Dysmenorrhea: Ayurvedic Treatment, Diagnosis, Home Remedies

Abstract

Women’s health has been a controversial topic of discussion for the past many years. Their health issues are still unnoticed. Women’s nutritional needs are also not fulfilled starting from puberty. Dysmenorrhea is one of the leading health issues among women and young girls. Its severity hampers the quality of female life. In simple words dysmenorrhea refers to painful periods. Sight discomfort during menstruation is completely alright but the discomfort or pain that interferes with day to day activity comes under dysmenorrhea. It is the most common gynaecological problem. The prevalence rate of dysmenorrhea varies from a wide range of 16% to 90% in women of reproductive age. Besides the painful periods, dysmenorrhoea has psychological effects on women especially adolescents who are suffering from it. They are often feared with the thought that something is wrong with their reproductive organ, or this might hamper their fertility in upcoming years. Lots of women have to skip their work and the school going girl population is being absent during their periods. So let’s begin reading dysmenorrhea, its causes, signs and symptoms, and its management with reference to modern as well as ancient systems of medicine.

Introduction

Dysmenorrhea refers to periodic cyclic pain during menstrual cycle. The characteristics of pain are cramp like or colicky. The pain is usually in the suprapubic region radiating towards lower back and legs that usually stays upto 24-48 hours. The intensity of cramps hinders the women’s routine activity. The other symptoms associated with pain are nausea, headache, vomiting, bloating diarrhoea or fatigue. A large population of females are being told to tolerate the pain during periods. Tolerating pain or even having pain is not normal. One should always seek a doctor’s opinion for painful menstruation.

What causes pain?

Before initiation of the menstrual cycle there is excessive production of prostaglandins inside the uterus of the female body. Due to the fall in the hormone prostaglandins, uterus endometrial lining sloughs off to prepare menstrual flow during periods. These endometrial changes increase the production of prostaglandins. Excessive rise in prostaglandins leads to dysrhythmic and hyper frequent uterine contraction which reduces the uterine blood flow often associated with crampy pain, nausea, dizziness etc.

Types of dysmenorrhea

There are basically two types of dysmenorrhea: primary and secondary.

Primary Dysmenorrhea

Pain in primary dysmenorrhea is due to prostaglandin induced uterine contractions. It mostly initiates with the onset of ovulatory cycle and usually improves with time. The character of pain is sharp and crampy. In primary dysmenorrhea there is no tenderness or pathological changes associated. It is really painful but it is good to know that it is harmless and does not hamper reproductive functions. Sometimes it resolves with a growing age.

Signs and symptoms

● Intense Cramps or throbbing kind of pain in lower abdomen
● Lower back pain radiating towards inner thighs
● Pain lasts for 48-72 hours
● Dull or continuous pain
● Nausea and vomiting
● Headache
● Loose stool with increased frequency
● Dizziness
● usually gets better with NSAIDs
● Non tender pelvis

Secondary Dysmenorrhea

Secondary dysmenorrhea on the other hand can be associated with some pathological changes in the women’s reproductive system. It is due to some disorder or disease.The pain may even start long before menses and remains during and after periods. The gynaecological problems that cause pain are endometriosis, adenomyosis, pelvic inflammatory disorder, intrauterine devices etc. This is often associated with tenderness.

Signs and symptoms:

● It begins in late teens or early 20’s and progressively worsens
● Irregular or heavy menstrual flow
● Responding poorly to NSAIDs or oral contraceptives
● Painful intercouse (dyspareunia)
● Can be associated with vaginal discharge
● Abnormality in pelvis during examination
● Tenderness over pelvic region
● Nausea and vomiting
● Headache
● Loose stool with increased frequency

Risk Factors

● Women having family history of painful menstruation
● Smoking
● Irregular periods
● Puberty occurs before 11years
● Heavy flow during periods
● High socioeconomic status
● Lack of physical exercise
● Anxiety and depression
● obesity

Complications

● Conditions like endometriosis can lead to infertility
● Pelvic inflammatory disease (PID) can lead to ectopic pregnancy (implantation other than uterus)

Diagnosis

● Proper history taking
● Family history
● Ultrasonography (USG)
● Magnetic resonance imaging (MRI)
● Vaginal examination
● Rectal Examination
● Laparoscopy
● hysteroscopy

Management

Primary dysmenorrhea: to provide relief from cramps and other associated symptoms.
The most common modality involves Non steroidal anti inflammatory drugs (NSAIDS) like ibuprofen, mefenamic acid, diclofenac, naproxen etc with the combination of oral contraceptives. They directly act by reducing the level of prostaglandins.

Secondary dysmenorrhea: The management protocol includes correction of the underlying pathology or disease.

Prevention

Certain modification in lifestyle and dietary changes dysmenorrhea can be prevented:

● Regular physical exercise
● Dietary supplements rich in omega 3 fatty acids (flax seeds and fish oil), magnesium etc
● Walnut, almonds,pumpkin seeds are rich in magnesium
● Reduce intake of caffeine and carbonated beverages
● Stop smoking
● Alcohol intake should be lowered
● Yoga and meditation
● More protein in the diet should be included

Home remedies

● Hot water shower
● Heating pad or hot water bottles
● Camomile tea
● Infusion of ginger, cinnamomum
● Fennel seed infusion
● Turmeric tea
● Eating papaya
● Stay hydrated
● Massage the abdomen with essential oil like rosemary, peppermint oil etc

Ayurvedic aspect and management of dysmenorrhea

Ayurveda is an ancient medical science existing from 3000 years in India. Or we can say it as science of life. It abolishes the disease from root. Ayurveda believes that your food is your first medicine. Ayurveda focuses on a balanced lifestyle and diet combined with yoga and meditation. In ayurveda the detailed description about all the gynaecological disorders including dysmenorrhea is mentioned separately in Yonivyapad.

“kashtena muchyati iti kashtaartava”

Dysmenorrhea is described as “kastartav” that means difficult periods in ancient text. It is not a separate disease but a symptom of many diseases.
Vata dosha inside the body is responsible for any kind of pain. Apana vayu is the subtype of vata which is responsible for the regular menstrual flow but in dysmenorrhea apana vayu is visited due to some factors. And hence responsible for painful periods.

Yonivyapad related to kashtaartava are as follows:

Vataj yonivyapad

It means having food which increases vata inside the body that travels the genital region giving rise to symptoms of aggravating vata such as frothy and thin menstrual flow associated with pain and sound. It is primarily associated with primary dysmenorrhea.

“वातलाहारचेष्टाया वातलायाः समीरणः |
विवृद्धो योनिमाश्रित्य योनेस्तोदं सवेदनम् ||९||
स्तम्भं पिपीलिकासृप्तिमिव कर्कशतां तथा |
करोति सुप्तिमायासं वातजांश्चापरान् गदान् ||१०||
सा स्यात् सशब्दरुक्फेनतनुरूक्षार्तवाऽनिलात् |”

Udavarta yonivyapad

This explained that when the normal urges like urination, defecation are suppressed , the apana vayu moves in upward direction and giving rise to symptoms like severe pain and difficulty in the evacuation of menstrual blood flow and when blood is evicted there is some relief in cramps. This is close to primary dysmenorrhea.

“वेगोदावर्तनाद्योनिमुदावर्तयतेऽनिलः |
सा रुगार्ता रजः कृच्छ्रेणोदावृत्तं विमुञ्चति ||
आर्तवे सा विमुक्ते तु तत्क्षणं लभते सुखम् |
रजसो गमनादूर्ध्वं ज्ञेयोदावर्तिनी बुधैः ||”

Mahayoni

In this yonivyapad when women indulge in bad positioning while in intercourse it aggravates the vata dosha giving rise to symptoms of painful menstruation. This is close to uterus prolapse and is related to secondary dysmenorrhea.

“विषमं दुःखशय्यायां मैथुनात् कुपितोऽनिलः |
गर्भाशयस्य योन्याश्च मुखं विष्टम्भयेत् स्त्रियाः |
असंवृतमुखी सार्ती रूक्षफेनास्रवाहिनी |
मांसोत्सन्ना महायोनिः पर्ववङ्क्षणशूलिनी |”

Artav khasya

In this condition various causative factors aggravate vata dosha that is vitiated apana vayu and is further responsible for irregular menstruation and scanty blood flow during menstruation. It can be correlated with dysmenorrhea caused due to nutritional deficiency.

Management

Dysmenorrhea is a vata predominant disease and the vayu involved here is apana vayu. Regimes such as therapies (panchkarma), diet (pathya ahara), herbs, exercises (yoga and meditation) to balance vata dosha are to be followed. Panchakarma therapies are effective in managing the chronic dysmenorrhea underlying with pathology. Panchakarma therapies are helpful in clearing the blocked channels and thus rebalancing the flow of vata dosha which provide more nutrition to the tissues of the uterus.

Most common panchakarma procedures involves:

1. Abhyanga (oleation therapy) with warm oil
2. Basti (medicated enema)
3. Uttarbasti
4. Anuvasan basti
5. Virechan therapy (purgation)

Ayurveda has a collection of herbs that are best suited for the management of painful periods. The magical herbs are Shatavari (Asparagus racemosus), ashoka ( Saraca asoca), kumari (aloe barbadensis) and many more. The classical formulations effective for dysmenorrhea described are chandraprabha vati, dashmoolarista, ashokarishta, kumaryasava etc.

Yoga asanas for dysmenorrhea

Regular yoga should be added to everyday regime. Yoga relaxes the muscles of the uterus and eases the pain. Also it maintains the flow of vata inside the body. Below are the effective yoga poses:

● Bala asana (child pose)
● Baddha konasana (bound angle pose)
● Uttanpadasana (forward bending pose)
● Vipritkarni asana ( leg up the wall pose)
● Janu shirshasana (head to knee pose)
● Supta baddha konasana (reclined bound angle)

Herbal remedies for Dysmenorrhea by Planet Ayurveda

Planet Ayurveda is a herbal manufacturing unit and is a renowned GMP certified company. Formulations are in the form of vatis (tablets), churan (powder), liquids (syrups), jams, capsules. Products made by Planet Ayurveda are 100% pure, herbal, vegetarian and natural. Supplements are formulated under the supervision of MD experts. With the goodness of herbs, Planet Ayurveda has formulated various preparations to manage dysmenorrhea. All the formulation is prepared strictly following the ancient Ayurvedic context.the herbs used are pure and unadulterated. All these herbal remedies are free from preservatives, additives and chemicals. These are safe to use. The herbal formulation by Planet Ayurveda for the effective management of dysmenorrhoea are as follows:

1. Chandraprabha Vati
2. Gyne Kalp
3. Ashokarisht
4. Hakam Churna

Product description

1. Chandraprabha Vati

Chandraprabha vati is a classical Ayurvedic formulation having remarkable effects on Kapha dosha. The main ingredients in Chandraprabha Vati includes Guggul (Commiphora mukul), Shilajit (Asphaltum),Vacha (Acorus calamus),Kapoor (cinnamomum camphora), Amalaki(Emblica officinalis)and many more. It has very good anti-inflammatory properties. It acts as a potent catalyst when used with other herbal formulations. It boosts fertility in females as well as in males. It helps in removal of toxins from the body (anti oxidant). It acts like a muscle relaxant, helps in relaxing uterine muscles, analgesic and maintains reproductive health.

Dosage– 2 tab twice daily with plain water after meals.

2. Gyne Kalp

Gyne kalp is a herbal formulation prepared by Planet Ayurveda. It is formulated to improve a female’s reproductive health. It is an amalgam of various herbs like Shatavari (Asparagus racemosus), Ashoka (Saraca asoca), Lodhra (Symplocos racemosa). Therapeutically it resolves all the menstrual related issues like irregular menses, scanty menses or even painful menses. It is helpful in fertility related issues. All the herbs effectively balances the vata dosha hence restoring normal flow of vata dosha. It contains shatavari which acts as rejuvenation of overall female health. Gne kalp is a very effective formulation tomange dysmenorrhea.

Dosage– 2 tabs twice daily with plain water after meals.

3. Ashokarisht

Ashokarisht is classical Ayurvedic herbal preparation reformulated by Planet Ayurveda. It contains various herbs some of them are ashoka (saraca asoka), musta (Cyperus rotundus), shunthi (ginger), haritaki (terminalia chebula), bibhitaki (terminalia bellerica), amalaki (indian gooseberry), dhataki (woodfordia fruticosa) and many others. It is a boon to female reproductive health. It balances all three doshas that are vata, pitta and kapha. It is helpful in relieving menstrual cramps and heavy period flow. It is a female health tonic. And along with this it increases the digestive fire (jatharagni), improves digestion. Ashokarisht is very effective in managing painful periods.

Dosage– 2 tsp twice daily with warmwater after meals.

4. Hakam Churna

Hakam Churna is a polyherbal formulation prepared by Planet Ayurveda. The herbs it contained are Chandrashoor (Lepidium sativum), Ajwain (Trachyspermum ammi), Kalonji (Nigella sativa), Methi (Trigonella foenumgraecum) etc. All the herbs possess anti inflammatory and anti analgesic properties. It pacifies the increased vata dosha and regulates the normal flow of vata dosha. It’s really potent to manage dysmenorrhea.

Dosage– 1/2 tsp twice daily with plain water after meals.

Conclusion

Female gynaecological health is the topic of ignorance since ancient times still continuing. We already discussed dysmenorrhea in detail which in simple words explained painful periods that hampers the day to day activity. Pain during periods is not normal. There is a strict need of consulting a physician. In Ayurveda this situation of painful crampy periods is mentioned as kastaartav. Kasta means difficult and artav means menses. Thus combining both it is called a difficult period. Ayurveda has lots of wonderful and effective formulations and procedures to effectively manage the condition of dysmenorrhea.