Tuesday, March 29, 2011

Menstrual Conditions/Irregularities - Dysmenorrhea

Dysmenorrhea (painful menstruation) is defined as a condition of severe uterine pain during menstruation. Some women may experience periodic pains during or prior to, or after menstrual periods in the lower abdomen as resulting of over production of certain hormones in the prostaglandins family. In traditional Chinese medicine, dysmenorrhea is defined as a pain in the lower abdomen, appearing with menstrual cycle that can spread over to the whole abdomen and lumbosacral region, depending to diagnosis.

Types of dysmenorrhea
1. Primary dysmenorrhea
Primary dysmenorrhea is defined as no underlying cause for menstrual cramps or difficult menstruation occurring just before or during menstruation. It occurs about 90% in the girls in the first 2 years of menstruation. Some researchers suggested that it may be caused immature of the reproductive organs.

2. Secondary dysmenorrhea
Secondary dysmenorrhea is caused by gynecological diseases. including hormone imbalance, endometriosis, fibromas, pelvic immflammatory disease, etc.

1. Spasmodic abdomen cramps
2. Headaches
3. Dizziness
4. Anxiety
5. Nausea
6. vomiting
7. Depression
8. Abdominal bloating
9. Painful breasts
10. Irritability
11. Etc.

After taking a brief family history and the physical exam including the Abdominal, pelvic, and rectal examinations to check any abnormality of which may be the underlined causes. Diagnosis in general includes
A. In primary dysmenorrhea
If the secondary dysmenorrhea underlined causes (See below) are rule out. No further test will be required.

B. In secondary dysmenorrhea
A. Blood test
1. Erythrocyte sedimentation rate (ESR)
The test is to rule out any inflammation is present in the body. The higher the level of ESR may be an indication of inflammation.
2. Electrolytes
The aim of the test is to determine the levels of Electrolytes, including Sodium, Chloride, Potassium, calcium, etc. to rule out the imbalanced electrolytes cause of dysmenorrhea.
3. Pregnancy test
The test is to rule out the ectopic pregnancy cause of the condition.
4. Tumor markers
The blood test of tumor markers is to rule out the malignant or benign tumor cause of dysmenorrhea.
5. Etc.

B. Swab of vaginal discharge
The aim of the test is to rule out any sexual transmitting diseases cause of the problem.

C. Other tests
1. Laparoscopy
Laparoscopy is a long, thin like tube with light and camera at the end insert into a woman abdomen to allow her doctor to visualize and abnormality in the abdomen region in the computer screen to rule out the cause of dysmenorrhea, such as ectopic pregnancy, endometriosis and pelvic inflammatory disease.

2. Dilatation and curettage
Dilatation and curettage (D & C) is procedure in which the cervix is dilated (expanded) and the lining of the uterus (endometrium) is scraped away to allow a visualization of the uterine cavity.

3. Pelvic ultrasound
Pelvic ultrasound allows your doctor to visualize the ovaries and around structures to check for any abnormality in the pelvic region, including uterus or fallopian tube, ovaries and ectopic pregnancy.

D. Etc.

A. Primary dysmenorrhea
1. Allergic reactions
Women eating food that causes the immune system to react over-aggressively and negatively due to a weakened immune system as well as resulting in an over-production of prostaglandins.

2. Nutritional deficiency
Deficiency of magnesium and DHEA encourages the excess prostaglandins that can facilitate onset of dysmenorrhea.

3. Unhealthy diet
Intake of high amounts of foods containing synthetic preservatives, color agents, additives, and caffeine causes tension in the nervous system, weakens the immune system, and increases inflammation of our body's system resulting in a distortion of hormone production.

4. Excessive estrogen
Balancing of estrogen and progesterone is necessary for a normal menstrual cycle. Women who are taking estrogen enhancing medications may cause an imbalance of estrogen and progesterone resulting in a hormone imbalance and menstrual cramps.

5. Over weight
Women who are overweight have twice the risk for having stronger and more persistent menstrual pain than women who are not.

6. Smoking.
Cigarettes are a stimulant that not only causes tension in our nervous system, but also distorts hormone production causing excessive production of prostaglandins. Women smokers are more likely to suffer from menstrual pain.

7. Stress
Stress is a psychological and physiological response to events that upset our personal balance in some way causing chemical imbalances in the brain resulting in irregular menstruation or menstrual cramps.

8. Etc.

B. Secondary dysmenorrhea (including those in primary dysmenorrhea)
1. Endometriosis
Endometriosis is a condition in which the cells that line the interior of the uterus dislodge and grows outside the uterine cavity resulting in no exit for the blood when estrogen levels drop causing dysmenorrhea.

2. Fibromas
These benign tumors form and grow in the uterus or the ovaries as a result of prolonged, dilatory menstruation or abortion as well as imbalances between estrogen and progesterone causing pain during the menstrual flow.

3. Pelvic inflammatory disease (PID)
PID is a bacterial infection of the uterus, fallopian tubes and ovaries.

4. Ectopic pregnancy
is defined as a condition in which the fertilized implant in somewhere else other than in the uterus. In most case, ectopic pregnancy occurs in the one of the Fallopian tube, causing tubal pregnancy. Ectopic pregnancy will end up in miscarriage cause of dysmenorrhea as the fertilized can not survive outside of uterus.

5. Sexual transmitting diseases
also known as sexually transmitted infection is an illness which can only transmit through sexual intercourse as a result from the infectious partner or IV drug needles after its use by an infected person, through childbirth or breastfeeding, including vaginal intercourse, oral sex, and anal sex. The disease can lead to infectious causes of dysmenorrhea.

6. Etc.

A. Diet
1. Tofu
Tofu is made from yellow beans. It contains high levels of isoflavones. Intake of tofu will help to stimulate the production of good estrogen which is low during menstruation resulting in reducing the inflammation as well as menstrual cramps. It also inhibits bad estrogen, also known as xenoestrogens which causes breast cancer and tumors in women. Raw yellow bean is toxic and harmful to our body.

2. Legumes
Legume is dark green food. It contains high amounts of vitamin C and chlorophyll that help to relax our abdominal muscles caused by inflammation during menstruation and fighting against forming of free radicals in our body.

3. Deep sea fish
Deep sea fish such as tuna and salmon containing high amounts of iron and omega 3 fatty acid helps to stimulate the production of red blood cells that is essential to replace blood loss during menstruation. Without omega 3 fatty acids to balance the excessive of omega 6 acid it will result in hormone imbalance thus increasing the risk of menstrual cramps.

4. Banana
Bananas contains high amounts of potassium and magnesium that work together to block the release of prostaglandins and occurrence of spasms.

5. Green tea
Green tea helps to stimulate the digestive system resulting in a cooling sensation and alleviating sharp, stabbing pain during menstruation.

6. Mexican wild yam
Mexican wild yam contains precursors to DHEA that help to regulate and balance hormones the natural way resulting in reducing symptoms of menstruation. Study shows that people with healthy DHEA levels when given a choice, chose lean protein and carbohydrate foods as opposed to foods comprised of high fat.

6. For more information of healthy foods visit 100+ Healthy Foods Classification

B. Nutritional Supplements
1. Vitamin B1
Vitamin B1 is also known as thiamin, thiamine or aneurine hydrochloride. Excessive alcohol drinking and unhealthy diet are the major causes of vitamin B1 deficiency, therefore women with bad drinking habits and women that eat more junk food will likely have dysmenorrhea.

2. vitamin E
Study shows that women who take Vitamin E two days before menstruation continuously and three days after the onset of menstruation, was significantly effective in relieving menstrual pain.

3. Magnesium
Since magnesium is an important mineral in maintaining muscle tone, women with deficiency of magnesium will result in overactive muscles leading to menstrual pain and symptoms. Adding magnesium in your daily diet will help to reduce or prevent menstrual cramps and pain.

4. Zinc
Women with dysmenorrhea have zinc deficiency and high levels of prostaglandins, hormones may be at higher risk of menstrual cramping. Since zinc has antioxidant and anti-inflammatory actions and inhibits the metabolism of prostaglandins, intake of zinc will help to reduce menstrual cramps.

5. Omega 3 fatty acid
Women with low intake of omega 3 fatty acid seem to be associate with menstrual pain. Study shows that including omega 3 fatty acid in your daily diet will reduce menstrual pain and menstrual symptoms.

6. Calcium
Since calcium deficiency causes hyperactive muscles, taking calcium supplements may help to reduce chances of menstrual cramps by maintaining normal muscle tone. Study shows that intake of calcium during the menstruate cycle will help to relieve premenstrual cramping, and pain during menses.

7. Etc.

A. In conventional medicine
A.1. NSAIDs non steroid anti inflammation
1. In a study of Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Marjoribanks J, Proctor M, Farquhar C, Derks RS., researchers found that NSAIDs are an effective treatment for dysmenorrhoea, though women using them need to be aware of the significant risk of adverse effects. There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea.
2. Risks and side effects
a. Stomach bleeding
b. Heart failure
c. Toxicity to the kidneys, ears, and stomach
d. Heart diseases
e. Some researchers advised that Taking more than one NSAID is risky.
f. Etc.

A.2. Birth control pill
1. Contraceptive pill
a. Low-dose combination birth control pills which contains low-dose synthetic forms of the hormones estrogen and progesterone may be use to treat amenorrhea by controlling the menstrual cycle or bring the period back.
b. Risks and side effects
b.1. Growth of fibrosis Growth of fibroid is caused high level of estrogen and progesterone. The intake of the pill increase the level of both hormones resulting in increase the risk of growth of fibroid.
b.2. Recurrent of menstrual symptoms Some women stop taking the pill may see all the menstrual symptoms coming back.
b3. Blood clots Estrogen in the pill may cause blood clots in the small vessels in the leg and the lung.
b.4. Stroke and heart diseases Study shows that women who have higher natural estrogen levels may have a higher risk of stroke and heart diseases.
b.5. Depression and mood swing At the beginning, it may cause abnormal fluctuations in estrogen and progesterone elevate both physical and psychological stress, eventually resulting in both depression and mood swing
b.6. Bleeding and spotting Bleeding and spotting is normal for the first six months for women who begin with any oral contraceptive combination pill treatment.
b.7. Lost interest in sex Some women may experience lower sexual desire
b.8. Nutritional deficiency Oral contraceptive pill causes vitamin and mineral imbalances or deficiencies.
b.9. Etc.

2. Progestogen-only contraceptive (Implanon)
a. According to the article of Impannon posted in chemeuro.com, the author stated that The 4 cm by 2 mm Implanon rod contains 68 milligrams of the gonane progestin etonogestrel which is released over a three year period..... Ovulation was not observed in studies of Implanon in the first two years of use and only rarely in the third year with no pregnancies. Study showed that imphanon decrease the symptoms of dysmenorrhea from 59% to 21% after treatment.
b. Risks and Side effects
b.1. Irregular periods,
b.2. Headaches,
b.3. Acne,
b.4. Weight gain
b.5. Excessive menstrual bleeding. Some women may have
b.6. No menstrual period
b.7. Broken or damaged implant
b.8. Slight migration of the implant
b.9. Fibrosis.
b. 10. Etc.

3. Contraceptive coil (Mirena)
a. It is a soft, flexible T-shaped (birth control) device placed inside the uterus by your doctor within 7 days after the start of your period with medication Mirena continuous release over a period of 5 years to prevent pregnancy and reduce symptoms of dysmenorrhea.
b. Risks and side effects
b.1.Spotting between periods
b.2. Complete absence of menstrual flow
b.3. Decreased bleeding during periods
b.4. Prolonged bleeding during periods
b.5. Breast pain and tenderness
b.6. Etc.

4. Etc.

B. Herbs
1. Ginger
Ginger is most commonly used in western medicine in treating dysmenorrhea for a long period of time due to its stimulated function of anti- inflammation, spasmolytic, and circulation. Ginger helps to inhibit cyclo-oxygenase and lipoxygenase enzymes that cause menstrual cramps.

2. Herbal tea
Herbal tea contains high amounts of phytochemicals that helps to relax stomach and uterus muscles resulting in reduced or no menstrual cramps. Drinking herbal tea until the cramping subsides is recommended.

3. Cramp Bark
Cramp bark is a a uterine tonic. It is used to relieve cramps and spasm of all kinds, to treat uterine and ovarian pain, dysmenorrhea as well as relaxing uterine muscle.

4. Raspberry leaf
Raspberry leaf has been used in traditional herbal therapy for a variety of conditions relating to the female reproductive tract, especially during pregnancy and to facilitate delivery. It is a uterine tonic that helps to relax the uterine muscles resulting in reduced menstrual cramps.

5. Pennyroyal
Pennyroyal is a relaxant and stimulant. It has the same property of relaxing the uterine muscle like raspberry leaf, and has been used for treating menstrual cramps.

6. Mugwort
Mugwort has been used in Chinese medicine to relieve pain by promoting blood circulation, restoring depressed liver by invigorating the flow of qi , regulating menstruation and alleviating pain as well as irregular menstruation and dysmenorrhea.

7. Cinnamon
Cinnamon is a highly antioxidant and anti-inflammation herb enhancing inhibition of the metabolism of prostaglandins, intake of cinnamon tea will help to reduce menstrual cramps. Overdose of cinnamon is toxic to your kidney and liver.

8. Etc.

C. Chinese herbs
A. Formula Herbs
A.1. Xiao Chai Hu Tang (Minor Bupleurum Decoction)
According to the study of Xiao Chai Hu Tang & Dysmenorrhea, abstracted & translated by Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM, researchers found that Xiao Chai Hu Tang treats all of the above disease mechanisms and it can treat all the various evolved patterns of dysmenorrhea, such as cold congelation, heat stasis, and hot and cold, vacuity and repletion painful menstruation.
A.2. Ingredients of Xiao Chai Hu Tang Jia Jian include
1. Chai Hu (Bupleurum Root)
Main uses; Regulates Heat, Clears Heat and Resolves depression, Raises Yang Qi.
2. Huang Qin (Skullcap Root)
Main uses; Clears Heat, Dries Dampness, Disperses Fire, Stops bleeding.
3. Dang Shen (Codonopsis Root)
Main uses; Tonifies the Middle, Strengthens Qi, Generation of Body Fluids, Nourishes Blood.
4. Ban Xia (Pinellia Tuber)
Main uses; Dries Dampness, Transforms Phlegm, Stops vomiting, Resolves masses.
5. Chuan Xiong (Szechuan Lovage Root)
Main uses; Moves Blood and Qi, Expels Wind, Calms pain.
6. Dang Gui (Angelica Root)
Main uses; Tonifies Blood, Moves Blood, Calms pain, Moistens the Intestines.
7. Pao Jiang (Blast-fried Ginger)
Main uses; Warms the Middle and Lung, Rescues Yang, Transforms Phlegm.
8. Gan Cao (Licorice Root)
Main uses; Tonifies the Spleen, Benefits the Qi, Moistens the Lungs; Calms cough.
9. Tao Ren (Peach Seed)
Main uses; Moves Blood, Eliminates accumulations, Moistens the Intestines to promote bowel movement.
10. Chuan Niu Xi (Cyathula Root)
Main uses; Expels Wind, Disperses Dampness, Soothes the joints.

B. Individual herbs
1 Dang qui (Chinese angelica root)
Chinese angelica root has been used in Chinese medicine for women's health in treating menstrual cramps, regulating menstrual periods, and lessening menopausal symptoms. Study shows that dang qui can help to reduce pain, dilate blood vessels, and stimulate the relaxation of uterine muscles.

2. Peach kernel
Peach kernel besides helping to enhance blood circulation and remove toxins from our blood, it also helps in moistening the bowels and relieving constipation. It is most often used in treating dysmenorrhea due to pathological blockage in blood circulation and abdominal pain before and after menstruation.

3. Curcuma Root
Chinese doctors believe that menstrual cramps and pain are due to stagnation of the liver-qi and retention of blood stasis in the interior. Curcuma root has been used to relieve pain by promoting blood circulation, restoring depressed liver by invigorating the flow of qi, and clearing away heat in the blood and heart.

4. Corydalis tuber
Corydalis tuber contains powerful alkaloids that have been used in postpartum abdominal pain due to pathological blockage in blood circulation and depressed liver causing qi stagnation. It is an important Chinese herb that has been used for hundreds of years to help relieve almost any painful condition especially for menstrual cramps, and chest and abdominal pains.

5. Safflower
Safflower is one of the many Chinese medicines used to treat difficult and painful menstruation by promoting blood circulation, and by removing any blood blockage substance and regulating blood flow.

6. Nutgrass flatsedge Rhizome
Nutgrass flatsedge rhizome is a Chinese herb that is used to sooth and regulate liver qi promote blood circulation, regulate menstruation, and alleviate pain as well as irregular menstruation and dysmenorrhea.

7. Chuan Niu Xi (Cyathula Root)
Chuan Niu Xi is a liver and kidney tonic herb that has been used in Chinese medicine to strengthen blood circulation, stimulate menstrual discharge, and promote urination.

8. Etc.

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