Dysmenorrhea is painful menstruation and affects more than 50% of menstruating women and it is the leading cause of lost time from school and work among women of childbearing age.

Type of pain:

Dysmenorrhea may involve sharp, intermittent pain or dull, aching pain. It is usually characterized by mild to severe cramping or colicky pain in the pelvis or lower abdomen that may radiate to the thighs and lower sacrum.

Causes of dysmenorrhea:

Adenomyosis: In this disorder, endometrial tissue invades the myometrium, resulting in severe dysmenorrhea with pain radiating to the back or rectum, menorrhagia, and a symmetrically enlarged, globular uterus

Endometriosis: In this disorder, steady, aching pain typically begins before menses and peaks at the height of menstrual flow, but it may also occur between menstrual periods.

Pelvic inflammatory disease: Chronic infection produces dysmenorrhea accompanied by fever; malaise; a foul-smelling, purulent vaginal discharge, menorrhagia, dyspareunia, severe abdominal pain, nausea and vomiting, and diarrhea.
Premenstrual syndrome: The cramping pain of PMS usually begins with menstrual flow and persists for several hours or days, diminishing as flow decreases. Abdominal bloating, breast tenderness, palpitations, diaphoresis, flushing, depression, and irritability commonly precede menses by several days to 2 weeks. Other findings include nausea, vomiting, diarrhea, and headache.

Primary (idiopathic) dysmenorrhea: Increased prostaglandin secretion intensifies uterine contractions, apparently causing mild to severe spasmodic cramping pain in the lower abdomen, which radiate to the sacrum and inner thighs. The cramping abdominal pain peaks a few hours before menses. Patients may also experience nausea and vomiting, fatigue, diarrhea, and headache.

Uterine leiomyomas: If these tumors twist or degenerate after circulatory occlusion or infection or if the uterus contracts in an attempt to expel them, they may cause constant or intermittent lower abdominal pain that worsens with menses. Associated signs and symptoms include backache, constipation, menorrhagia, and urinary frequency or retention.

Homoeopathic approach:
Cimicifuga.
The characteristic indication for this remedy in dysmenorrhoea is pain flying across the pelvic region from one side to the other.

It is especially useful in rheumatic and nueralgic cases,and in congestive cases.

Headache preceding menses, during menses sharp pains across abdomen.

Caulophyllum
The dysmenorrhoea of Caulophyllum is essentially spasmodic in character the pains are bearing down in character.
It produces a continued spasm of the uterus simulating first stage of labor the flow is mostly normal in quantity.
The spasmodic intermittent pains which call for Caulophyllum are in the groins, a useful remedy in these spasmodic cases if given between the periods.

Gelsemium
It is similar in many respects to Caulophyllum.
It is very useful remedy in neuralgic and congestive dysmenorrhoea when there is such bearing down.
The pains are spasmodic and labor-like, with passages of large quantities of pale urine.

Viburnum opulus
This remedy produces a sudden pain in the region of the uterus before menstruation and much backache during menses.
In neuralgic and spasmodic dysmenorrhoea it has achieved considerable reputation. are bearing down, aching in sacral and pubic region, excruciating, cramp, colicky pains in hypogastrium, much nervousness, and occasional shooting pains in he ovaries.

It has pains going around the pelvis and also the empty, gone feeling in the stomach; but the bearing down is more violent, culminating in an intense uterine cramp.

Xanthoxylum
This remedy has about only one use in homoeopathic medicine, and that is in dysmenorrhoea and uterine pains.
It is useful where the pains are agonizing, burning, extending down thighs along the crural nerves with a feeling as if the limbs were paralyzed, the mensturation is usually profuse and with it agonizing bearing down pains
Leftsided are the pains of Xanthoxylum, though it also affects the right ovary.

It corresponds closely to the neuralgic form of dysmenorrhoea.

Magnesia phosphorica
This remedy has achieved a greater clinical reputation in dysmenorrhoea than has Magnesia phosphorica.
The pains calling for it are neuralgic and crampy preceding the flow, and the great indication for the use of this remedy is the relief from warmth and the aggravation from motion.

Uterine engorgements with the characteristic crampy pains will indicate the remedy.

It has also been used successfully in membraneous dysmenorrhoea.

Pulsatilla:
Dysmenorrhoea calls for Pulsatilla when the menses are dark in color and delayed, the flow will be fitful and the more severe the pains are the more chilly the patient will get.

The pains gripe and double the patient up.

It is perhaps more useful when given between the periods, and in congestive dysmenorrhoea, from wetting of the feet.

Cocculus:

A most useful remedy in dysmenorrhoea and scanty, irregular menstruation.

Uterine cramps. Profuse discharge of clotted blood and severe headache accompanied by nausea, a heaving up and down of the stomach as in seasickness.

It suits cases on the borderland between the neuralgic and congestive types of dysmenorrhoea.

Uterine cramps with suppressed irregular menstruation and a sero-purulent bloody discharge were favorite indications.

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