Dr Ashok Yadav , Dr Virendra Chauhan , Dr Bhavneet Kaur *, Dr. Rekha Sharma 
- Professor , H.O.D., Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research centre, Jaipur, Rajasthan
- Associate Professor, Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research centre, Jaipur, Rajasthan
- D. Scholar, Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research centre, Jaipur, Rajasthan Email: firstname.lastname@example.org
- D. Scholar, Department of Practice Of Medicine, Dr. MPK Homoeopathic medical College, Hospital and Research centre, Jaipur, Rajasthan
Dysmenorrhea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression. In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology, while in secondary dysmenorrhea gross pathology is present in the pelvic structures. With primary dysmenorrhea the pain is suprapubic and spasmodic, and associated symptoms may be present. Characteristically dysmenorrhea starts at or shortly after menarche. The pain lasts for 48-72 hours during the menstrual flow and is most severe during the first or second day of menstruation. It is now clear that in many women with primary dysmenorrhea the pathophysiology is due to increased and/or abnormal uterine activity because of the excessive production and release of uterine prostaglandins. Homoeopathic medicines such as pulsatilla nigricans, viburnum opulus, sepia etc. helps a lot in managing the cases of dysmenorrhea efficiently.
Keywords: Dysmenorrhea, homoeopathy, pain management, painful menstruation
The term dysmenorrhea means difficult menstruation but it is used to describe painful menses. Dysmenorrhea is defined as the presence of painful cramps of uterine origin that occur during menstruation and is one of the most common causes of pelvic pain. It is the most common gynecological problem in women of all age groups and races and economic status. The estimated prevalence of dysmenorrhea varies widely, ranging from 45 to 93% of women of reproductive age and the highest rates are reported in adolescents. This may lead to abstinence from school and work as well limitations on activities such as social gatherings, sports and academics. In this way it negatively affects the quality of life of the patient. [2,3]
Types of Dysmenorrhea:
- Primary dysmenorrhea :
The pain is of uterine origin and is directly linked to menstruation and there is no visible pelvic pathology. Pain usually occurs on the first day of menses and it produces spasmodic dysmenorrhea. Symptoms improve with abdominal massage, counter pressure or movement of body Pain usually occurs in lower abdomen or pelvic region with or without radiation to back or legs. Other associated symptoms may are low backache, headache, fatigue, diarrhea, nausea, or vomiting. Vital signs are normal, no abdominal tenderness is found.[1,3]Associated factors are : early age at menarche, long menstrual periods, smoking and increased body mass. Parity appears to improve symptoms. Hyper-production of uterine prostaglandins, particularly PGF2A and PGF2 have been identified as probable cause of dysmenorrhea. Prostaglandins are responsible for causing increased uterine tone and high altitude contractions. 
- Secondary dysmenorrhea:
The pain is associated with pelvic or ureteric pathology. The pain continues throughout the flow and it produces congestive dysmenorrhea. The pain is worse pre menstrually and relieved during the flow. It is associated with symptoms such as menorrhagia, intermenstrual bleeding, dyspareunia, postcoital bleeding, dysuria and infertility.[3,4] The causes of secondary dysmenorrhea include endometriosis, fibroids (endometriomas), adenomyosis, endometrial polyps, pelvic inflammatory disease, cervical stenosis, uterine anomalies, transverse vaginal septum and the use of an intrauterine contraceptive device. Endometriosis and adenomyosis are the most common cause of secondary dysmenorrhea in premenopausal women. [1,5]
Types of pain :
- Congestive :
This is the pre menstrual pain which is situated either in the back or lower abdomen. It occurs three to five days before the onset of menstruation and is always relieved by menstrual flow. It is associated with constipation and flatulent distension of upper colon.
- Spasmodic :
It starts on the first day of menstrual period, and last for a relatively short time , it is intermittent and spasmodic. It is associated with faintness, collapse, nausea and vomiting. Severe attack is followed by similar but less pain in lower abdomen and pubic region and on the anteromedial area of perineum. Pain does not persist for more than 12 hours.
- Membranous :
There is passage of membranes, which takes the form of cast of uterine cavity. The prognosis is poor.
Homoeopathic management of dysmenorrhea :
- Belladona :
Dysmenorrhea of belladona is congestive and neuralgic type. There is violent bearing down sensation , as if everything would issue out.  The blood is bright red, hot and offensive with clots of dark decomposed blood. Menses are early and copious. The patient is extremely sensitive and cannot bear touch , pressure or jerk.  There is pain in ovarian region at the onset of menses. Painful menstrual cramps with spasmodic contractions of the uterus. 
- Calcarea carbonicum:
The constitution of Calcarea carbonicum patient is fair, fatty , flabby , having strong inclination to obesity The patient suffers with headache, colic , chilliness and leucorrhea before menses. During menses , there is cutting pain in the uterus. A little physical exercise or mental excitement causes dysmenorrhea. Menses started at early age, occur too early, lasts too long and flows profusely with vertigo and toothache accompanied by cold, damp feet. There is infertility with copious menses.  The heavy menstrual flow is mostly due to abnormal growths in the uterus like fibroid tumor or a polypus. 
- Caulophyllum :
There is spasmodic and intense pain which fly in all directions, shivering without progress. Violent , intermittent cramping pains with little flow. Menorrhagia after hasty labor. There is painful contractions, congestion and irritability of the womb.  It is often used in congestive dysmenorrhea with severe spasmodic pains in first two days of menses. The pain is of intermittent type. 
The pain is neuralgic type with drawing, clawing pain from back towards front. Menorrhagia with black clots, profuse with coldness of limbs . Membranous dysmenorrhea especially at puberty. Dysmenorrhea is caused by anger or emotions. Menstrual cramps with lot of pain and irritability. 
There is severe pain in the uterine region , darting from side to side. Menses are irregular, flow is scanty sometimes but generally it is profuse. There is severe pain in back , down the thighs and through the hips , with heavy pressing down .  Menses are suppressed from emotions and cold. There is great debility between menses.  During menses, the patient becomes hysterical or suffers from epileptic spasms. Mental symptoms aggravates during menses. There is sharp , lancinating electric like pains in various parts of body when sympathy with ovarian irritation or due to reflex from uterus. 
It is suited to women of sedentary habits, blondes with copious menstruation. Suppression of menses from indignation. Menses increased and too frequent. Dysmenorrhea is worse by eating or drinking. Bearing down cramps with boring down pains in ovary. Must bend double with great pain and restless to get relief. Wants abdomen supported by pressure.  She experiences sharp, gnawing, darting pains in stomach with extreme nausea and vomiting. Symptoms are relieved at the onset of menses. 
It acts especially well at the beginning and closure of menstruation. It is one of the best medicine for premenstrual syndrome. Menses are too short, feeble, scanty, black , lumpy , acrid, vicarious from nose. The lesser the flow , the more pain. Dysmenorrhea on first day of menses with pain in left ovary, labor like pains during menses. Menorrhagia with chills at night , hot flushes of heat by day.  There is intolerance of least contact or pressure over the uterine region. Pains in the uterine region increases and relieved by flow of blood from vagina but after a few hours or days , the pain reappears again and so on. 
- Pulsatilla nigricans :
It is pre-eminently a female remedy , especially for mild , gentle , yielding disposition with weeping tendency , can hardly narrate her symptoms without weeping. Menses are delayed at puberty. Menses are intermittent, irregular, vicarious, too late, scanty, flow is clotted and changeable and is more during day while walking about. Dysmennorhea since puberty. It is accompanied with chilliness, paleness of face, stretching and yawning. getting feet wet. Painful menstruation with great restlessness, the patient tosses in every possible directions.
Menses usually appear late every month , and are usually scanty , sometimes last only a day. Menses is preceded by violent aching in abdomen which causes faintness, chilliness and shuddering. The patient is sad, morose and despondent during menses. Dysmenorrhea is accompanied by toothache, headache, discharge of plugs from nose , pain in tibia , epistaxis and colicky pains .  There is bearing down pains in uterus , with sense of lump or ball in anus , not relieved by evacuation.  The patient is never well since puberty, child birth and after weaning. There is dryness of vagina and vulva after menses. 
- Viburnum opulus :
Menses are too late , scanty and lasting for a few hours and offensive. Spasmodic and membranous dysmenorrhea. Bearing down pains before menses. There is heavy aching feeling or excoriating cramps in pelvis extending down to thighs, which is better from menses. Ovarian region feels heavy and congested.  Menstrual flow is thin and light colored. 
DISCUSSION & CONCLUSION :-
Dysmenorrhea creates a substantial public health burden and significantly decreases quality of life of patient. Homoeopathic Materia-medica is enriched with many such symptoms and their effectiveness has to be explored further to relief the suffering of females and also to enrich the homoeopathic literature that will guide many more practitioners for better and healthy outcomes. With help of homoeopathic medicines we can improve quality of life of women and decrease abstinence from work and school.
- Salhan S. , Textbook of gynecology , 1st New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. ; 2011, p.98, 99
- Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Res. 2017; 6: 1645. [Internet] 2017 Sep 5. [cited may 2022] doi:10.12688/f1000research.11682.1
- Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. American family physician. 2014 Mar 1; 89 (5):341-6.
- Hoffman B.L., Schorge J.O. , Schaffer J.I. , Halvorson L.M. , Bradshow K.D., Cunningham H.G., William’s Gynaecology , 2nd United states : McGraw- Hill Medical ; 2012, p. 318
- Nagy H, Khan MA. Dysmenorrhea. InStatPearls [Internet] 2021 Sep 1. [cited may 2022]
- Raue C.G. , Special pathology and diagnostics with therapeutic hints , 4th Calcutta : Sett Dey & CO ;1965
- Choudhri N.M. , A study of materia Medica , export ed. New Delhi : B. Jain Publishers Pvt. Ltd. ; 1965
- Murphy R. , Lotus Materia Medica , 3rd New Delhi : B. Jain Publishers Pvt. Ltd. ; 2010
- Nash E.B. , Sivaraman . , Expanded works of Nash , 1st New Delhi B. Jain Publishers Pvt. Ltd. ; 1995