Dysmenorrhea is defined as severe uterine pain during menstruation. How does dysmenorrhea affect fertility? Depending on the cause of the dysmenorrhea (fibroids, endometriosis, and polyps) can change the environment of the uterus resulting in monthly pain and an unfertile atmosphere. In cases of large fibroids or polyps, it is best to have them removed with surgery. With endometriosis, if the scar tissue or adhesions are numerous, once again surgery is the best mode of action. Post surgery, acupuncture and herbs are extremely helpful. Even though the surgery has removed the problem, it has not changed the cause which allowed the environment to develop. That’s why even after the problem is removed with surgery, fibroid/polyps/adhesions return (especially when women have been stimulated with follicle stimulating drugs). Most women experience these issues related to hormonal imbalances or an over active immunity system, which continues to be a dilemma after the surgery. Often I treat women for the cause of dysmenorrhea after the environment has been “cleaned up”. Yet, the energetic qualities (of dysmenorrhea) are usually still present on the pulse and tongue (i.e.: blood stagnation and phlegm accumulation). By addressing the energetic problem, women will experience physical improvements (i.e. less clots with period, diminished back pain and migraines) and the steps of balancing can lead to successful IVF cycles.
The below article was released via email to the medical public via Pubmed. It discussed the success in treating dysmenorrhea with Chinese medicine and the possibility of Chinese medicine offering pain relief to patients who do not respond to traditional medical methods.
Chinese Herbal Medicine for Primary Dysmenorrhea
Zhu X, Proctor M, Bensoussan A, Smith CA, Wu E
Cochrane Database of Systemic Reviews. 2007; Issue 4. Article No. CD005288
Summary
Primary dysmenorrhea is a common condition that can have a significant impact on the lives of women. Although currently available treatments may be effective for dysmenorrhea, many young women may not seek treatment and are unaware of treatment options. Chinese herbal medications may be an attractive treatment alternative for many women, but there are questions regarding their efficacy. The current review highlights this issue as well as challenges in applying medical practices across different cultures.
Background
Primary dysmenorrhea may occur in more than half of young women. A population-based study in Canada found that 60% of respondents met diagnostic criteria for primary dysmenorrhea. More than half of these women had moderate or severe pain, and 51% also reported that dysmenorrhea symptoms limited their activities.
Another survey of young women in secondary school demonstrated an even higher rate of primary dysmenorrhea, with a prevalence of 80%. More than one third of subjects reported that dysmenorrhea interfered with their school activities, but only 18% had seen a physician for their symptoms. Women in this trial were generally naive regarding the treatment of dysmenorrhea. Medications had been used by 58% of the subjects to treat their symptoms, but most of these women had used only simple analgesics. These medications were considered effective in only 53% to 59% of those using them.
Many patients may consider the use of complementary treatment for their symptoms. This reflects a larger healthcare trend in Western countries. Of subjects who used herbal medications, 72% were also receiving prescription medications.
Current Review
The current systematic review generally supports the use of Chinese herbal medicine for the treatment of primary dysmenorrhea, but it also highlights some of the difficulties in applying Western standards of evidence-based medicine to treatments used in the Far East. The review considered only trials of treatment of primary dysmenorrhea, and focused on trials in which women had previously received nonsteroidal anti-inflammatory medications (NSAIDs) or hormones for dysmenorrhea. The main study outcome was the reduction in pain associated with treatment; others included additional analgesia and quality of life.
Thirty-nine trials of Chinese herbal medication for dysmenorrhea were fully reviewed, but many of these trials had methodologic problems. In particular, 18 trials were not randomized, and 4 other trials failed to mention randomization.
Most research was conducted in mainland China, and the use of traditional Chinese medicine significantly affected the way the research was conducted. Chinese medicine emphasizes a different approach to patient symptoms and diagnosis compared with Western medicine, with a greater emphasis on clusters of symptoms across different organ systems. The clusters of symptoms in most of the studies examining the treatment of dysmenorrhea were consistent with the Western definitions of dysmenorrhea, but 19 studies used variations in the herbal treatment protocol based on individual participant’s diagnostic patterns.
Only 3 studies compared Chinese herbal medications with placebo; most of the other trials compared herbal treatments with: NSAIDs, hormonal therapy; or other Chinese herbal treatments.
The size of all included studies was small, with only 1 trial involving more than 100 patients. Most participants in the trials received multiple herbal treatments, although the dosage ranges of these many different therapies (19 main herbs were investigated) generally conformed to standard Chinese practice.
Results
Regardless of these study limitations, Chinese herbal medications were generally effective against dysmenorrhea. Herbal medications were approximately twice as likely to improve pain compared with conventional therapy. In particular, Meiguihua (Rosa rugosa Thunb) was demonstrated to reduce dysmenorrhea-associated symptoms (pain, stress, and anxiety) over a 6-month time course:
Chinese herbal medications can also be rapidly effective against dysmenorrhea; one trial demonstrated an analgesic effect within 30 minutes. There was evidence as well that Chinese herbs may reduce patients’ use of other analgesic medications for dysmenorrhea.
Chinese herbal medications were superior to over-the-counter health supplements in improving dysmenorrhea. A tailored herbal regimen was more than twice as likely to improve dysmenorrhea as a routine herbal preparation available without a prescription. Chinese herbal medication was also found to be superior to acupuncture for dysmenorrhea in 2 trials.
Adverse events associated with study therapy were reported in only 8 of the 39 trials. There were no significant events found with either Chinese herbal medications or the comparator agents.
Conclusion
Traditional Chinese medicine has proven itself through the test of time, and it has much to offer patients around the world. However, the previous studies of the efficacy of Chinese herbal medications as well as the current review of herbal preparations for dysmenorrhea highlight the difficulty of translating medical treatment across cultures. The currently available research is not only limited regarding methodology in determining the efficacy of Chinese herbal medications, but also of importance, many of these studies do not adequately address concerns regarding tolerability and safety.
More high-quality research focused on Chinese herbal medications is forthcoming, but until that time, it appears that the most prudent approach for the incorporation of these medications in clinical practice is to partner with a practitioner who has significant experience in their use. The wealth of experience and knowledge accumulated over time is the strength of traditional Chinese medicine, and healthcare providers should build relationships and treatment teams with experienced providers to provide the most complete and effective care for a variety of patient conditions.