The efficacy of a phytotherapeutic complex (Angelica sinensis, Dioscorea villosa, Matricaria chamomilla, Viburnum opulus and Zingiber officinalis) compared with homoeopathic similimum in the treatment of primary dysmenorrhea
[Caroline Shange Nondusimo]
Dysmenorrhoea is menstrual cramps or pain in the pelvic areas experienced by woman as a result of menstrual period, and is the most common gynaecological complaints in younger women who present themselves to clinicians (Stoppler 2014).
Dysmenorrhoea is classified as:
1. Primary dysmenorrhoea (spasmodic) is defined as cramping pain in the lower abdomen occurring before or during menstruation, in the absence of secondary causes such as endometriosis. Initially present in adolescence stage. It is a common cause of absenteeism and reduced quality of life in women. Mostly this problem is often underdiagnosed and untreated. There is increased production of endometrial prostaglandin, resulting in increased uterine contractions (Coco 1999).
Aetiology for primary dysmenorrhea
The risk factors for primary dysmenorrhoea incl.: early age of menarche (below 12 years), nulliparity, heavy or prolonged menstrual flow, smoking, positive family history, obesity (Holder 2011).
Several theories try to explain the possible aetiologies for primary dysmenorrhoea. Behavioural and psychological factors, uterine ischaemia, cervical stenosis or narrowing, increased vasopressin release, increased uterine activity, increased uterine prostanoid production and release have been implicated as possible causes for primary dysmenorrhea. Evidence suggests that most women with primary dysmenorrhea have increased or abnormal uterine prostanoid production and release, giving rise to abnormal uterine activity and therefore to pain (Dawood 2008).
About 50% of menstruating females suffer from primary dysmenorrhea with prevalence decreasing with age. Prevalence is highest in the 20 to 24 year - old age group and decreases progressively thereafter. It worsened by smoking and occurs only during ovulatory cycles (Dawood 2008).
Pathophysiology: During a menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus sheds off (Tortora and Derrickson 2006).
2. Secondary dysmenorrhea (congestive) is defined as menstrual pain caused by a disorder in the reproductive system, may first present later in life than primary dysmenorrhoea and gets worse overtime as the person gets older. This condition is common in women aged 30 - 45 years (The American College of Obstetricians and Gynaecologist 2012).
3. Membranous dysmenorrhea is a rare form of dysmenorrhoea, present with extreme forms of spasmodic. The pain is accompanied by the passage of membranes(looks like clots) which may take the form of casts of the uterine cavity (Omar and Smith 2007).
In ovarian dysmenorrhea the pain is felt for 2 or 3 days before menses in one or both lower quadrants, it associated to the ovarian diseases such as ovarian cyst (Wood 2003).
Events during primary dysmenorrhea.
Shedding of the endometrium result in damage of cell membrane damage to phospholipids release of arachidonic acid cyclo-oxygenase pathway lipoxygenase pathways. COX 1, 2 and 35HPETE
prostaglandins (PGs) leukotriene B4 and C4 (myometrium contraction) thromboxane synthesis (production of thromboxane A2) and isomerase, reductase (production of PGF2a and PGE2
Resulting in uterine muscle contraction, vasoconstriction and hypersensitization of pain fibres (Harel 2006).
Increased circulation of vasopressin → produce dysrrhythmic uterine contractions → reduced blood flow to the uterine → uterine hypoxia → ischemia → cramp-like pain (Dawood 2008: 430-431).
Prostacyclin, a potent vasodilator and uterine relaxant are reduced in primary dysmenorrhoea Dawood (2008: 430).
The pain mostly begins a few hours prior to or just after the onset of a menstrual period and may last as long as 3 days. The pain is labor-like with supra-pubic cramping and may be accompanied by back ache in the lumbosacral region, pain radiating down the thighs, nausea, vomiting and diarrhoea. The pain is colicky in nature, is improved with abdominal massage, counter pressure, or body movement. The main symptom is pain. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain (Berek, Adashi and Hillard 1996).
It is necessary to rule out underlying pelvic pathology and confirm the cyclic nature of pain. Pelvic examination should be performed to assess the size, shape, and mobility of the uterus.
Pelvic ultra-sound examination is necessary to rule out pelvic pathologies (Berek, Adashi and Hillard 1996).
Important DD.: primary dysmenorrhoea is secondary dysmenorrhoea. Other conditions with similar clinical presentation incl. abdominal trauma, dysfunctional uterine bleeding, endometriosis, inflammatory bowel disease, irritable bowel syndrome, ovarian cysts, ovarian torsion, ovarian neoplasm, pelvic inflammatory disease, ectopic pregnancy, vaginitis, vulvo-vaginitis, sexual assault, syphilis, peritonitis, urinary tract infection, uterine neoplasm, arthritis and disclesions. All of the mentioned conditions present with abdominal pain, but there will be other clinical features present
in their cases e.g. urinary tract infection, there may be ketones or haematuria present in the urine (Douglas et al 2005).
Assessment methods for dysmenorrhoea
No laboratory tests are specific to the diagnosis of primary dysmenorrhoea. Diagnosis is based on clinical findings.
The following can be performed to exclude organic causes of dysmenorrhoea:
Blood tests: full blood count, white blood cell count to exclude infection, human chorionic gonadotropin level to exclude ectopic pregnancy, cancer antigen 125 (CA-125) assay (this has limited clinical value in evaluating women with dysmenorrhoea because of its relatively low negative predictive value), erythrocyte sedimentation rate (while nonspecific, erythrocyte sedimentation rate
can help the physician to identify the patient with sub-acute salpingitis).
o Non-invasive studies may include abdominal and trans vaginal ultrasound.
Pelvic ultrasound scans are indicated to evaluate for situations such as ectopic pregnancy, ovarian cysts, fibroids, and intrauterine contraceptive devices. This is a highly sensitive test for detecting pelvic masses.
o Hysterosalpingograms are used to exclude endometrial polyps, leiomyomas, and congenital abnormalities of the uterus.
Other more-invasive studies, incl. laparoscopy, hysteroscopy, and dilatation and curettage, may be required.
An endometrial biopsy may be indicated if endometriosis is suspected. (Calis 2013).
TREATMENT OF DYSMENORRHOEA
Allopathic treatment focuses toward reducing the production or action of the causative prostaglandins (Smith 1997).
Nonsteroidal anti-inflammatory (NSAIDs) drugs relieve primary dysmenorrhoea by inhibiting prostaglandin production and also have direct analgesic properties at the central nervous system level. NSAIDs do not affect the development of the endometrium when given during the menstrual phase for primary dysmenorrhea but directly inhibit cyclo-oxygenase (COX) activity and thereby suppressing endometrial prostaglandin synthesis and release. Thus, menstrual fluid volumes are not affected, but menstrual fluid prostaglandin levels are significantly decreased. Accompanying the reduction in menstrual fluid prostaglandins is a return of the uterine activity to a pattern similar to normal pain free menstruation.
But the regular use of NSAIDs can lead to long term health problems due to NSAIDs side effects such as, gastrointestinal symptoms, central nervous system symptoms, nephrotoxic and hepatotoxic effects, haematologic abnormalities, bronchospasm, fluid retention, and oedema (Dawood 2008).
The oral contraceptive pill prevents menstrual pain through a different mechanism than the NSAIDs. The action of oral contraceptives is twofold: decreases the menstrual fluid volume and suppression of ovulation therefore it is not a true menstrual period but a menstrual bleed controlled by hormonally and associated with the absence of ovulation.
Oral ontraceptives are up to 90% effective. 10% of women with primary dysmenorrhea do not respond to treatment with NSAIDs or oral contraceptives and some have contraindications to these medications (Coco 1999). The oral contraceptive pill can produce side effects such as headache, depression, breast lumps, chest pain, dyspnoea and tingling of arms or legs (Calis 2011).
Allopathic treatment for primary dysmenorrhea has a 20-25% failure rate and the numerous side effects encountered point to an increased need for alternative treatment (Wilson and Murphy 2001).
Is effective in some cases. These include essential fatty acids that are anti-inflammatory and needed for hormone production. Omega 3 fatty acids, eicosapentaenoic acid (EPA) and docasahexaenoic acid (DHA) may decrease prostaglandins levels. Vitamin E improves blood supply to muscles, promoting oxygenation. Vitamin B-complex reduces stress effects.
Magnesium to be taken throughout the cycle is thought to enhance hormone production and induce relaxation of muscles (Wong 2007).
A form of medical treatment which relies on the use of plants, either whole or in the form of prepared extracts and essences. When phytotherapy is used responsibly, the preparations used are standardized, which means that they are grown, harvested, and processed in a way which is designed to create a very reliable and stable dose of active ingredients. This technique involves the studying of plants to determine their properties, and the careful application of plants to treat medical problems. Many of the remedies used in homoeopathy are also phytotherapeutic in origin.
Some commercial pharmaceuticals are prepared form the extracts of plants, and also the synthetic drugs which are based on compounds found in plants. Quality and safety are important issues in phytotherapy (Smith 2012).
The herbal remedies are prepared in several standardized ways, which include:
(a) Infusions are used for delicate herbs, leaves and fresh tender plants, preparing an infusion is much like making a cup of tea. Boiled water is poured over the herb, covered allowed to sit for 10 - 15 minutes.
(b) Decoctions used when working with tougher and more fibrous plants, barks and roots, the plant material is boiled in water for longer periods of time to soften the harder woody material and release active constituents.
(c) Tinctures (alcohol and water extracts), used when plants have active chemicals which are not soluble in water, or when the prepared product is wanted for longer shelf-life.
decoctions (boiled teas), tinctures (alcohol and water extracts), and macerations (cold-soaking)
According to Hoffman (2003) when treating dysmenorrhoea using a phytotherapeutic complex, the complex should include of the following:
Anti-spasmodic herbs to ease the muscle spasms that are the immediate cause of pain;
Nervines helps with the associated psychological tension or anxiety;
Diuretic remedies if the dysmenorrhoea is of a congestive nature accompanied by water retention;
Hormonal normalizers if the diagnosis suggests a pivotal contribution of hormonal imbalance.
In order to address all the requirements necessary for the treatment of dysmenorrhoea, the study was conducted using a phytotherapeutic complex consisting of the following substances:
Angelica sinensis, Dioscorea villosa, Matricaria chamomilla, Viburnum opulus and Zingiber officinalis.
Homoeopathic remedies help the body to heal itself, by stimulating the body’s own energy or vital force (Bloch and Lewis 2003).
According to (Chauhan, Gupta 2013), homoeopathy is a system of medicine that treats disease by remedies prescribed in little or minute doses, if given to a healthy individual would develop symptoms like those of the disease.
The following are the cardinal principles:
a. The law of similia - the symptoms experienced by the sick are not the disease, but are a reaction of the body’s defense mechanism. The choice of remedy is based on the principle of “similia similibus curentur.” The remedy must have the ability to produce similar symptoms to the disease which is to be cured in the sick person, in a healthy person if they are administered the remedy.
b. The law of simplex - only one single, simple medicinal substance is to be administered in a given case at a time, which is called a similimum. The remedies are proven singly so should be administered singly.
c. The law of minimum dose - reduction of the drug dose by succussion or trituration at every step of dilution employing an inert medium like alcohol or lactose.
d. Drug proving - systemic investigation of the disease producing power of the drug. Conducted on healthy human beings only. These recordings constitute the reliable knowledge of their capability to cure a similar symptom complex.
e. Drug dynamization - the process in which the crude medicinal substance is reduced to its sub-physiological state, by the method of potentization or dynamization. The idea is that life energy is dynamic in nature; the disease is also at the dynamic level, so the intervention can be sought at the dynamic level by a medicine which can act on the same plane.
f. The theory of vital force - this force animates the body. All life functions are carried out by this immaterial entity which animates the material organism in health and in disease.
g. The concept of causation of chronic disease - chronic diseases are due to a defect in the organism called ‘miasm’. Miasm is defined as hereditary in respect to the fundamental cause (the psora) and secondary miasmatic indispositions. This helps the homoeopath in treating patients with speed, accuracy, efficiency and an ability to predict the outcome
Homoeopathic pharmacies potentise remedies according to three different scales to suit different prescribing purposes. These scales are the: centesimal scale, decimal scale and quinquagintamillesimal scale.
The Centesimal Scale
The first scale that Hahnemann developed during the early years of Homeopathy is the centesimal scale. As its name would suggest, it has a1:100 dilution ratioCentesimal remedies are versatile. Practitioners may prescribe them aspilules, tablets or liquids in high or low potencies for the treatment of both acute and chronic disease. They can also be found in lower potencies in retail stores for self-treatment of simple acute problems (in germany only in pharmacies).
If doses are repeated unnecessarily, centesimal potencies may produce proving symptoms (Jones 2014).
The Decimal Scale
The decimal scale was the second potency scale to be produced in the development of Homeopathy. It has a dilution factor of 1:10 meaning that one part of the mother tincture or potency is diluted in 9 parts of a water alcohol mixture. Like the centesimal scale, the decimal scale still has 10 succussions between each dilution phase. Once again, the remedy’s name is followed by a number to show how many stages of dilution and succussion it has been through and the Roman numeral “X” to indicate its 1:10 dilution ratio. A 3X potency, for example, indicates three stages of dilution and succussion according to the decimal scale while a 12X indicates that the process has occurred 12x.
Decimal potencies are easy to use and can be dispensed as pillules, tablets or liquids. Being “low potency” remedies, they can be repeated frequently with little risk of producing proving symptoms. For this reason they are commonly sold by retail outlets for self-treatment of simple acute problems (in germany only in pharmacies). The Schuessler Tissue Salts are one such example. They are less
commonly prescribed by homeopathic practitioners as they have limited use in the treatment of deep-seated chronic conditions (Bloch, Lewis 2003).
The Quinquagintimillesimal Scale (or Q-Potenz or LM-Potenz).
These potencies are the third and final scale developed just prior to the death of Hahnemann. They are usually known by the simpler name of fifty-millesimal or Q potencies. The process by which fifty-millesimal potencies are prepared is different and more complex than that used for the centesimal and decimal potencies but fundamentally the dilution ratio is 1:50,000 with each stage of dilution being followed by 100 succussions. The remedy’s name is followed by either the letter “Q” or the symbols, “0/..” to indicate it has been prepared in a 1:50,000dilution ratio. As with the
centesimal and decimal scales, the accompanying number on the remedy indicates how many stages of dilution and succussion have occurred. For example, a Q6 (or Q/6) remedy will have passed through six stages of potentisation while a Q30 (or 0/30) will have been potentised thirty times.
The fifty-millesimal scale is deep acting and flexible. Unlike other potency scales, fifty-millesimal remedies should not be dispensed as tablets or pilules but only as liquids. Liquid dosing allows the
homeopathic practitioner to adjust the degree of dilution and the number of succussions before each dose to suit the individual sensitivity of the recipient. For this reason, remedies from this scale require a greater degree of knowledge to prescribe appropriately and should be reserved for practitioner use only. They are rarely available from retail outlets for self-treatment. As with the remedies from the centesimal scale, proving symptoms may occur if fifty-millesimal remedies are repeated unnecessarily (Homeopathy plus 2014).
Homoeopathy has a the holistic approach to health, treating the person as a whole so not only focusing on getting rid of the presenting symptoms but also looking at the aetiology as well as how that individual reacted to the problem in all three dimensions i.e. physical, emotional and mental. The careful selection of an appropriate remedy, and the minute dose of that remedy, prevents any aggressive side effects of the intervention. These are the reasons homoeopathy was selected as an intervention in this study.
Previous studies have shown the similimum to be effective in the treatment of primary dysmenorrhea (Tsolakis 1995), (Christie 2005), (Jose 2005) and (Mokabane 2009).
The homoeopathic simillimum has shown significant improvement in reducing premenstrual symptoms such as irritability, depression, anxiety, breast swelling, breast tenderness, abdominal bloating and food cravings (Patel 2010).
The homoeopathic simillimum showed improvement that was not statistically significant on the symptoms of endometriosis such as dysmenorrhoea, but there was significant improvement in the
symptoms associated with endometriosis, such as the amount of bleeding, constipation, depression, diarrhoea, nausea and pelvic pain (Clark 2005).
These symptoms are also clinical features associated with primary dysmenorrhoea.
A study conducted by Christie (2005) showed that the homoeopathic similimum had a significant effect on reducing the severity and duration of pain as well as associated symptoms of primary dysmenorrhoea. In addition, the need for allopathic pain medication was significantly reduced. The improvements were most significant after two to three months of treatment with the homoeopathic similimum, as opposed to only one month of treatment.
During the first menstrual period, participants received no homoeopathic treatment and no placebo, thereby creating a baseline from which the results from the remaining three months of treatment were compared. These results, together with the progression of each participant’s symptoms as noted by the researcher at each consultation, were used to determine the effect of the similimum on severity of pain during menstruation and the necessity for allopathic pain medication during the dysmenorrhoea. In striving to abide by the laws and principles of the classical homoeopathic approach, each participant was evaluated as a totality. The intent of this research was to evaluate the effect of the homoeopathic similimum on ten participants with primary dysmenorrhoea. The study aimed to provide a safe and effective alternative therapy for primary dysmenorrhoea. A study conducted by Witt, Lüdtke and Willich (2009) concluded that homoeopathy, as a holistic therapy, was effective in treating primary dysmenorrhoea.
Evaluating homeopathic treatment for dysmenorrhoea, a prospective multicentre observational study in primary care, using standardized questionnaires to record for 2 years diseases, quality of life, medical history, consultations, all treatments, other health services use was conducted. Results showed that 57 physicians treated 128 women and 11 girls.
Patients received homeopathic prescriptions. Diagnoses and complaints severity improved markedly [at 24 months, dysmenorrohea relieved by > 50% of baseline rating.
Conventional medication changed little and use of other health services decreased.
A study conducted by Christie (2005) showed that the homoeopathic simillimum had significant effect on reducing the severity and duration of pain as well as associated symptoms of primary dysmenorrhoea. The need for allopathic pain medication was significantly reduced in this study.
Homoeopathic remedies with a strong affinity for the female genital System.
It is one of the most important uterine remedies
Mind: aversion to company, yet dreads to be alone.
Angry, sensitive, irritable, easily offended and miserable. Poor memory.
Head: headache in terrible shocks at menstrual nisus, and scanty flow.
Female Organs: menses too late and scanty, irregular, early and profuse, sharp clutching pains. Violent stitches upward in the vagina, from uterus to umbilicus. Uterus and vagina prolapse. Mania from profuse menses. Dull, heavy pain in the ovaries (l. ovary). (Vermeulen 2001)
Indications: painful, late, or suppressed menses, sometimes with a feeling that the pelvic floor is weak or as if the uterus is sagging. The woman may feel irritable, dragged out, and sad - losing interest temporarily in marital and family interactions, wanting to be left alone. <: Dampness, perspiring/doing housework; >: Warmth and exercise (dancing) often brighten the woman’s outlook and restore some energy (Ezine 2014)
Mind: great melancholy, looks on the dark side of everything (during menses). Irritability before menses. Cannot stand injustice
Female Organs: menses cease at night, with clots, scanty and prosopalgia. Dysmenorrhoea, and tearing pain in back and thighs. Sadness, anxiety and weakness during menses. Cutting colic pain and diarrhoea during menses (Vermeulen 2001).
Female Organs: menses too early and scanty, not profuse but prolonged. Uterine prolapse. (Vermeulen 2001).
Female Organs: Menses too early, irregular, blood black. Dysmenorrhoea, and pain in the sacrum and constant urging to stool. During menses, nausea in morning, and chilliness and attacks faintness
Female Organs: May be indicated when a woman has irregular menstrual periods with constricting pains that can extend to the rectum or the area above the tailbone. Tends to be impatient, irritable, and easily offended. Chilliness and constipation are also common. Mental strain, anger, physical exertion, stimulants, strong foods, and alcohol are likely to make things worse. Warmth and rest often help (Ezine 2014).
Generally action centers around the liver, nerves, uterus and rectum. Spasmodic hysterical complains. Pains are boring, spasmodic, contractive, cramping and darting. Excitement during menses.
Menstrual flow is black, profuse, clotted, prolonged. Tinea ciliaris, eruptions on the face and forehead, < before menstrual flow. Dysmenorrhoea < pressure on the back or lying on a hard pillow.
Face is pale during menses and pain in loins and mental depression (Vermeulen 2001).
Sadness before menses, Prefers to be alone. Menses irregular, usually profuse. Bearing down pains < motion, > lying on the back.
Dysmenorrhoea and convulsions. Delayed appearance of menses in girls (Vermeulen 2001).
Symptoms l. sided mostly then go to the r. (throat) and ovaries. It great female remedy. Headaches in the vertex, fainting. Menses too short, too feeble, pains are better on the onset of the flow.
Left ovary painful. Menses are black, scanty, and lumpy. Dysmenorrhoea on the first day, pain shooting upward in the left ovary. Desire to go into open air and run about before menses
> deep contractions of menstrual cramps. Similarly indicated for any painful muscle cramp (following strenuous exercise).
Perhaps no remedy has achieved a greater clinical reputation in dysmenorrhea than has Magnesia phosphorica. The pains calling for it are neuralgic and crampy preceding the flow, and the great
indication > warmth and < motion. In neuralgia of the uterus Magnesia phosphorica vies with Cimicifuga.
Uterine engorgements with the characteristic crampy pains will indicate the remedy. It has also been used successfully in membraneous dysmenorrhoea. We have very few remedies for this affection. Hale: Viburnum, Guaiacum and Ustillago for membranous dysmenorrhoea.
Their indications are chiefly empirical. Colocynth, a useful remedy in dysmenorrhea, may be compared with Magnesia phosphorica. The symptoms of Colocynth are severe left-sided ovarian pains, causing patient to double up; pains extend from umbilicus to genitals (Ezine 2014).
Cimicifuga race/Actea racemosa
The characteristic indication for this remedy in dysmenorrhea is pain flying across the pelvic region from one side to the other. It is especially useful in rheumatic and neuralgic cases, and in congestive cases it may also be thought of along with Belladonna and Veratrum viride. Headache preceding menses; during menses sharp pains across abdomen, has to double up, labor-like pains, and during menstrual interval debility and perhaps a scanty flow. The resin Macrotin is preferred by many practitioners. The pains of Cimicifuga are not severe and intense nor felt with such acuteness as are those of Chamomilla (Ezine 2014).
The dysmenorrhea essentially spasmodic in character; the pains are bearing down in character. It produces a continued spasm of the uterus simulating first stage of labor; the flow is mostly normal in quantity. The spasmodic intermittent pains which call for Caulophyllum are in the groins, a useful remedy in these spasmodic cases if given between the periods. to various part of the body.
Magnesia muriatica is also a remedy which may be studied in uterine spasm.
Gelsemium is similar in many respects to Caulophyllum. It is very useful remedy in neuralgic and congestive dysmenorrhea when there is such bearing down. The pains are spasmodic and labor-like, with passages of large quantities of pale urine. It is one of the best given low in hot water. It will surely relieve the pains at the start (Ezine 2014).
Sharp, cutting, tearing pains that make the person double over bring this remedy to mind. Cramping may be felt throughout the pelvic area or be focused near the ovaries. The woman feels restless from the pain, but lying down and keeping hard pressure and warmth on the area improve things. This remedy is often indicated if problems are worsened by emotional upsets, especially after feeling anger or suppressing it (Ezine 20014).
The menses are accompanied by many accessory symptoms (nausea, deafness, and abdominal colic). The menstrual flow often ceases on the 3rd or 4th day, and after a few hours, or a day, reappears.
In this respect Kreosotum resembles Sepia, but the flow of Sepia is scanty and retarded, while that of Kreosotum is abundant and anticipates; and the local symptoms and general condition of Sepia are less pronounced, or decidedly different.
The menses are followed by leucorrhoea, which is at first very acrid and dark brown in colour, and quite offensive. Nitric acid has a dark flesh-coloured discharge after the menses, but it is thin and watery, looking like the washings of meat, and it is not offensive.
In a day or two the leucorrhoea of Kreosotum becomes deep yellow, and has a peculiar odour, like that of fresh green corn when it has just been husked.
Along with the leucorrhoea there is much pain in the back, a dragging pain from above downward, a pain as if something would come out, or as after long stooping. This pain is relieved by motion and < rest (opposite of the backache of Sepia and Nux vomica) and similar to that of Belladonna.
These series of symptoms have led to the use of Kreosotum in prolapsus uteri, in which it has proved of great value. Along with Sep. Puls. Stann-met. Nux-v. Bell. and Podo, it enables us to avoid altogether the use of those miserable make-shifts, pessaries and supporters, which, affording temporary relief, entail so great miseries on those who use them (Boericke 1999).
Platinum metallicum./ Platina
Platinum may be of great help in a variety of menstrual problems, making it a very popular remedy in homeopathy. Many women rely on it for help with heavy, brief, or even absent menstrual cycles and therefore it is used for a wide range of conditions. It can bring relief for painful cramps and help to reduce any other pains or constrictions felt around the uterus area.
Oversensitivity of the Female Genitalia:
Women may suffer from a variety of different painful and irritating issues surrounding the female genitalia, and this is where platinum is recommended. It is used as a homeopathic remedy for women who suffer from overstimulation, or pain associated with the vulva or vagina. These problems may be heightened during menses or may come on out of nowhere. For any sort of pain or unusual stimulation in or around the female genitalia, platinum may be of great help.
Numbness and Cramps:
The numbness and pain that platinum homeopathy often helps with is usually associated with cold skin. This may be due to a constricted feeling in the limbs, and is most common in the thighs or the calves. If there is a sensation that the limbs are bandaged, even when they are not, then platinum may be a helpful homeopathic remedy (Vermeulen 2001).
Menses early, profuse or too late, pale and scanty, with soreness about genitals; pains from back pass down through gluteal muscles, with cutting in abdomen. Pain through left labium, ext. through abdomen to chest. Delayed menses in young girls, with chest symptoms or ascites. Difficult, first menses. Complaints after parturition. Uterine hæmorrhage; constant oozing after copious flow, with violent backache > sitting and pressure (Vermeulen 2001).
Before menses, headache, colic, chilliness and leucorrhœa. Cutting pains in uterus during menstruation. Menses too early, too profuse, too long, with vertigo, toothache and cold, damp feet; the least excitement causes their return. Uterus easily displaced. Leucorrhoea, milky (Sepia). Burning and itching of parts before and after menses; in little girls. Increased sexual desire; easy conception.
Hot swollen breasts. Breasts tender and swollen before menses. Milk too abundant; disagreeable to child. Deficient lactation, with distended breasts in lymphatic women. Much sweat about external genitals. Sterility with copious menses. Uterine polypi (Kent 2000).
Her sufferings at puberty when she is slow in maturing are often met by this medicine. From taking cold at first menstrual period often comes a painful menses that lasts during menstrual life, unless cured by this remedy. Violent cramping in uterus and groin several hours before the flow starts, relieved after the flow has been fully established. The pains make her cry out. Intense sexual excitement (like Plat. Grat. Orig.). Weak, sinking sensation in the pelvis. Prolapsus of uterus during stool and micturition. Uterine polypus. Labor-like pains at the beginning of menstruation. Copious menstrual flow, with very dark clots and membranes.
Leucorrhea like white of egg day and night. Throbbing, titillating in external genitalia. Burning in the vagina and uterus during menses. Child refuses mother's milk. It may be given to a woman who has brought forth one or two children that may be considered Calc-p. babies. The next child will be stronger and have a better constitution (Kent 2000).
Produces and cures dryness in the vagina in which coition becomes very painful. Burning in the vagina during and after coition. It has disturbance of menses. Absence or suppression of menses for many months, the patient being withered, declining, pale and sallow, becoming feeble. It seems that she has not the vitality to menstruate. It is also suitable in girls at puberty when the time for
the first menstrual flow to appear has come, but it does not come. She goes on to 15, 16, 17 or 18 without development, the breasts do not enlarge, and the ovaries do not perform their function.
When the symptoms agree, Lycopodium establishes a reaction, the breasts begin to grow, the womanly bearing begins to come, and the child becomes a woman. It has a wonderful power for developing, and in that respect it is very much like Calc-p. (Kent 2000).
2.4.5 Other complimentary therapies
Chiropractic manual adjustments of the spine, physical therapeutics, acid free diets, herbal supplements and eastern therapies are effective methods for the management of primary dysmenorrhea (Spears 2005).
In a study conducted by Moosa (2002), the study was designed to determine whether lumbar and sacral adjustments, full spinal adjustments or placebo is more effective in treating women
with primary dysmenorrhea. 45 volunteers were divided into 3 groups of 15 each. Group 1 received lumbar spinal and sacral adjustments, group 2 received full spinal adjustment, and group 3 received detuned ultrasound (placebo).
Patients received thirteen treatments over 2 months. Results showed that all 3 groups experienced pain relief at the follow-up consultation. 35 of 45 participants reported that their pain had decreased. There was a statistically significant difference in all 3 groups. However there was no statistical difference between the 3 groups, which suggests that there was no difference between the treatments administered.
Allopathic treatment for primary dysmenorrhea has a 20 - 25% failure rate and the numerous side effects encountered point to an increased need for alternative treatment (Wilson and Murphy 2001).
A study conducted by Witt, Lüdtke and Willich (2009) concluded that homoeopathy, as a holistic therapy, was effective in treating primary dysmenorrhoea. One small trial showed a hytotherapeutic combination to be more effective for pain relief than placebo, and less additional pain medication was taken by the treatment group
(Proctor and Murphy 2001). At a dose of 6mg/day, the standardized phyto-drug (Psidii guajavae folium extract) reduced menstrual pain significantly compared with conventional treatment and placebo (Doubovaa et al 2007).
No information was found in an extensive literature search by the author, comparing these two therapies (homoeopathy and phytotherapy) in the treatment of primary dysmenorrhoea. No clinical trial has been conducted on this particular phytotherapuetic complex;
The interventions of the individual herbs are well known, but no information is available on the intervention of these substances in a combined phytotherapeutic complex.
Homoeopathic similimum had been proven in previous studies to be effective in primary dysmenorrhoea treatment, but people are still unaware of this as a potential therapy, therefore this study made the trial participants aware of this therapy.
This study used five herbs which act in different ways in order to relieve dysmenorrhoea, thereby the assumption was to produce better results with a combination of substances than when using a single phytotherapeutic substance.
MATERIALS AND METHODOLOGY
The experimental medication was dispensed in liquid format (25ml) and comprised of either the phytotherapuetic complex (Angelica sinensis , Dioscorea villosa, Matricaria chamomilla, Viburnum opulus and Zingiber officinalis) or the homoeopathic similimum in a 30CH plussed potency.
Participants were asked to return for follow-up consultations in the week following the menstrual period once every month for a period of three months.
The medicines utilised for the study were prepared at the Durban University of Technology Homoeopathic Day Clinic dispensary. The medicines were in a liquid format and were dispensed in 25ml amber glass bottles from the first consultation up to the second follow-up.
Manufacturing of the homoeopathic similimum Homoeopathic similimum treatment was based on homoeopathic principles and a qualified homoeopath at the Durban University of Technology Homoeopathic Day Clinic supervised each case to confirm an appropriate remedy was chosen.
The purpose of this double blind, clinical trial was to compare the efficacy of a phytotherapeutic complex:
Angelica sinensis, Dioscorea villosa, Matricaria chamomilla, Viburnum opulus, and Zingiber officinalis with a homoeopathic similimum in a 30ch plussed potency, in the treatment of primary dysmenorrhoea in terms of the participant’s perception of the treatment. The study was conducted over a period of three menstrual cycles for each participant.
Phytotherapy was statistically effective and the homoeopathic simillimum had no significant effect on the “control” symptoms.
The homoeopathic simillimum had a greater statistically significant effect on water retention, when compared to the phytotherapeutic complex.
In the studies that were conducted by Mokabane (2009) where they tested the efficacy of the homoeopathic similimum in the treatment of the symptoms of primary dysmenorrhea on black females, conducted for the period of three months, and the one done by Christie (2005), which was a qualitative study on the effect of the homeopathic similimum on the treatment of primary dysmenorrhoea conducted for the period of four months. Similar approach was used, they both used the same measurement tool, used number of 10 participants in their studies, there was no control used in these two studies, and the homoepathic similimum was found effective on both trials, even though different population groups were used.
This study results also showed the homoepathic similimum to be effective in the treatment of primary dysmenorrhoea. But on this study a different form of recruitment was used, since participants had to see the gynaecologist for the ultrasound exam to confirm the diagnosis suspected by the researcher. This study used two treatments forms, homoeopathic similimum being a control, the study was also conducted for the period of three menstrual cycles.
The number of 25 participants were used, including all races even though there was a majority of African participants which was not intended. This study used two measurement tools which are different from the ones used on the previous studies but the MDQ have the similar symptoms which were evaluated on the measurement tool used on the other trials in it.
On this study the evaluation of symptoms was done on the follow-up, and that might have affected the results as it easy for participants to forget what exactly happened during the menses. There was no treatment free month to obtain the baseline.
COMPARISON BETWEEN GROUPS
Friedman’s test showed that most measured parameters relating to experience during the previous menstrual flow showed statistically significant reductions in intensity. This is to say that both the phytotherapy group and the similimum group experienced reductions in their symptoms as measured by the MDQ. Neither group noted any significant improvements in the symptoms grouped under the Arousal heading (affectionate, orderliness, excitement, feeling of well-being, burst of energy and activity). This may have been due to the subtle and highly subjective nature of these symptoms.
It may have been difficult for the subjects to note and recall changes in these parameters in detail at the time of the next consultation. Under the “Control” heading (feeling of suffocation, chest pain, ringing in the ears, heart pounding, blind spots and fuzzy vision) the phytotherapy group recorded a significantreduction while the similimum group did not. There was evidence that less change
was experienced in the week before the last period than in the actual menstrual period itself.
Pertaining to the remainder of the most recent menstrual cycle significant changes experienced in the rest of the menstrual cycle were hardly noted (only one heading was seen to statistically reduce
in intensity, namely “Appetite Changes”).
The results of Friedman’s score for participant responses to the PRS questions showed that both interventions resulted in the decrease of pain during the menstrual cycle. These results support the previous discussion as to the notability of symptoms outside of the menstrual flow time. In both question categories no significant changes were noted in questions relating to the week before the last
The inter-group analysis was conducted using the Mann-Whitney U test for two independent samples. This tests the null hypothesis that there is no significant difference between data measurements from the different treatment groups (i.e. phytotherapy and similimum group).
The final comparisons of groups’ results were obtained using data from the third and final consultation (Follow up 3). There was no significant difference between the phytotherapy and similimum group in all except the water retention category, as a reflection of the subjects answers to questions relating to the symptom perception during the last menstrual flow of the trial.
Therefore, according to this study homoeopathic similimum and phytotherapeutic complex provided the same result in the treatment of primary dysmenorrhea. The participants were directed to take the treatment on the first three days of the menstrual flow.
However, administration of the treatment could have started a week before the menstrual periods to cover the pre-menstrual symptoms experienced at that time. This could be one of the reasons why there were no statistically significant improvements of the pre-menstrual symptoms. In addition, it may have been difficult for the subjects to note and recall changes at that time or it could have been that they didn’t recognize these symptoms as part of the menstrual cycle.
Considering that both phytotherapy and homoeopathic similimum were effective in reducing the symptoms of dysmenorrhoea, either one could be used as a treatment modality with a favourable response. Similimum is more cost effective as a prescription, but it is more time consuming to arrive at with regard to case taking, analysis and final choice of remedy. Phytotherapy would be suitable, therefore, when Homoeopathic prescriptions
Both the phytotherapeutic and similimum interventions were effective in reducing the clinical features of dysmenorrhoea experienced during the menstrual flow, but they were both equally effective i.e. there was no significant difference between the groups. The therapies were less effective in reducing the clinical features of dysmenorrhoea experienced in the week before menstruation, and no effects were noted in the remainder of the menstrual cycle, except for changes in appetite.
First and second objectives
The first and second objectives were to determine the effectiveness of a phytotherapeutic complex and similimum, respectively, in the treatment of primary dysmenorrhea.
Results from intragroup analysis showed that in both groups most measured parameters relating to experience during the previous menstrual flow showed statistically significant reductions in intensity. This is to say, both the phytotherapy group and the similimum group experienced reductions in their symptoms as measured by the MDQ. The PRS results showed that both interventions resulted in the decrease of pain during the menstrual cycle. However, in both question categories no significant changes were noted in questions relating to the week before the last menses.
The first and second hypothesis were therefore rejected, since both the phytotherapeutic complex and the simillimum group were effective in the treatment of the clinical features of primary dysmenorrhoea.
Results from intergroup analysis showed that there was no significant difference between the phytotherapy and similimum group in all aspects, except the water retention category during the last menstrual period as measured by the MDQ
Further more, there was no statistically significant difference between groups treated with phytotherapy compared to similimum as measured by the PRS.
The third hypothesis is therefore supported.
Benefits of the study
Participants taking part in this study benefitted in various ways. A significant number of them did experience an improvement in the clinical features associated with primary dysmenorrhoea, which
as the main objective of the study.
Furthermore other benefits were experienced; participants gained information about homoeopathy. Most of them had little understanding of what homoeopathy is and began to appreciate the profession as a natural complementary method, in its holistic approach.
Participants gained more knowledge about their bodies and their health, especially regarding the connection between mental/psychological symptoms and physical symptoms. Participants were educated on the condition itself, dysmenorrhoea (primary and secondary) as well as on the menstrual periods.
The following recommendations are made for future research studies:
Symptoms of primary dysmenorrhoea occurs during menstruation, but in a number of patients the onset of the symptoms are also pre-menstrually, thereby a study where the administration of
treatment starts a week before the menstrual flow, would possibly reveal significant results.
A comparative study, comparing homoeopathic similimum, phytotherapy and allopathic treatment could be of benefit.
The study could be repeated with greater flexibility with regard to potency selection in the simillimum group.
A future study with a placebo in addition to the homoeopathic similimum and phytotherapy treatment could be of benefit and rule out the possibility of treatments causing improvement because
of a placebo effect.
A longer period of study over six months or longer is recommended, since if this has been a long standing problem left unattended short-term treatment will not have a lasting effect.
Administration of the treatment could possibly be changed to intervals as required, instead of fixed times like in this study where it was taken every three hours. The researcher noticed in at least one participant that the effect of treatment only lasted for two hours. The impact of lifestyle and dietary changes should not be underestimated in the improvement of symptoms related to primary dysmenorrhoea. Future studies could include aspects related to this such as diet, supplementation, stress management, exercise etc.