Background: Primary dysmenorrhoea is a type of cyclical chronic pelvic pain among adolescent and young women which is be due to excessive prostaglandin, leukotriene, and vasopressin production as well as myometrial ischemia or due to uterine malformation.
Material and method: A prospective observational open-labeled study having 30 diagnosed cases of primary dysmenorrhoea, selected according to inclusion and exclusion criteria, case taking was done on the basis of the principles of homoeopathy, prescription was based on totality of symptoms, reportorial totality and analysis and finally referring to materia medica. Follow up was evaluated by changes in clinical presentation, changes in score of WaLIDD monthly and lastly statistical analysis of data was done using MS Excel.
Results: This study result showed significant reduction in the disease intensity scores after the homoeopathic treatment.
Conclusion: This study result suggested a positive role of homoeopathic treatment as an alternative medicine in cases of primary dysmenorrhea.
Keywords: gynecology, homoeopathy, individualization, primary dysmenorrhoea, WaLIDD
Abbreviations: Prostaglandin-F2α (PGF), non-steroidal anti-inflammatory drugs (NSAIDs), outpatient department (OPD), in-patient department (IPD), working ability, location, intensity, days of pain, dysmenorrhoea score (WaLIDD)
Pain, in itself, speaks a language, and if it cannot be shared, then it becomes more insurmountable from the rest. Menstrual pain or dysmenorrhoea is most prevalent yet most neglected disorder faced by a woman thinking it to be a normal physiological process, for at least once while attaining their womanhood. It is chronic cyclical lower abdominal or pelvic pain which may radiate to the back or to the thighs, occurring during menstruation.1of sufficient magnitude making incapacitate the patient in day-to-day activities2 where they may experience associated physical and emotional symptoms,3 interrupting their educational and social life4. The true incidence and prevalence are not clearly established in India.1,3 due to cultural reasons menstrual problems often get unreported5 but some studies has mentioned it in range of 50% to 87.8%.3 and found to be the leading cause of school/work absenteeism.6 It is been broadly categorised into two types: primary due to absence of any underlying uterine condition and secondary where pelvic pathology is present.2 Aetiology can be summarised in Psychosomatic factors, abnormal anatomical and functional aspect of myometrium like irregular thickening, difficulty in peristalsis, etc., imbalance in the autonomic nervous control of uterine muscle, role of prostaglandins, especially PGF2α, vasopressin, endothelins, leukotrienes and platelet activating factors. The pain mostly starts with or few hours before the onset of menses. The severity of pain usually lasts for few hours, may extend to 24 hours but seldom persists beyond 48 hours.2 Further investigations are rarely warranted if the history and examination ﬁndings are suggestive of primary dysmenorrhoea.7 Women usually seek medical advise when self-help measures such as heat and over the counter drugs fail to relieve. The mainstays of conventional therapies are NSAIDs, contraceptive pills8 and in cases where formers don’t help invasive and surgical intervention is opted. But several times, these conventional therapies are not better tolerated by some females9 and have also been seen to have adverse effects associated with it.10 So many women prefer to seek Complementary and alternative therapies to cope with the conditions.11 Homoeopathy is seen to be an effective and safe alternative to synthetic hormones without placing the patient at risk.12 Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period.13 The best part of the homoeopathic medicines is that it not only relieves pain, but also cures the tendency to have menstrual cramps. This means that after some time of treatment, the problem is completely cured and one is able to get rid of the problem permanently. 14 The treatment should be continued until the patient menstruates normally or nearly so. Prescriptions made during the inter-menstrual period were seen to be most efficacious, as latent expression is shown more clearly and the acute expression has quieted down, so it is better to base prescription upon this symptomatology.15
METHODOLOGY: (MATERIAL and METHODS)
- Sources of data – OPD and IPD of Govt. Homoeopathic Medical College & Hospital, Bhopal,
- Number of cases – 30 cases excluding dropouts
- Definitions used for study purpose –
- Selection of medicine – Was based on individualization after proper analysis, evaluation and miasmatic analysis of the case as per homoeopathic principles.
- Follow up- Cases were followed up properly on one month interval and results was assessed on the basis of clinical symptoms and changes in WaLIDD scores
- Methods of tests/procedures- Detailed and thorough case taking of each and every case having primary dysmenorrhoea.
- Relevant clinical examinations and laboratory investigations if required.
- Evaluation of symptoms as per homoeopathic principles and framing the totality
- Analysis, evaluation and Repertorisaton of the totality of symptoms taking help of Computer-aided (digital) Radar repertory.
- Final selection of medicine by miasmatic inference and consulting homoeopathic materia medica.
- On the basis of susceptibility, potency, dose and repetition was decided following strict homoeopathic principles.
- General management which includes proper diet and regimen, hygiene and rest.
- Timely review of homoeopathic prescription on the basis of patient’s response.
- Statistical method-
Assessments of cases were done with the help of WaLIDD score and changes in values at the baseline visit and last follow up visit. Final calculation was done to find out the p-value with the help of paired t- test for two variables in Microsoft Office Excel 2007
Observation and result: In total no. of cases (n=30) the critical ratio, paired-t follows a distribution on with n-1 degree of freedom. The 0.1% level is 3.659, 1% level is 2.756 and 5% level is 2.045 for 29 degree of freedom. WaLIDD score table which is the summation of the entire variables, on analyzing the “t” value through Microsoft excel, P (T<=t) two-tail value is 2.93 which is greater than the table at 5% (p<0.05).This study provided evidence to say that there was significant reduction in the disease intensity scores after the homoeopathic treatment.
Discussion: In this study, 35 cases of primary dysmenorrhoea of age group 11 to 25 years were enrolled from general screening of patients out of which 5 cases were dropped out rest 30 cases completed the study with regular follow ups (n= 30). Before enrolling in the study population, every patient was evaluated and diagnosed on the basis of clinical history, clinical examination and WaLIDD scoring which is dedicatedly used for diagnosis of primary dysmenorrhoea. Proper case taking is been done with proper evaluation and analysis of case making totality of symptoms to prescribe. The patients are been prescribed indicated medicine and doses as per the totality of symptoms and requirement in every individual case. The analysis of the sample size of the 30 cases depicted highest preponderance of the primary dysmenorrhea disorder in age group 14 to 16 years. The age incidence depicts the disease start and reporting in clinic or to physician by the patients. Among the sample size population it is been noted that the majority of cases are which are affected had the onset of menstrual period or menarche before or at the age of 13 years comprising the data as suggesting the relation of early menarche. The study expresses that the role of family history is more or less related to the disorder. The miasm is an important aspect to be taken into account while prescribing in homoeopathic system of medicine. The effect of miasm cannot be overlooked while treating any case. In study’s sample size population depicted that the disorder covered more of pseudo-psoric miasm and sycotic miasm. Homoeopathy is a science of individualization in which each and every case is different and it should be dealt differently on basis of symptom similarity and totality of symptoms. The medicine should be based on strict homoeopathic principle then only it would bring out the true miraculous results. In this study, all patients were prescribed on the basis of individualization and totality of symptom following homoeopathic principles. It is been seen that the remedy Pulsatilla nigricans has relieved and brought about positive changes in majority of cases. Other medicine which is seen emerging in such cases is from Natrum group, Silicea terra, Phosphorus, Calcarea phosphorica, Lachesis mutus, etc. To analyse and evaluate the effect of prescribed medicine the WaLIDD score itself is been used.16 Analysis of WaLIDD score which is the integrated tool having the entire variable showed marked changes suggesting the positive effect of homoeopathic remedies on primary dysmenorrhoea disorder.The period of this clinical study was too short to assess the curability for primary dysmenorrhoea. Although there was good improvement in majority of cases, but there was no surety of their continuous improvement, and noting the curability of the disease demands more time.
Conclusion: The statistical demonstration of the study implicates the effectiveness of homoeopathic treatment in cases of primary dysmenorrhea as it reduced the severity of complaints with other associated complaints as well.
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About the Authors :
Dr Laxmi Mahto (MD scholar)
Under guidance of Prof (Dr) Praveen Jaiswal
Dept. of Practice of Medicine
G.H.M.C. & H, Bhopal