  associated with Primary Dysmenorrhea.

Two of the most well-studied include an SNP in the promoter of MIF  and an SNP in the Tumor Necrosis Factor gene. When a cytosine  173 base pairs upstream of macrophage migration inhibitory factor (MIF) promoter was replaced by guanine there was an associated increase in the likelihood of the individual experiencing PD. 

Genes related to immunity

Genes related to immunity have been identified as playing a significant role in Primary Dysmenorrhea as well. IL1A  was found to be the gene most associated with  Primary Dysmenorrhea in terms of its phenotypic impact. This gene encodes a protein essential for the regulation of immunity and inflammation.

While the mechanism of how it influences Primary Dyskinesia has yet to be discovered, it is assumed that possible mutations in IL1A or genes which interact with it impact the regulation of inflammation during menstruation. These mutations may therefore affect pain responses during menstruation which leads to the different phenotypes associated with Dysmenorrhea.

Dysmenorrhea Diagnosis

The diagnosis of dysmenorrhea is usually made simply on a medical history of menstrual pain that interferes with daily activities. However, there is no universally accepted standard technique for quantifying the severity of menstrual pains. There are various quantification models, called menstrual symptometrics, that can be used to estimate the severity of menstrual pains as well as correlate them with pain in other parts of the body, menstrual bleeding, and degree of interference with daily activities.

Further work-up

Once a diagnosis of dysmenorrhea is made, further workup is required to search for any secondary underlying cause of it, in order to be able to treat it specifically and to avoid the aggravation of a perhaps serious underlying cause.

Further workup includes a specific medical history of symptoms and menstrual cycles and a pelvic examination. Based on results from these, additional exams and tests may be motivated, such as:

• Gynecologic ultrasonography
• Laparoscopy

Dysmenorrhea Treatment

Treatments that target the mechanism of pain include non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives. NSAIDs inhibit prostaglandin production. With long-term treatment, hormonal birth control reduces the amount of uterine fluid/tissue expelled from the uterus. Thus resulting in shorter, less painful menstruation. 

These drugs are typically more effective than treatments that do not target the source of the pain (e.g. acetaminophen). Regular physical activity may limit the severity of uterine cramps.

NSAIDs for Dysmenorrhea

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are effective in relieving the pain of primary dysmenorrhea. They can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.

Hormonal birth control

The use of hormonal birth control may improve symptoms of primary dysmenorrhea. A 2009 systematic review found limited evidence that the low or medium doses of estrogen contained in the birth control pill reduce pain associated with dysmenorrhea. In addition, no differences between different birth control pill preparations were found.

Norplant and Depo-Provera are also effective since these methods often induce amenorrhea. The intrauterine system (Mirena IUD) may be useful in reducing symptoms.

Other birth control

A review indicated the effectiveness of transdermal nitroglycerin. Reviews indicated magnesium supplementation seemed to be effective. A review indicated the usefulness of using calcium channel blockers. Heat is effective compared to NSAIDs and is a preferred option by many patients, as it is easy to access and has no known side effects.

Tamoxifen has been used effectively to reduce uterine contractility and pain in dysmenorrhea patients. There is some evidence that exercises performed 3 times a week for about 45 to 60 minutes, without particular intensity, reduce menstrual pain.

Alternative medicine for Dysmenorrhea

Herbal or dietary supplements

There is insufficient evidence to recommend the use of any herbal or dietary supplements for treating dysmenorrhea, including melatonin, vitamin E, fennel, dill, chamomile, cinnamon, damask rose, rhubarb, guava, and uzara.

Further research is recommended to follow up on weak evidence of benefit for fenugreek, ginger, valerian, zataria, zinc sulfate, fish oil, and vitamin B1. A 2016 review found that evidence of safety is insufficient for most dietary supplements. There is some evidence for the use of fenugreek.

Thiamine and vitamin E

One review found thiamine and vitamin E to be likely effective. It found the effects of fish oil and vitamin B12 to be unknown. Reviews found tentative evidence that ginger powder may be effective for primary dysmenorrhea. 

Reviews have found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but the evidence was limited by its poor methodological quality.

Acupuncture

A 2016 Cochrane review of acupuncture for dysmenorrhea concluded that it is unknown if acupuncture or acupressure is effective. There were also concerns of bias in study design and in publication, insufficient reporting, and that they were inconsistent. 

There are conflicting reports in the literature, including one review which found that acupressure, topical heat, and behavioral interventions are likely effective. It found the effect of acupuncture and magnets to be unknown.

Behavioral interventions

A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to the poor quality of the data.

Spinal manipulation

Spinal manipulation does not appear to be helpful. Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms, a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for the treatment of primary and secondary dysmenorrhea.

Passiflora incarnata

Valerian, Humulus lupulus, and Passiflora incarnata may be safe and effective in the treatment of dysmenorrhea.

Surgery

One treatment of last resort is presacral neurectomy.

Ayurveda treatment for Dysmenorrhea

Correction of Apana Vata vitiation is the main objective of the treatment. The site of Apana Vata is the last part of the intestines.

Snehana

• Generally, snehana or oleation is done with medicated oil or ghee.
• It may be administered orally (Shatavari ghrit) or externally (sesame oil).
• Local massage with sesame oil and hot water bag fomentation or nadi sweda are helpful in painful conditions.

• Oleation helped in pacifying vitiated Apana Vata.

Virechana-Medicated purgation

• Purgatives or laxatives are useful here for, example Gandharva haritaki.

Basti

• As Basti is the primary treatment of vitiated apan vata, it is of prime importance during painful episodes as well as to prevent dysmenorrhea.
• Enema with medicated oils is used to pacify Apana Vata.
• Uttarbasti with Bala taila, Dashamool ksheer Basti and decoction Basti, and Sahchar oil matrabasti are helpful.

Diet

• Take Fresh fruits and vegetables.
• Avoid salty spicy fried junk food.
• Take Asafoetida into the diet.
• Add Cow ghee to the diet.

Some useful Medicines

• Yograj guggul, maharasnadi Kashaya, dashmool kashay, shankhavati, ashokarishta, lodhra, jatamansi, Shatavari, ashwagandha, shunthi, hingu, black sesame, haritaki, etc.
• Yoga, Pranayama and meditation, and exercise.
• Stress is the main factor contributing to this disease and hence pranayama and meditative techniques are proven to be effective in relieving the condition and preventing further recurrence.
• Regular exercise is inevitable and part of your lifestyle.

Home remedies for Dysmenorrhea

Regular Exercise

Exercising during dysmenorrhea or menstrual cramps can help ease your belly pain. This practice increases the release of endorphins and reduces your cramps.

Use Hot Water Bottle

Place a hot water bottle on your stomach or lower abdomen for 15 to 20 minutes to reduce cramps.

Drink Water

Keep drinking water to make sure you won’t become dehydrated, as this will only worsen your menstrual cramps.

Yoga

Yoga stretches or asanas during your monthly period not only treat abdominal cramps but also provide relaxation that can help ease other symptoms associated with the menstrual cycle.

Drink Hot Liquids

Drinking hot liquids like hot herbal tea and warmed-up lemonade during menstrual cramps can help increase your blood flow and relax your muscles.

Mint

Peppermint is an effective agent for providing relief from menstrual cramps. Drink one to two cups of peppermint tea per day during your monthly menstrual cramps.

Parsley

Parsley juice treats painful cramping. Drinking about 75 ml of a blend of parsley juice with beet, carrot, and cucumber juices can provide maximum results.

Ginger

Ginger is an effective home remedy during times of painful menstruation. Boil a piece of ginger in a cup of water for a couple of minutes, add sugar and drink three times daily after meals.

Vitamins and Minerals

Make sure that your body is getting enough vitamins and minerals to prevent menstrual cramps.

Basil

Basil leaves contain a pain-killing component called caffeic acid, which can reduce menstrual cramps and pain. Boil a cup of water and add two tablespoons of basil leaves, let it steep and leave till it gets cooled. Drink ½ to one cup of basil tea every hour to ease your cramps.

Cinnamon

Cinnamon has anti-inflammatory and antispasmodic properties that can reduce the symptoms of menstrual cramping. You can either sprinkle cinnamon powder on your breakfast foods or add it to a tea.

Magnesium

Several types of nuts are high in magnesium, vitamin E, calcium, and other nutrients which help reduce menstrual cramps considerably.

Siddha remedies for Dysmenorrhea