Dr Bhavana P
Abstract
Dysmenorrhea is the most common problem faced by women in their reproductive age. Aside from physical health, dysmenorrhea also disturbs the Quality of Life and productivity of young females. Up to 15% of women with dysmenorrhea experience symptoms of sufficient severity to cause absenteeism from work, school, and other activities. The work “Uterine Therapeutics” by Dr. Henry Minton, is a masterpiece work on the female uterine diseases. This work is a meticulous compilation of all the symptoms related to uterine disorders. The repertory part of this book is useful for solving cases with all common symptoms, clinically diagnosed cases. It helps in managing the cases of dysmenorrhea efficiently.
Keywords: dysmenorrhea, Minton’s uterine therapeutics, regional repertory
Introduction
Dysmenorrhea is the most common gynaecologic condition experienced by menstruating women. The term dysmenorrhea is derived from the Greek words dys (difficult, painful, or abnormal), meno (month), and rrhea (flow). Dysmenorrhea literally means painful menstruation. But a more realistic and practical definition includes cases of painful menstruation of significant magnitude so as to incapacitate day to day activities. It is characterized by crampy lower abdominal pain and has significant medical and psychosocial implications.1 In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology, while in secondary dysmenorrhea gross pathology is present in the pelvic structure.
Repertory is a systematic and logically arranged index of homoeopathic Materia medica. It a very useful tool for arriving at the similimum. The “Uterine Therapeutics” is a type regional repertory. It is a useful monograph on the problems of menstruation and other related functions. It is a result of 16 years of patient study and clinical practice of Dr. Minton. The purpose of this repertory is to collect and arrange in a systematic and convenient form for ready reference all those symptoms of Materia Medica that have any direct or specific bearing upon the subject of uterine disorders.3
Epidemiology
Globally, the estimated prevalence of dysmenorrhea varies widely, ranging from 45 to 93% of women of reproductive age and the highest rate are reported in adolescents. The prevalence of dysmenorrhea in India was estimated to be 70% with 34.7% complaining of severe dysmenorrhea.2
Types of dysmenorrhea and its clinical features4
Primary dysmenorrhoea: It refers to the one that is not associated with any identifiable pelvic pathology. Prostaglandins are responsible for causing increased uterine tone and high magnitude contractions.
- The pain begins a few hours before or just with onset of menstruation. The severity of pain usually lasts for few hours, may extend to 24 hours but seldom persists beyond 48 hours.
- The pain is spasmodic and confined to lower abdomen, may radiate to the back and medical aspect of thighs.
- Systemic discomfort like Nausea, vomiting, fatigue and tachycardia may be associated.
- Abdominal or pelvic examination does not reveal any abnormal finding.
Secondary Dysmenorrhoea: It starts later and is due to pelvic pathology. It is most often congestive in nature, and is associated with the presence of organic pelvic pathology such as fibroids, adenomyosis, IUCD in utero, pelvic inflammatory disease and endometriosis.4
- The pain is dull, situated in the back and in the front without radiation.
- It usually appears 3-5 days prior to the onset on menstruation and relieves with the onset of bleeding
- No systemic discomfort.
- Abdominal and pelvic examination usually reveals the pathology.
Investigations
- Ultrasonography
- Transvaginal sonography
- Laparoscopy
General Management
General measures include improvement in nutritional state and dietary changes, regular exercise, explanation regarding the condition & reassurance, psychotherapy.
Uterine Therapeutics by Henry Minton published in 1883 is a regional repertory which is mainly focused on uterine disorders. This book is an easy access for cases that are rich in common symptoms, clinically diagnosed cases as well as short cases with a few symptoms.
The book contains 177 remedies (although the list of remedies contains 178 remedies: cimicifuga and actea racemose are repeated)
Two types of Typographies have been used in the whole book.
- Italics
- Ordinary Roman.
The repertory is divided into 2 parts
Part I contains ‘Remedies and their indications’ in which remedies are discussed under the following headings:
- Menstruation
- Before menstruation
- During menstruation
- After menstruation
- Amenorrhoea
- Metrorrhagia
- Lochia
- Leucorrhoea
- Concomitants
- Aggravations
- Ameliorations
Last paragraph of each remedy deals with the constitution and adaptability of the remedy in brief.
Part II contains the Repertory part. It has following sections:
- Menstruation:
- Before menstruation
- During menstruation
- After menstruation
- Amenorrhoea
- Metrorrhagia
- Lochia
- Leucorrhoea
- General concomitants
The following rubrics from this repertory can be used for the selection of remedy in a case of dysmenorrhea:
Primary dysmenorrhoea
During menstruation, concomitant symptoms
- Abdomen, pains in, spasmodic
- Abdomen pains in, extending to thighs
- Colic
- Diarrhoea
- Fainting, fits or spells of
- Headache, pain in the head
- Nausea
- Vomiting
Secondary Dysmenorrhoea
Before menstruation, concomitants
- Abdomen, pains in, spasms in
- Back pain in
- Pelvis congestion of
During menstruation, concomitants
- Pains in general, dysmenorrhoea
- Uterus, congestion of
- Uterus, displacements of
- Uterus enlargement of
A case worked out using Minton’s Uterine therapeutics:
A 22-year-old female patient presented to the out-patient department of government homoeopathic medical college and hospital on 4/03/2024 with the complaints of pain during menstruation since 2 years.
The pain is severe and spasmodic in nature and is present on the first 2 days of menstruation. Pain starts in the lower abdomen and radiates to the back and thighs. She feels slightly relieved by bending double, has to take allopathic medications for pain on both the days.
Her LMP was on 20/02/2024.The cycles are regular- 30 days, flow is moderate (2 pads/day)- 5 days, it is dark red in color, no odor or clots. She also complains of increased weakness during menses.
No significant personal and family history. On physical examination, the heart rate was 78 beats per minute, blood pressure was 120/70 mmHg, respiratory rate was 17 per minute and she was afebrile at the time of examination.
On USG abdomen and pelvis no significant abnormality was detected.
A working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) score was used to assess the severity of dysmenorrhea.6 The WaLIDD scale integrates the following features of dysmenorrhea such as
- Pain intensity: Wong-Baker pain range
- Number of anatomical pain locations
- Number of days of pain during menstruation
- Frequency of disabling pain to perform their activities
With a minimum score of 0 to each item and maximum score of 3, and the final score ranged from 0 to 12 points. Depending on the total score obtained the severity of dysmenorrhea is classified as 0- no dysmenorrhea, 1-4 mild, 5-7 moderate, 8-12 severe.
The WaLIDD score of the patient was 8, meaning the patient was suffering from severe dysmenorrhea.
Rubrics selected
- During menstruation, pain in general, dysmenorrhea
- During menstruation, pain compel her to bend double
- During menstruation, uterus, pain in, spasmodic
- Menstrual discharge, dark
- During menstruation, weakness, debility, lassitude, exhaustion, etc
After repertorisation actea racemosa 200 BD for 3 days was prescribed.
Follow-up:
25/03/2024:
LMP-18/03/2024
WaLIDD score came down to 7, patient didn’t take any allopathic medicines. C/O weakness was better.
Actea racemose 200 was repeated for 3 days.
30/04/2023:
LMP- 16/04/2024
WaLIDD score -5
c/o pain in abdomen better, no radiation of pain.
C/o weakness better but still persists.
Actea racemose 200 was repeated for 3 days.
Conclusion
Dysmenorrhoea impacts a substantial public health burden and it significantly decreases the quality of life of patients. With the help of homoeopathic medicines, we can improve quality of life of women and decrease the abstinence from work and school. This book of Repertory having Materia Medica alongside furnishes a great information about the symptoms and its related rubrics related to female uterine complaints all under in a compacted roof. In spite of having limited clinical rubrics, this book can serve as a ready reference for the beginners in making a precise and quick prescription.
References
- Morrow C, Naumburg EH. Dysmenorrhea. Primary Care: Clinics in Office Practice. 2009;36(1):19–32. doi:10.1016/j.pop.2008.10.004 (Accessed on :29-09-2023). Available from- https://www.sciencedirect.com/science/article/abs/pii/S0095454308000997
- Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiologic reviews. 2014 Jan 1;36(1):104-13. https://doi.org/10.1093/epirev/mxt009 (Accessed on :29-09-2023) Available from- https://academic.oup.com/epirev/article/36/1/104/566554
- Henry Minton, “Uterine Therapeutics”, 2012 Edition, B. Jain publishers (P) ltd.
- Dutta D C. Dysmenorrhea and other Disorders of Menstrual Cycles.In: Hiralal Konar. D C Dutta’s Textbook of Gynaecology.6/e, Jaypee Brothers Medical Publishers(p) ltd; New Delhi, 2016
- Tiwari S K, Essentials of Repertorization, New Delhi: B Jain publishers; 2012.
- Teherán AA, Piñeros LG, Pulido F, Mejía Guatibonza MC. WaLIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International journal of women’s health. 2018 Jan 17:35-45. https://doi.org/10.2147/IJWH.S143510 . (Accessed on :10-09-2023). Available from-https://www.tandfonline.com/doi/full/10.2147/IJWH.S143510
Dr Bhavana P
MD(HOM) Part 1-PG Scholar
Department of Case taking and Repertory
Government Homoeopathic Medical College and Hospital, Bengaluru.
UNDER THE GUIDANCE OF
Dr Anusuya M Akareddy MD (HOM)
Associate professor and PG guide
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