Lower Abdominal Pain During Menstruation - Medical Case Study

Jennet had complained about lower abdominal pain during menstruation for more than ten years.

Supporting signs and symptoms

Jennet, who is currently married, said that she had her menarche at the age of fifteen. The patient complained of sensations of coldness and a colicky pain in the lower abdomen every first day of her menstruation. She asserted that the pain significantly affected her daily work and life. Although Jennet said that the pain was slightly alleviated by using hot compresses, she claimed that the pain could only be stopped by injections of painkillers. She experienced a normal menstrual cycle with a heavy flow that lasted for seven to eight days. The menstrual color was dark with blood clots.

Other signs and symptoms

The patient seemed emaciated and pale, had a light red and dark tongue. She also had a deep, slow, moderate pulse.

Relevant past medical and family history

Jennet had been married for four years and had a normal sexual life without the use of contraceptive. The patient had never been pregnant. She was diagnosed as having endometriosis in England two years ago, and a chocolate cyst on her left ovary was removed surgically. Dysmenorrhea was relieved afterward but worsened in the recent past.

Additional relevant information in the case

The last menstrual period of the patient started in January eighteenth, 1989. Menarche began when the patient was fifteen years old with a menstruation cycle of seven to eight days. The blood flow was dark and contained clots. Normally, Jennet would have a poor appetite, loose stools, cold limbs, and a bearing-down sensation of the abdomen and rectum before menstruation.

Clinical examination

Vulva: normal

Vagina: unobstructed

Cervix: smooth

Uterus: retroverted fixed uterus of a normal size

Nodules: size of a bean.

Initial diagnosis and pattern differentiation

TCM Diagnosis: DysmenorrheaWestern Medical Diagnosis: DysmenorrheaPattern Differentiation: Cold obstruction and blood stasis in the uterus

Treatment principle

Warm the channels, expel cold, eliminate blood stasis, and stop the pain.

Chinese Herbal Treatment and other treatment (s)

Initial consultation: Acupuncture only

I treated the patient once per week for consecutive five weeks. On her first visit, Shao Fu Zhu Tang was administered including Xiao Hui Xiang 6g, Rou Gui 1.5g, Gan Jiang 2g. Mo Yao 6g, Pu Huang 6g, Dang Gui 9g, Chi Shao Yao 6g, and Wu Ling Zhi 4.5. The acupuncture treatment was Liv-3 (Taichong), Li-4 (Hegu), REN-6 (Qihai), REN-4, REN-3, and SP-4 (Gongsun). The needles were retained for thirty minutes and moxa for ten minutes.

The second visit occurred seven days later. The same points and herbal points were applied. The cold symptoms had reduced, and the hands of the patient felt warmer. Also, the patient did not experience the profuse water vaginal discharge. Additionally, the complexion was more lustrous. However, the color of the tongue was still light red and dark.

On her third visit, the Herbal Formula applied was Shao Fu Zhu Yu Tang. The patient said that the pain had reduced significantly. Indeed, she was happy and did not feel cold anymore. The tongue was pale and moist while the pulse was moderate and forceful. However, the patient experienced a headache at certain occasions. Jennet also said that she woke up tired and felt heavy in the afternoon. The patient said that she wanted to continue with the herbal medicine but at a less frequent rate.

Lifestyle/Dietary suggestions

Dress according to the weather and avoid cold

Drink room temperature water

Avoid indulging in cold foods

Eat cooked warm foods consisting of vegetables and meat

Literature review

Dysmenorrhea is simply a cyclic menstrual pain. Clinically, dysmenorrheal is classified into primary and secondly dysmenorrhea. Primary dysmenorrhea refers to painful menses with the normal pelvic anatomy. It is associated with lower abdominal pain and starts just before or at the onset of menstruation. Additionally, Primary dysmenorrheal reaches the peak within twenty-four. On the other hand, secondary dysmenorrhea refers to painful menses together with pelvic disorders including endometriosis (Li, & Msaom, 2007). Secondary dysmenorrhea can even occur in women who did not experience cyclical pelvic pain in their early twenties or thirties. Epidemiologic surveys carried out in different regions show that about 34% to 50% cases of dysmenorrhea among young women can be prevented. Additionally, research has demonstrated that dysmenorrhea patients with moderate or severe are symptoms likely to avoid social interactions and decrease personal activities (Habek, Cerkez Habek, Bobic-Vukovic, & Vujic, 2003). For instance, Andersch and Milsom found out that more than seventy percent of nineteen-year-old Swedish girls suffered from dysmenorrhea (Andersch, & Milsom, 1982). As a result, dysmenorrhea limited the daily activities of the Swedish girls. Dysmenorrhea is said to cause the loss of six hundred million work hours as well as a financial loss of about two billion dollars annually. Apparently, the prevalence of dysmenorrhea varies with age. Indeed, adolescent girls have a high prevalence compared to older women.

Acupuncture has a long history of usage in South East Asian countries such as China, Korea, and Japan. Traditional Chinese medicine (TCM) describes a state of health maintained by balancing the energy in the body (Helms, 1987). Acupuncture that is performed in the context of TCM represents a complex intervention that involves technical needling skills and development of a therapeutic relationship, development of a diagnosis, provision of lifestyle advice as well as other co-interventions such as tuina, moxibustion, electrical stimulation, and gua sha. In clinical practice, acupuncture is the main modality with the application of other co-interventions. Acupuncture entails the use of fine needles that are inserted into various parts of the body rectify the imbalance of energy in the body (Davis, & Westhoff, 2001). TCM and classical acupuncture explain disease and physiological function regarding the theoretical concepts developed by Ying and Yang. A westernized medical application of acupuncture entails the use of acupuncture using segmental points, triggers points, and commonly used formula. Auricular therapy is a type of westernized acupuncture that entails the use of the ear to make a diagnosis and ensuing needling to points on the ear.

Medical acupuncture may engross the use of acupuncture on the basis of the principles of neurophysiology and anatomy as opposed to the TCM principles and philosophy. The style and approach of acupuncture determine the acupuncture point selection, as well as the related parameters used in clinical practice and research. Acupuncture points used to treat dysmenorrhea are mainly found in the lower abdomen, the lower legs, and the lower back and sacrum areas. Acupuncture is not entirely free of adverse effects. Surveys have reported several side effects of acupuncture. The side effects include severe tiredness, exhaustion, pain at the point of needling, as well as a headache. Additionally, some patients have encountered minor events such as needling pain, bleeding, and aggravation of symptoms. However, it is evident that the risks associated with acupuncture are relatively low.

Currently, the western medicine does not provide a radical cure for dysmenorrhea. In contrast, traditional medical treatment such as acupuncture, herbal medicine, or moxibustion is known for curing dysmenorrhea radically, noninvasively, and safely. Empirically, the value of traditional medicine for dysmenorrhea has been verified by numerous case studies and clinical research. Additionally, Oriental medicine offers more satisfactory results for patients because it utilizes different therapies for every patient according to differentiation of syndromes including stagnation of Ki, cold-damp stagnation, stasis of blood, deficiency of Ki and blood, and deficiency of the liver and kidney.

The mechanism that acupuncture influences primary dysmenorrhea is yet to be understood. According to TCM, acupuncture points are used to treat period pain. For instance Stomach 30, Liver 3, or Ren 6 is selected on the basis of pattern differentiation during a diagnosis (Cho & Hwang, 2010). Acupuncture is used to treat several painful conditions, and it is anticipated that acupuncture may modify the perception of pain or alter the physiological functions. On the other hand, western acupuncture involves the selection of points according to the innervations of a target organ such as the uterus (Moodley, & West, 2005). Establishment of muscle afferents in such a segmental level transmits signals in the spinal cord and central nervous system. Researchers have suggested that the therapeutic effect of acupuncture for dysmenorrhea might be through its impact on prostaglandin F2 alpha levels in the menstrual fluid (Gan-gong, Lin-ying, & Xian-qun, 2004). Besides, auricular acupuncture might have therapeutic actions on period pain through an increasing level of hormone beta-endorphin in peripheral plasma as well as regulation of uterine activity.

Liu et al. conducted a study on three types of dysmenorrhea conditio...