Western medicine differentiates primary from Secondary dysmenorrhoea.
Primary dysmenorrhoea starts during adolescence and is not associated with any organic
disorder. From the Chinese point of view, this is often due to invasion of Cold in the uterus when
young girls are exposed to cold during puberty either because they often play outdoor games
during cold and wet winters, or because they have been engaged in physical work (such as
farming) outdoors.
Secondary dysmenorrhoea starts later in life and may be associated (although not necessarily)
with organic diseases such as endometriosis, pelvic inflammatory disease or myomas.
Endometriosis
In endometriosis ectopic endometrium is implanted in adjacent pelvic organs such as ovaries,
fallopian tubes, pelvic ligaments, vagina, sigmoid colon, rectum, ureters or bladder.
Endometriosis is on the increase and it has become the commonest cause of secondary
dysmenorrhoea. Other symptoms apart from painful periods with the pain radiating to the rectum
or perineum may include menorrhagia and dyspareunia (pain on intercourse).
Some Chinese doctors say that if no results are obtained in a case of dysmenorrhoea, one should
suspect endometriosis.
Myoma
Myomas do not usually cause pain. However, if there is torsion they may cause dysmenorrhoea.
Dysmenorrhoea due to myomas may be helped even if the myomas cannot be dissolved.
Regulating Blood and eliminating stasis will help the dysmenorrhoea and will make the abdomen
feel more comfortable in general in spite of the myomas.
Very small myomas (up to about 2 cm in diameter) may be dissolved with acupuncture and
Chinese herbs. If the diagnosis of myomas is definitely confirmed, then the formulae used should
include strong herbs which "break" Blood such as E Zhu Rhizoma Curcumae zedoariae, Ze Lan
Herba Lycopi lucidi and San Leng Rhizoma Sparganii. A particularly good formula for myomas
from stasis of Blood is Gui Zhi Fu Ling Tang Ramulus Cinnamomi-Poria Decoction which
contains Gui Zhi Ramulus Cinnamomi cassiae, Fu Ling Sclerotium Poriae cocos, Tao Ren
Semen Persicae, Chi Shao Radix Paeoniae rubrae and mu Dan Pi Cortex Moutan radicis.
Mittelschmerz
Mittelschmerz consists of pain in mid-cycle. It is probably due to the rupture of a follicular cyst.