Dysmenorrhea

Dysmenorrhea refers to the uncoordinated contractions of the uterus just before and during menstruation, resulting in a decreased volume of blood flow through the uterus and the resultant pain and cramping. Typically the pain experienced is dull, with a sense of pelvic heaviness or congestion. There may also be symptoms of fatigue, bowel irregularity, shivering, sweating, leg pain, nausea and vomiting, faintness, and mood swings. Primary dysmenorrhea is common in young women and rare after childbirth, whereas the usual onset of secondary dysmenorrhea is in the 30's, or after childbirth. The most common cause for primary dysmenorrhea is an eicosanoid imbalance, with excessively high levels of PGE2 and PGF2, and in severe cases, high levels of the leukotrienes LTC4 and LTD4.

The usage of oral contraceptives seems to reduce the symptoms, which suggests a relative estrogen excess and a progesterone deficiency. Secondary dysmenorrhea is most often associated with other gynecological conditions such as uterine inflammation, fibroids, endometriosis, pelvic inflammatory disease (PID), and occurs with premenstrual syndrome (PMS). In secondary dysmenorrhea, the underlying cause for the pain, such as fibroids or PID must be resolved. (Trickey 1998, 223-26; Berkow 1992, 1792-93)

The primary treatment for both primary and secondary dysmenorrhea is essentially the same: relaxing the uterine muscle, altering the eicosanoid imbalance and reducing the inflammatory cascade, enhancing uterine circulation, regulating hormonal imbalance, and correcting liver function. In secondary dysmenorrhea, the underlying cause for the pain, such as fibroids or PID must be resolved.

Uterine tonics are herbs that regulate the muscular activity of the uterus, making the contractions more regular and efficient. Examples of uterine tonics include False Unicorn root (Chamaelirium luteum), True Unicorn root (Aletris farinosa), Blue Cohosh (Caulophyllum thalictroides), Dang gui (Angelica sinensis), and Raspberry leaf (Rubus idaeus).

Antispasmodics are used before or at the first signs of pain, taken several days before the beginning of the period. Useful antispasmodics include Black Cohosh (Cimicifuga racemosa), Cramp bark (Viburnum opulus), Wild Yam (Dioscorea villosa), and Parsley root (Petroselenum crispum).

Emmenagogues are herbs that increase the strength of uterine contraction, especially indicated in cases of pelvic congestion, dull cramping pain and a slow starting period. Examples of emmenagogues include Mugwort (Artemisia vulgaris), Rue (Ruta graveolens), Tansy (Tanacetum vulgare), Cotton root (Gossypium herbaceum), and Pennyroyal (Mentha pulegium).

Circulatory stimulants are an important aspect in the treatment of dysmenorrhea to enhance uterine circulation. Circulatory stimulants include Ginger root (Zingiber officinalis), Prickly Ash (Zanthoxylum americanum), Cinnamon bark (Cinnamomum cassia), and Cayenne pods (Capsicum spp.). Circulatory stimulants are often included in a formula simply to enhance the activity of the other herbs in the formula.

Relaxing nervines can be an important aspect of treatment, especially if anxiety or emotional lability is part of the symptom picture. Useful relaxing nervines include Valerian (Valeriana officinalis), Vervain (Verbena officinalis), and Chamomile (Matricaria recutita). For more severe symptoms as well as pain, the use of anodynes and sedatives such as Pasque flower (Anenome occidentalis), Jamaican Dogwood (Piscidia erythrina), and California Poppy (Eschscholzia californica) may be necessary.

Hormonal amphoterics are botancials that appear to act upon the hypothalamic-pituitary axis or otherwise regulate hormonal levels. Some herbs such as Peony root (Paeonia lactiflora) and Chaste berry (Vitex agnus castus) appear to enhance progesterone levels, whereas herbs such as Red Clover (Trifolium pratense) compete with estrogen-binding, leading to a down-regulation in estrogenic activity. Vervain (Verbena officinalis) has a relaxing nervine property, a bitter cholagogue and an amphoteric activity upon hormonal levels similar to Paeonia and Vitex.

Liver support is an important aspect in treatment, and are especially indicated in pelvic congestion, and premenstrual depression and irritability. Although the mechanism of action is not entirely clear, using hepatics such as Barberry (Berberis vulgaris) and Yellowdock root (Rumex crispus), as well as pelvic decongestants such as Yarrow (Achillea millefolium) and White Dead Nettle (Lamium album), relieve symptoms of pelvic heaviness and pain, perhaps by increasing the metabolism and elimination of estrogens, as well as relieving portal congestion. Although cholagogues, that enhance bile synthesis and secretion can relieve the constipation that can accompany dysmenorrhea, sometimes the additional usage of aperients such as the Triphala, Rheum and Rhamnus is helpful.

One particularly formula I have found particularly ujseful in the symptomatic treatment of dysmenorrhea is Hayden's Viburnum Compound:

• Black Haw (Viburnum prunifolium) 6 parts
  
• Cramp Bark (Viburnum opulus) 4 parts
  
• Beth root (Trillium erectum) 4 parts
  
• Clove (Eugenia caryophyllus) 4 parts
  
• Cinnamon bark (Cinnamomum cassia) 3 parts
  
• Orange peel (Citrus reticulata) 2 parts
  
• Wild Yam (Dioscorea villosa) 2 parts
  
• Skullcap (Scutellaria lateriflora) 1 parts
  

Coarsely grind herbs, mix together, and add enough alcohol to make a 1:4 tincture, macerating for 2 weeks, or by making a percolation. Add 1 part simple syrup to the strained tincture to bring the strength to 1:5. Dosage is 5-15 mL, taken 3-4 times daily for severe cramping.

Useful supplements to inhibit the inflammatory cascade includes oils rich in GLA such as evening primrose oil, black currant oil, borage oil, flax oil, and hemp oil, and oils rich in EPA such as salmon and halibut oil. The are some herbs as well that can help to inhibit inflammation, including Turmeric (Curcuma longa) and Feverfew (Tanacetum parthenium). Calcium and magnesium supplementation are also useful treatments to relieve uterine spasm, 800-1000 mg of each, on a daily basis.

Dietary changes are an important aspect in the treatment of dysmenorrhea, with an emphasis upon whole grains, cold water fish, and leafy green vegetables, and the avoidance of cold and heavy foods such as dairy, flour, and sweets. Topically, castor can be rubbed into the lower abdomen and back, followed with the application of heat with an electric blanket, hot water bottle, or hot shower. Massage can be helpful too, and some women find that orgasm seems to help to relieve the pain of dysmenorrhea, perhaps by coordinating uterine contraction.