Sujal Torgal Patil
We are conditioned to believe menstruating is supposed to be a hush-hush affair. Furthermore, in the rigmarole of cultural impositions, emotional turbulences that follow after menarche and lack of proper awareness about menstrual periods, young girls develop an aversion towards this natural process right from the start and it becomes rather an imposition. 70 to 80 per cent of the female populace in any region suffers from some form of menstrual disorder for sure. Some find solace in hiding it; some just consider it to be normal. In any case, everybody takes it as the way of life.
Conventionally, dysmenorrhoea or painful monthly periods is one of the most common gynaecological complaint in young women, affecting approximately 40 to 70 per cent women of the reproductive age, with 10 per cent women describing severe symptoms. It is classified into primary and secondary. Primary dysmenorrhoea occurs when pelvic anatomy and ovarian function are normal and no organic cause can be found for pain. Secondary dysmenorrhoea describes pain due to pelvic pathology. It can occur at any age but it is most commonly observed in women between 20 and 45 years of age.
Going against nature has its effects. As a combined effect of today’s hectic lifestyle, erratic schedules, unjust food habits, increased pollution levels, improper sleep or increase in stress levels we see an ever-increasing number of gynaecological disorders on a rise today. And often it all starts with that very difficult period. If one suffers from irregular; painful, heavy, scanty periods associated with headaches; cramps; nausea or vomiting; giddiness; swelling or anorexia, it needs to be corrected.
Primary dysmenorrhoea usually coincides with the start of menstruation. The initial onset is usually shortly after the first menses. Secondary dysmenorrhoea is associated with a later age of onset, after years of pain-free menses and the patient is usually over 30 years of age. The pain begins as a dull pelvic ache three to four days before the menses and becomes more severe during menstruation. Other symptoms that may be associated with it include pain during sex, irregular cycles, heavy bleeding, bleeding in between cycles or after sex. It should be noted that all these symptoms can also be caused by other gynaecological conditions.
Symptoms experienced may vary in different individuals and these include:
Low midline abdominal or pelvic pain but may radiate to back or thighs
Varies from a dull dragging to a severe cramping pain (especially in a uterine pathology like endometriosis)
Maximum pain at the beginning of the period may commence up to 12 hours before the menses appear
Usually lasts 24 hours but may persist for two to three days
May be associated with nausea and vomiting, headache, syncope or flushing, etc.
There are no specific tests to diagnose primary dysmenorrhoea. Specific investigations are ordered based on history, examination findings and severity of pain or other associated symptoms. Investigations are only important if a secondary cause is suspected or in refractory cases of primary dysmenorrhoea. For patients with the secondary, investigations should be directed to the most likely cause.
Common causes of secondary dysmenorrhoea include endometriosis, uterine fibroids, pelvic adhesions, pelvic inflammatory disease, ovarian cysts, gastrointestinal disturbances and very rare causes such as malignant tumours of the uterus, ovary, bowel or bladder. Investigations should be directed to the most likely after history and examination.
The conventional approach of treating primary dysmenorrhoea is with pain medication usually NSAIDs. In the secondary type dependant on the cause, analgesics, NSAIDs or combined oral contraceptives (COCPs) are prescribed along with vitamin supplements. There is rarely any consideration of the causative factors related to the diet or lifestyle of the patient. Moreover, the analgesics and other kinds of pain medications tend to increase the possibility of a gastrointestinal upset in women who are already suffering. Through scientific ayurvedic management, the pain can be reversed in a menstruating patient in minimal time with a minimal dosage of medication without any side effects.
According to ayurveda, vata dosha is responsible for maintaining the intricate physiology of hormones pertaining to the female reproductive system along with other factors. Vata dosha is responsible for the easy flow of menstrual blood, known as raja through the uterus every month. Causative factors which hinder the functions of vata are responsible for pathologies like pain, excessive or decreased menstrual pain, irregular cycles, etc.
Vata has a multitude of directional flows and without a fine balance; the downward flow of menstruation can be compromised by strong, upward functions in the body. Apana vata is a type of vata that governs downward flow, particularly in the pelvis, and is the vehicle for a continuous and easy outlet of wastes such as stools and urine, in addition to menstruation. Without normalcy of this vata subtype, many imbalances happen in the pelvis, creating a variety of disorders. Generally, it is the upward flow of energy caused by activities that pull apana up (retrograde direction) out of its normal directional flow (downward) leading to painful menses or scanty flow.
Causes are eating heavy or oily food, diet predominant in non-vegetarian food, fermented or stale food, foods dominant in cold properties like cold water or beverages or astringent foods like tea, coffee in excess before or during menstruation, and activities like too much speaking, thinking, laughing, and running, exercising, biking, swimming, jumping, jogging, excessive talking or laughing, sexual intercourse, exposure to heat and radiations, heavy work, weight lifting, etc, during or immediately before periods precipitate the abnormalities by deranging vata.
It is important to speculate the dietary inclusions of menstruating women in detail as most disorders pertaining to the female reproductive system are borne out of faulty food habits and lifestyle and therefore can be reversed easily too with the correction of the same.
To be continued…
(The writer is CMO at Traya Natural Health Centre and can be reached at firstname.lastname@example.org)