(Congestive) Secondary dysmenorrhea is normally considered to be menstruation —associated pain occurring in the presence of pelvic pathology.
CAUSES OF PAIN: The pain may be related to increasing tension in the pelvic tissues due to pre-menstrual pelvic congestion or increased vascularity in the pelvic organs.
COMMON CAUSES OF SECONDARY DYSMENORRHEA
Cervical stenosis, chronic pelvic infection, pelvic endometriosis, pelvic adhesions, adenomyosis, uterine fibroid, endometrial polyp, IUCD in utero and pelvic congestion. Obstruction due to mullerian malformations are the other causes.
Patient profile: The patients are usually in their thirties; more often parous and unrelated to any social status.
CLINICAL FEATURES: The pain is dull, situated in the back and in front without any radiation. It usually appears 3–5 days prior to the period and relieves with the start of bleeding. The onset and duration of pain depends on the pathology producing the pain.
There is no systemic discomfort unlike primary dysmenorrhea. The patients may have got some discomfort even in between periods. There are symptoms of associated pelvic pathology.
Abdominal and vaginal examinations usually reveal the offending lesion. At times, the lesion is revealed by laparoscopy, hysteroscopy or laparotomy
TREATMENT OF SECONDARY DYSMENORRHOEA
The treatment aims at the cause rather than the symptom. The type of treatment depends on the severity, age and parity of the patient.
- ovarian dysmenorrhea
- bicornuate uterus
- unilateral location of pelvic endometriosis
- small fi broid polyp near one cornu.
- right ovarian vein syndrome
- colonic or cecal spasm.
CAUSES OF SECONDARY DYSMENORRHOEA
Ovarian Dysmenorrhea: Right ovarian vein syndrome: Right ovarian vein crosses the ureter at right angle. During premenstrual period, due to pelvic congestion or increased blood flow, there may be marked engorgement in the vein → pressure on ureter → stasis → infection → pyelonephritis → pain.
HOMOEOPATHIC MANAGEMENT OF SECONDARY DYSMENORRHOEA
Abroma radix Q:- A specific remedy for managing Menstrual cramps.
Pulsatilla:- Pulsatilla is one of the top remedies for dysmenorrhoea. Menses painful,too late, scanty, changeable in character. Irregular, intermittent flow with chilliness. Pains rapidly shifting,appear suddenly,leaves gradually. Leucorrhoea thick, acrid excoriating.
Actaea racemosa:- During menses sharp lancinating electric like pains in Uterine region and various parts, dart from side to side with chorea, hysteria or mania, increase of mental symptoms during menses. The more profuse the flow the greater the suffering.
Caulophyllum:- Pains intermittent, paroxysmal, spasmodic,across Lower Abdomen extending to groin , erratic pains changing place every few minutes. Chorea, hysteria, epilepsy at puberty, during establishment of menstrual function. Habitual Abortion from uterine debility.
Sepia :- Dysmenorrhoea with violent stitches upward in the vagina, lancinating pains from Uterus to umbilicus. Pain extends from other parts to back.
Menstrual irregularities early or late, scanty or profuse, menorrhagia or Metrorrhagia. Bearing down sensation as if everything would protrude through the vagina.
Damiana Q :- A specific remedy.