Menstruation period, Menstruation Disorders

Written by : Dr. Shraddha Thakur 

The reproductive system of women is structurally and functionally much more complex than that of men. Despite not being visible from outside, all the organs inside a woman's body work like a sensitive and complex but efficient instrument of nature to create a new life in the form of a baby.

But due to this system being very sensitive and complex, there is a possibility of becoming a victim of many types of problems. Generally, the problem of menstruation is seen in women, mainly in modern unnatural environment. These problems continue to trouble many women throughout their lives. A detailed analysis of menstrual periods is given further in this article.

Table of contents

•  What is Menstruation Period 

•  Menstruation disorders 

•  Dysmenorrhea 

•  Primary Dysmenorrhea 

•  Secondary Dysmenorrhea 

•  PMS( premenstrual syndrome)

•  Amenorrhea 

•  Primary amenorrhea 

•  Secondary amenorrhea

 

•  Management

•  Asanas

•  Acupuncture for dysmenorrhea 

• Treatment - main point 

•  Supplementary points

•  Cooling pranayama

•  Home remedies for amenorrhea

What is Menstruation Period ?

The menstrual period, commonly known as a "period," is a regular and natural part of the menstrual cycle in most women of reproductive age. 

The menstrual period refers to the shedding of the uterine lining, called the endometrium, that occurs approximately once a month. This process is initiated to prepare the body for a potential pregnancy.  

A typical menstrual period typically lasts between 3 to 7 days, although it can vary from person to person. In a standard menstrual cycle, women typically have one period every 21 to 35 days, although variations can be considered normal. Menstrual blood is not just blood; it also includes tissue from the uterine lining, mucus, and sometimes small clots. The blood exits the body through the vagina. Proper menstrual hygiene is essential to maintain health and prevent infections. This involves using sanitary products such as pads, tampons, or menstrual cups and changing them regularly. The menstrual period is an indicator of a healthy reproductive system and plays a role in fertility. It marks the release of an egg (ovulation) from the ovaries. Many women experience symptoms before and during their periods, such as cramps, bloating, breast tenderness, mood changes, and fatigue. These symptoms are often collectively referred to as premenstrual syndrome (PMS). Hormonal changes, particularly involving estrogen and progesterone, regulate the menstrual cycle. These hormones coordinate the thickening and shedding of the uterine lining.

The menstrual period is a normal and healthy part of a woman's life. While some women may experience discomfort or symptoms like cramps, these are typically manageable. Further detailed information about menstrual disorders is given in this article.

Menstruation disorders 

Menstruation disorders, also known as menstrual abnormalities or menstrual disorders, refer to a wide range of atypical or problematic conditions related to a woman’s menstrual cycle. These disorders can manifest in various ways and may indicate underlying medical issues. Here are some common menstruation disorders:

1. Dysmenorrhea 

2. PMS ( premenstrual syndrome)

3. Amenorrhea 

 1. Dysmenorrhea 

• Painful menstruation of sufficient magnitude so as to incapaciate day to day activities 

• The word dysmenorrhea is derived from Greek word DYS means difficult, painful or abnormal MENO -means -month and RRHEA- means- flow 

• It can be manifested in the form of different kind of pain including sharp, throbbing, dull , nauseating, burning or shooting pain 

• Painful cramping pain accompanying menstruation 

• May or may not be associated with other symptoms like nausea , vomiting 

 Epidemiology 

It is a common gynecological condition that is under diagnosed prevalence estimates vary from 45% to 95% worldwide 

  Aetiology 

Primary Dysmenorrhea  

• One that is not associated with any identifiable pelvic pathology.

• It is a menstrual pain that is not a symptom of an underlying gynecological disorder but is related to the normal process of menstruation 

• The pain is related to dysrhythmic uterine contractions and uterine hypoxia 

• Pain is attributable to biochemical derangement.

• Affects more than 50% women between 18-25 years.

 Causes

Psychosomatic factor- due to stress and anxiety, lower pain threshold is often attributed as an aggravating factor 

• Abnormal anatomical and functional aspect of uterus 

 Clinical features 

• The pain begins few hours before or just with onset of menstruation 

• Asual duration 48- 72 hours 

• The pain is spasmodic and confined to lower abdomen, may radiate to back and medial aspect of thighs 

   Secondary Dysmenorrhea 

• It may be related to increasing tension in the pelvic tissue due to premenstrual pelvic congestion or increased vascularity in pelvic organ

• Associated with organic pelvic pathology example- fibroids, PID ( pelvic inflammatory disease) , endometriosis 

 Clinical features 

• Pain is dull , mainly in back and in front without any radiation 

• Heavy menstrual flow or irregular bleeding 

• The onset and duration of pain depends upon the pathology behind the pain

   Varieties 

(1) Spasmodic dysmenorrhea- 

Most common manifest as cramping pains , mostly on the 1st and 2nd day of menstruation 

(2) Congestive dysmenorrhea- 

Manifest as increasing pelvic discomfort and pain a few days before menses begain. Then patient rapidly experience relief seen in PID.

 (3) Membranous-

 Special group endometrium is shed as cast at the time of menstruation which is accompanied by painful uterine cramps.

   Clinical features 

• Uterine cramping 

• Nausea and vomiting

• Backache

• Diarrhea 

• Giddiness 

• Syncope and fainting 

• Both local and systemic symptoms are the result of increased levels of PG

• Dysmenorrhea is responsible for highest incidence of absenteeism resulting in loss of work hrs and economic loss

• Primary dysmenorrhea accors in ovulatory cycles. Hence it appears few years after menarche.

• It is most intense on the 1 st day and progressively lessen with time and after childbirth.

 Investigation

Secondary dysmenorrhea- usg- transvaginal 

• Diagnostic hysteroscopy 

  Treatment 

• Counseling 

• Psycho therapy 

• Surgery 

• Medical measures 

Counseling is most important.

Medical measures- consist  of 

• Pain relief 

• Suppression of ovulation- if patient desire contraception additionally 

Drugs- 1. Analgesic 

              2. Antispasmodic 

              3.ocp

              4. PG synthetase inhibitors 

Secondary dysmenorrhea- 

Only in secondary dysmenorrhea to treat underlying pelvic pathology.

When medical measures fails option are- hysteroscopy 

Laparoscopy 

Hysterectomy/ laparotomy - depending on the pathology 

 2. PMS( premenstrual syndrome)

• It is a symptoms complex recognised primarily by cyclic changes associated with ovulatory cycles.

• Occurs 7-14 days prior to menstruation.

• More frequently encountered in middle aged women.

 Aetiology 

• Exact cause not known.

• It has been postulated that it represent a syndrome which is result of multiple biochemical abnormalities.

The following are implicated- 

• Estrogen excess or progesterone deficiency in luteal phase 

• Increase carbohydrate intolerance in luteal phase 

• Pyridoxine deficiency- role in estrogen synthesis and also in dopamine and serotonin production and many other 

• It is yet not clear whether PMS is abnormal response to result of hormonal abnormalities 

  Clinical features 

• Increased breast tenderness 

• Abdominal bloating 

• Fatigue 

• Emotional lability 

• Mood swings 

• Depression 

• Weight gain 

• Fluid retention 

All this begin 7- to 14 days prior to menstruation 

 Diagnosis 

• History and careful questioning 

• Menstrual diary 

 Treatment 

• Reassurance 

• Counseling 

• Life style modification example- salt restriction, fluid restriction etc

• Psychotherapy 

• Selective use of medication 

  3. Amenorrhea 

Absence of menstruation.

   Classification 

(1) Primary amenorrhea 

(2) Secondary amenorrhea 

   Primary amenorrhea 

Failure of onset menstruation beyond 16 years regardless of development of secondary sexual characters 

Primary amenorrhea-

 (1) Hypergonadotropic 

  (2) Eugonadotropic 

   (3) Hypogonadotropic 

   Secondary amenorrhea 

Failure of occurrence of menstruation for 6 months or more in previously menstruating women 

Secondary cause- 

physiological-

 1 Pregnancy 

 2 Lactation 

 Pathology 

(1) Genital tract-

 Example- a Sherman's syndrome 

(2) Ovarian-

 Example- PCOD , radiotherapy 

(3) Pituitary- 

Example- Hyperprolactinemia 

(4) Hypothalamus 

(5) Adrenal 

(6) Nutritional 

(7) Thyroid- hypothyroidism 

(8) Diabetes, T.B. , severe anemia 

  Investigation 

UPT- pregnancy is the most common cause of secondary amenorrhea 

Blood test- 

• PRL ( prolactin levels) 

• TSH ( thyroid stimulation hormone)

•  CBC ( complete blood count)

  According to naturopathy 

• Dysmenorrhea is caused due to severe congestion in the abdominal organ

• The pain and unpleasantness caused by menstruation is due to encumbrance of the body by morbid matter 

• Imperfect digestion due to accumulation of foreign matter in the abdomen 

The encumbrance leads to lowerd vitality 

 Yoga philosophy describes dysmenorrhea as impairment of apana vayu, which is responsible for menstrual cramps 

This disturbance in apana vayu reroute its natural dawnward movement towards the upper part of body resulting in dysmenorrhea 

Management- 

IAYT( integrated approach yoga therapy)

Dysmenorrhea 

• Aim of management 

• To relieve menstrual cramps 

• To reduce stress and anxiety 

• To restore normal physiological activities 

• To manage other complications related to dysmenorrhea 

 Annamaya Kosha

Diet : Sattvic diet 

• Tender coconut water , raw ash guard juice, fruits and raw vegetables salads 

• Ginger - anti inflammatory and analgesic effects 

• Cinnamon- for menstrual cramps and excessive bleeding it is anti inflammatory and antispasmodic due to the presence of cinnamal dehyde and eugenol , can prevent the biosynthesis of prostaglandin and further help to rreduce inflammation 

• Dietary calcium has a functional role in dysmenorrhea, because low level of calcium may increase neuromuscular exacitability resulting in spasm and muscular contractions 

• Therefore consuming foods rich in calcium like - ragi, almond , mustard seeds, sunflower seeds, cumin seeds etc

• Iron ( nuts, leafy green vegetables)

• Magnesium rich foods ( regulate serotonin levels) 

  Asanas 

• Supta baddha konasana 

• Upavistha konasana 

• Supta veerasana 

• Supta swastikasana 

• Matsyasana ( fish pose)

• Bhujangasana ( cobra pose)

• Shavasana 

• Makarasana 

•  Shashankasana 

•  Supta baddha konasana -

Benefits - it gives relief from fatigue 

•     Reduce stress 

•      Increase energy levels 

     Upavistha konasana -

Benefits- stretches the thighs stimulates abdominal organs 

• Strengthen the spine 

• Calms down mind 

• Release groins 

  Supta veerasana -

Benefits- provides good stretch to thighs and back 

• Relieve spasm

• Relieve leg pain 

• Improve digestion 

• Relieves menstrual discomfort 

  Supta swastikasana -

Benefits- stretches and strengthens the spine, hips and leg muscles 

• Good for lower back 

Makarasana ( dolphin pose ) -

Benefits- it also relieve menstrual cramps 

•    Relieve Back pain      

•     Relieve headache and fatigue 

•     Improve digestion 

 Savasana ( corpse pose)

Benefits - it can be especially useful in the practice of mindfulness to overcome menstrual pain 

• Using savasana during your periods gives you the apportunity to relax your abdominal and vaginal muscles as well as relieve cramps 

Ustrasana ( camel pose)-

Benefits- stretchening the back muscles and improve posture 

• Energizing and anxiety relief 

• Believed to help ease menstrual cramps 

  Overall Benefits of asanas 

• Relieves aches and pain

• Helpful in constipation and bloating 

• Boost mood and energy levels 

• Combats fatigue or tension 

• Improves flexibility of spine 

• Strengthens back muscles 

• Gentle forward bends , twisting, backward bends give light massage to abdominal and pelvic region, helping to relieve congestion, heaviness, cramping and heavy bleeding 

• Strengthenes core 

• Stretches thigh , leg and back muscles 

   Absolute contraindication 

• Halasana 

• Bandhas 

• Sarvangasana 

• Naukasana

• Sun salutions 

• Chandra Namaskara asana 

• A sequence of 17 asana 

• Restorative practice

• It calms down the body and enhances good sleep 

• Strengthening thighs and pelvic muscle 

• Energizing the body 

  Hydrotherapy treatment 

• Soaking in hot tub may ease menstrual cramps- heat bring blood flow to your pelvic area and that help relax the uterine muscles that cause period cramps 

• Hot hip and leg pack with very thick fomentation over the abdomen- 20 minutes 

• Hot fomentation on the abdomen

• Neutral douch hydrotheraputic tool to manage pain and systemic symptom in dysmenorrhea 

         

Acupuncture for dysmenorrhea 

treatment - main point -

•  CV-3  ( Zhongji)

•  CV-4 (Guanyuan)

•  CV- 12 ( Zhongwan)

•   St - 29 ( Guilai)

•   UB- 23 ( shenshu)

 Supplementary points - 

•  GV- 20 Baihui)

•   Sp- 6 (sanyinjiao)

•    Sp- 8 ( Diji)

•   K-3 ( Taixi)

•   St-36 ( Zuasanli)

   Ear points - ovary 

•      Uterus 

•       Kidney 

Scalp needling - Genital area 

Stimulation - 1. Mild electrical stimulation, 20 to 30 minutes daily, for 10 days 

2. Course should be started 3 days before the menstruation and should continue during the period 

3. Indirect moxibustion be applied on Qugu (CV-2 ) and Guanyuan (CV -4 ) 

Remarks - 1. Minimum three courses of the treatment should be advised to the patient 

2. Treatment should be given on once a week in between the periods 

                                                    

   Amenorrhea 

Some of the asanas that help fight this disease include -

• Padmasana (lotus posture )

• Halasana ( plough posture)

• Dhanurasana ( bow posture)

• Sarvangasana ( shoulder stand posture)

• Shalabhasana ( locust posture)

• Bhujangasana ( serpent posture)

• Paschimottasana ( posterior stretching posture)

  Home remedies for amenorrhea 

• Add Jeggery seasam powder ( one teaspoon) and mix it properly take it thrice a day 

• Keep five almonds and 10 dates in goat milk ( fresh ) for one night make them into proper paste and consume with honey 

   Ayurvedic management for amenorrhea 

• Honey ( two teaspoon ( and gooseberry juice need to be mixed and taken twice daily 

Another effective remedy is the mixture of asparagus root and milk ( one cup ) it should be consume twice a day 

Acupuncture for Amenorrhea 

treatment -  main points -

 

• CV -4 ( Guanyuan)

•  CV-6 ( Qihai)

•   St-29 ( Guilai)

•   St-30 ( Qichong)

•   GV-3 (Yaoyangguan)

•    GV-4 ( Mingmen)

•     UB-23 ( shenshu) 

    Supplementary points- 

• GV-20 ( Baihui)

•  LI-4 ( Hegu)

•  LI- 11 ( Quchi) 

•  Sp-6 ( sanyinjiao)

•   Sp-8 ( Diji)

•    K-5 ( Shuiquan)

Scalp needling- Genital area ( both sides) 

Stimulation - 1. Moderate stimulation, 20 to 30 minutes daily, for 10 days 

2. Course may be repeated after 2 to 3 weeks 

Remarks -

 

1. The cause of the disease should be investigated properly and treatment can be combined with modern medicine 

2. Results are good 

 Conclusion 

amenorrhea can be treated with medical intervention yogic asana and Ayurvedic , naturopathy treatment are also effective for the treatment of amenorrhea 

   Pranayama kosha

• Cooling pranayama- Chandra  Anuloma Viloma , Chandra bhedna , sheetili, Sheetkari 

• Nadishodhana pranayama 

• Bhramari pranayama 

Benefit- balance emotion and calm down the mind 

 Manamaya kosha 

• IRT

• QRT

• DRT

• Yoga Nidra 

Benefits- help to ease pain 

•    Control mood swings 

•    Effects on limbic system- balance of emotions 

    Vijanmaya kosha 

• Yogic counseling, hygiene, mood swings, stress, pain 

• Reading scriptures 

Benefits- it maintain the normal state of mind and to distract attention from pain 

  Anandmaya kosha 

• Living in blissful awareness 

• Developing positive attitude 

Benefits- it helps us to live in present 

•    It gives the feel of love and happiness all around 

   Should you practice yoga during periods 

• Yoga during periods is a controversial issue 

• Therefore those who say no woman should practice yoga during her periods, other say practice everything. Some say practice inversion, other say avoid. Some say a strong practice is useful other say to practice restorative asanas 

• This totally depends on how a woman feels 

• Yoga is generally seen a mild physical activity which is why most expert regard is a safe during period - just to avoid high intensity yoga workouts like power yoga or hot yoga 

• High intensity asana are not ideal but low or moderate intensity asana can actually help you 

Alleviate period pain cramps and bloating 

• National health service explains yoga actually relieves pain, yoga could actually help your ease period pains, cramps and even symptoms of anxiety

If you or someone you know is experiencing menstrual disorders that significantly impact their quality of life, it’s advisable to consult a healthcare provider, dietitian and yoga therapist They can diagnose the underlying cause and recommend appropriate treatments, which may includes medications, lifestyle changes, yoga ,Naturopathy, acupuncture, acupressure or, in some cases, surgical procedures. Which can be helpful in your Menstruation period