INTRODUCTION:

Dysmenorrhea and its symptoms may affect academic performance, physical activity and functioning, and overall quality of life. Stress, on the other hand, makes pain more sensitive and severe by triggering sympathetic responses while inhibiting parasympathetic responses.⁹

In the absence of other diseases such as endometriosis, primary dysmenorrhea is characterised as cramping pain in the lower abdomen just before or duringmenstruation. Adolescence is the most common time for primary dysmenorrhea to appear. The issue is often misdiagnosed and untreated.³ Adolescents with dysmenorrhea have less chances for healthy psychosocial and cognitive growth. Depression, anxiety, and smoking all have an impact on menstrual cycles and dysmenorrhea in adults.⁵

Painful menses usually appear in adolescence, around 6-12 months after menarche or when normal ovulatory cycles have been formed⁶ when prostaglandins are formed as a result of ovulation. The most intense menstrual pain is endured by women whose prostaglandin concentrations exceed their maximum amount¹⁰. Pain normally begins within hours of the start of menstruation and peaks within the first day or two of the cycle, when the discharge is at its worst⁵. Associated signs are a wide range of emotional and physical issues that arise during menstruation period. Nausea, vomiting, diarrhea, headache, exhaustion, dizziness, tiredness, and syncope, as well as cramping, can last up to 72 hours; however, many people do not seek medical attention.¹¹

Primary dysmenorrhea, according to Blakey et al., may be caused by incompatibility between pelvic circumference muscles and soft tissue¹². However, there have been few research on the relationship between primary dysmenorrhea and the musculoskeletal system, as well as concrete and accurate studies on the stability of the pelvic cavity diameter. The stability of the pelvic cavity is linked to passive elements like bones and ligaments, as well as active elements like muscles and tendons, which allow for smooth structural and functional movement¹⁵. The musculoskeletal incompatibility was thought to trigger structural and functional changes in the body, as well as a shift in the position of the uterus, increasing dysmenorrhea.¹⁴

Dr. Kecia Gaither discusses the situation. “The uterine lining thickens each month in preparation for pregnancy,” she explains. “If there is no fertilisation, the thickened uterine lining is no longer required and is shed; this shedding is known as the menstrual process.” When this lining sheds, the uterus contracts in order to help free it, which causes cramps. Menstrual cramps are caused by uterine contractions, to put it simply. “If the uterus contracts too hard, it may strain against nearby blood vessels, cutting off oxygen to the uterus' muscle tissues,” Fasula says. “Pain occurs when the oxygen supply is cut off.”¹

Menstruation is a part of life for women. It's also a source of excruciating discomfort for most women in the form of menstrual cramps. We take unpaid time off from work to stay in bed for days or spend a lot of money on doctors who recommend invasive surgery. It's also normal to spend hours searching for relief from cramps or medication for excruciatingly painful periods, however just a handful of us are aware that complementary and alternative therapies can help relieve dysmenorrhea and provide genuine menstrual relief.¹

Nonsteroidal anti-inflammatory drugs:

An NSAID is the most effective first-line treatment for most women with primary dysmenorrhea. These drugs function by preventing the development and release of prostaglandins, which are responsible for nausea and diarrhoea. NSAIDs normally produce a response in 30 to 60 minutes. Since each person's reaction can differ, Prostaglandin inhibitors provide pain relief to approximately 80% of women who are affected¹⁵. While nonsteroidal anti-inflammatory drugs (NSAIDs) are extremely effective and widely available without a prescription¹⁶.

Prostaglandin synthetase inhibitors were given to three classes of patients with primary dysmenorrhea. Thirty-one women were given indomethacin at a dosage of 25 mg 3-4 times per day, typically one to two days before menstruation, and 38 women were given naproxen 250 mg 3-4 times per day, generally on the first day of bleeding (open studies). Indomethacin relieved pain in 71% of patients, while naproxen relieved pain in 67%. In a third series, a double-blind crossover analysis in 26 patients comparing naproxen sodium to placebo revealed that naproxen-sodium was significantly more successful than the placebo (p0.05).¹⁷

Oral contraceptives:

Oral contraceptives are the second line of therapy for most patients, unless birth control is also required. In comparison to the highly effective NSAIDs, they are too cumbersome as a first-line option since they need regular treatment to avoid symptoms for one or two days a month. Effective Oral contraceptives work differently than NSAIDs in preventing menstrual pain. Oral contraceptives have two effects: they reduce menstrual fluid volume and inhibit ovulation. They can be as good as 90% of the time. When compared to a placebo, both oral contraceptives are extremely successful. Menstrual pain can last up to three periods, so emphasise this to patients at the time of the initial prescription and consider adding an NSAID for breakthrough pain in the interim.^2,3,18

Various approaches, such as local fire, medication, thiamin, vitamin E, fish oil supplements, acupuncture, and transcutaneous nerve stimulation, are now used to relieve and monitor pain and symptoms. Prostaglandin synthesis inhibitors, which reduce prostaglandin synthesis by about 80%, are among the most powerful of these approaches^17,19. Like other chemical remedies, these drugs, such as mefenamic acid and ibuprofen, have many side effects. The side effects of synthetic medications, such as oral contraceptives that are used for a long time, are particularly noticeable¹⁹. The use of herbal medicines such as herbs or nutrients in the treatment of primary dysmenorrhea or other complications has gained particular attention^15,19 due to the side effects of these medications (20). This review paper discusses alternative therapies that have been used in the treatment of dysmenorrhea, either clinically or historically.

Vitamin B1:

B1 is an important nutrient in humans, which means we can't produce it ourselves and must get it from diet or supplements (21, 22). The study on vitamin B1 and period pain is still in its early stages, but it appears to be positive. While we don't yet understand how it works, evidence indicates that it does.^18,21 in fact, seem to work. Several research involving vitamin B1 and period cramps are currently being conducted. Despite the small number of trials, they all found that vitamin B1 is an effective cure for menstrual cramps, even in extreme cases. On the basis of several scientific results, here is the current state of science for vitamin B1 and period cramps. For three months, taking 100mg of vitamin B1 a day alleviated perimenopause symptoms.^21,23,24.

Vitamin C:

Vitamin C is a strong antioxidant. It is a necessary vitamin for the human body, and it has been related to the reduction of menstrual pain. While it is recommended that vitamin C be obtained from foods, many people resort to supplements to fulfill their needs. An intravenous vitamin C injection, on the other hand, can be obtained for even faster results. Menstruation results in a loss of blood, including iron. If the amount of iron we absorb in our diet does not equal the amount of iron we lose during our lifetime, we will develop an iron deficiency. Vitamin C improves iron absorption, which helps to avoid iron deficiency. It's a potent antioxidant that improves immunity by improving the function of white blood cells.²⁵

Vitamin D:

Vitamin D has traditionally been used to treat dysmenorrhea. Calcium's function in reducing contractions can be attributed to the connection between calcium intake and dysmenorrhea. Low calcium levels exacerbate uterine spasticity and contractions. Vitamin D levels influence calcium homeostasis, so it can help with dysmenorrhea.²⁶

Vitamin E:

It's also used to help with dysmenorrhea symptoms. Progesterone deficiency during the luteal phase of the menstrual cycle may lead to enzyme lysis, phospholipid peroxidation, and the development of arachidonic acid. Both of these changes result in an increase in prostaglandin levels, which stimulates uterine cramps and contractions. Vitamin E decreases phospholipid peroxidation and prevents the release of arachidonic acid and its conversion to prostaglandins due to its antioxidant properties. As a result, it has the potential to significantly reduce the incidence of dysmenorrhea.¹⁶

Magnesium:

Every two months, prostaglandin F2 alpha (PGF2 alpha) was assessed to monitor treatment progress. On Mg therapy, the researchers were able to reduce PGF2 alpha levels in menstrual blood to 45 percent of what they were before starting care. Mg's unique therapeutic activity is most likely due to its inhibition of PGF2 alpha biosynthesis, as well as its direct muscle relaxant and vasodilatory effects. Magnesium supplementation, in addition to PG-synthesis and ovulation inhibitors, is a natural option for treating primary dysmenorrhoea. In a double-blind trial, 50 patients with primary dysmenorrhoea were treated with Magnesium (Mg 5-longoral, Artesan GmbH). Just four women recorded no therapeutic effect after six months, while 21 out of 25 women reported a decrease in symptoms.^20,23,27.

Omega-3 Fatty Acids:

The anti-inflammatory properties of omega-3 fatty acids contained in fish oil may be used to treat primary dysmenorrhea by affecting the synthesis of prostaglandins and other factors involved in pain and inflammation.²⁸ Omega-3 two months will obtain a blood concentration of this substance to cause anti-inflammatory and analgesic effects, according to research²⁹. Most studies have shown that omega-3 fatty acids are well tolerated by most people, with adverse side effects occurring only in large doses (more than 6 gm per day It has anti-inflammatory properties because it produces vasodilator ecosanoids like PGE3 and PGF3 and inhibits the development of vasoconstrictor prostaglandins like PGE2 and PGF2 from omeg-6.³⁰

Fish and fish oil:

In dysmenorrhea, the form of fat consumed can also make a difference. Fish oil, which is rich in omega-3 fatty acids, can help with menstrual cramps by modulating prostaglandin output. Menstrual pain was found to be substantially associated with a low consumption of animal and fish products, as well as a low omega-3 to omega-6 dietary ratio, in a Danish study of 181 women aged 20 to 45.²⁷ In a placebo-controlled, crossover study, 42 dysmenorrhea-affected adolescents were randomly assigned to either a placebo or fish oil supplements (containing 1,080mg eicosapentaenoic acid, 720mg docosahexaenoic acid, and 1.5mg vitamin E); the groups were switched after two months. Dysmenorrhea symptom scores decreased dramatically (from 69.9 to 44.0) after fish oil therapy, according to the Cox Menstrual Symptom Scale.²⁷

Chaste Tree or Chasteberry (Vitex Agnus-Castus) (Vac):

For decades, chasteberry has been used to address a variety of menstrual issues. It primarily functions by influencing the levels of certain hormones in our bodies. The therapeutic dosage of chasteberry varies depending on the brand and formulation. It comes in liquid, pills, and tablet form. The majority of clinical trials used a dosage of 20-40 mg/day, but some trials used doses as high as 1800 mg/day, which should be avoided during pregnancy²¹.

Chasteberry produces a variety of phytochemicals, including flavonoids, which are believed to have a variety of health benefits. Chasteberry contains many different forms of flavonoids. Some of these flavonoids have been shown to influence hormone levels in the body, especially prolactin, progesterone, and to a lesser extent oestrogen.

Relieves PMS symptoms such as irritability, mood swings, frustration, headaches, breast fullness and pain, and abdominal bloating; can also aid in the regulation of the menstrual cycle and PCOS. 20mg VAC extract, one capsule daily can be used to treat.

Fennel (Foeniculum Vulgare):

Fennel essential oil has been found to be equivalent to mefenamic acid, a nonsteroidal anti-inflammatory drug (NSAID). Prostaglandin E2 and Oxytocin-induced uterine contractions appear to be inhibited by the mechanism. 30 drops of fennel extract at the start of menstruation and then every 6 hours for the first three days of menstruation²². Soak some fennel seeds overnight in a glass of water and drink it first thing in the morning. This beverage aids in the contraction of the uterus, the regulation of bleeding, and the reduction of pain. Cinnamon is another home remedy for menstrual pain that may help with excessive bleeding and pain²³. Since in vitro experiments have shown some adverse effects on foetal cells, fennel supplements should be avoided during pregnancy.³¹

Ginger:

Ginger is one of the herbs for which there has been a lot of study. Jenabi discovered that ginger reduced pain and nausea in women suffering from primary dysmenorrhea. In women with primary dysmenorrheal pain, Ozgoli et al. found that ginger was just as good as mefenamic acid and ibuprofen at relieving pain. The mechanism by which ginger relieves pain is unknown. Nonetheless, evidence indicates that ginger contains anti-inflammatory and analgesic ingredients (such as gingerol and gingerdione). In addition, laboratory studies show that ginger helps to relieve dysmenorrhea by inhibiting cyclooxygenase, which in turn suppresses prostaglandins and leukotrienes.²⁵

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Received on 28.02.2021 Modified on 17.03.2021

Int. J. Nur. Edu. and Research. 2021; 9(3):381-384.

DOI: 10.52711/2454-2660.2021.00089