Editor's note: This is the third article in a series on the utility of herbs / herbal formulas in clinical chiropractic practice.
Chiropractors have long treated women for menstrual pain (dysmenorrhea). Since roughly 60 percent of all chiropractic patients are women1 and 30-50 percent of women have a history of menstrual cramps,2 the vast majority of doctors of chiropractic will inevitably see patients with dysmenorrhea.
Patients with chronic, recurrent menstrual pain are highly motivated to get well. They often look to alternative care for treatment as an adjunct to their medical care or even as a new primary methodology of treatment.
Success ratios for treatment with chiropractic spinal manipulative therapy (SMT) are generally quite good, with SMT having less risk and fewer side effects than medicinal prophylactics.3 However, many women tend to have menstrual cramps and pain on a recurring basis, which may require OTC or prescription drug intervention. Fortunately, nondrug alternatives exist that can complement your adjustments, such as herbal medicine.
Symptom Patterns
The symptoms of dysmenorrhea have a wide host of causes. Often the cause is complex and multi-layered, falling outside the scope of our diagnostic realm. Some of your patients have received or may need medical diagnosis. In complex, undiagnosed cases it behooves us to refer to a medical specialist, such as an OB/GYN, who has access to advanced-imaging methods and testing to get an exact, specific diagnosis.
But even with the intervention of a medical specialist and the use of traditional medical treatment, our patients are often very symptomatic. As DCs, we are often left wondering what more we can do to help our suffering patients.
Dysmenorrhea can be further broken down into two broad categories. The most common is primary dysmenorrhea, which occurs in the absence of pelvic pathology. This is the type of dysmenorrhea you will see in your clinical setting most often. There is also secondary dysmenorrhea, which results from identifiable organic diseases. While less common, you will almost certainly encounter this as well.
Patients with secondary dysmenorrhea will likely enter your office already having been diagnosed medically. However, it is important for you, the clinical chiropractor, to understand the difference between the two.
In patients with primary dysmenorrhea, symptoms usually last 48-72 hours. Symptoms often start hours before or just after the onset of menstrual flow, and usually subside as menses tapers off. Dysmenorrhea may coexist with excessive blood loss, known as menorrhagia.
Symptoms of dysmenorrhea or painful menstruation can include cramping and sharp, dull, nauseating, burning or shooting pain. Frequently there is a background of constant lower abdominal pain that radiates to the patient's back or thigh.4 This radiation of pain is most often what brings these patients directly to your office for help.
Patients with secondary dysmenorrhea can have symptoms of excessively heavy menstrual flow or irregular bleeding, infertility, poor response to nonsteroidal anti-inflammatory drugs (NSAIDs), vaginal discharge and dyspareunia (painful sexual intercourse), among other complaints. These patients may present with existing medical diagnoses including but not limited to endometriosis, pelvic inflammatory disease, ovarian cysts or tumors, cervical stenosis or occlusion, fibroids, uterine polyps, intrauterine adhesions or pelvic congestion syndrome.5 These are obviously more complex cases, so a complete intake history is vitally important.
Herbal Remedies
Herbal medicine has long been used around the world and has been thoroughly researched for symptoms related to painful menstruation. The Chinese herb Dan Gui Shao Yao San, known in Japan as Toki-shakuyaku-san, has been proven effective in the treatment of dysmenorrhea, including symptomatic relief of concomitant symptoms such as feeling cold, dizziness, headaches and shoulder stiffness. Of note, no significant side effects were observed in the group of patients who used Toki-shakuyaku-san6 – an important finding because by comparison, all Western medicines have some side effects.
A February 2014 study evaluated numerous herbal formulas for the treatment of primary dysmenorrhea in women ages 13-25. This study targeted the analgesic, mood-modifying and hormonal adjustments of the herbs. In reviewing more than 57,000 prescriptions of traditionally used herbal formulations, the study found that Dan Gui Shao Yao San and Yan Hu Suo (Corydalis) were significantly more effective than other formulations.
In addition, these two herbs, taken in combination, proved to be among the most effective.7 Sometimes combining herbs and herbal formulas may be useful in difficult cases or in patients who are not responding well to a singular herb or herbal formula.
Another herb, Gui Zhi Fu Ling Tang, can be used when dysmenorrhea is accompanied by uterine fibroids, which occur in approximately 25 percent of all women of reproductive age and 30-40 percent of all women over the age of 40. About half the time, they are symptomatic with menstrual pain and pressure being among the primary complaints. Gui Zhi Fu Ling Tang was shown to potentially reduce the volume of uterine fibroids, the most common benign tumor of the female reproductive tract.8
Research also suggests the primary complaints of lower abdominal pain and pain that radiates to the back (spinal pain) and thigh (leg pain) chiropractors commonly see in patients with dysmenorrhea are well-addressed by Dan Gui Shao Yao San. In addition, patients who have the common concomitant condition of uterine fibroids have an herbal alternative as well, not only for the symptoms of dysmenorrhea, but also to potentially reduce the number of uterine fibroid tumors.
When you are looking for a better and more complete way to treat your patients with dysmenorrhea, scientific research has proven herbal medicine to be effective. These highly motivated patients may be suffering unnecessarily month after month. Now you have several new tools in your toolbox to help alleviate the symptoms of dysmenorrhea and its more complex variants.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
