Osteopathic Manipulative Treatment and menstruation

OVERVIEW OF DYSMENORRHEA

Dysmenorrhea is painful or difficult menstruation. Primary dysmenorrhea is diagnosed when no obvious underlying cause is found. Secondary dysmenorrhea is associated with an identified cause. Secondary dysmenorrhea is most often linked to gynecologic disorders such as endometriosis.

Primary dysmenorrhea is more common than secondary dysmenorrhea and usually starts during adolescence. Either form of dysmenorrhea can be severe enough to interfere with daily activities, disrupting school or work. Primary dysmenorrhea often becomes less severe with age and after pregnancy. Although the cause of primary dysmenorrhea is unknown, the pain experienced is thought to result from contractions of the uterus that occur when the blood supply to its lining (endometrium) is reduced.

Dysmenorrhea can cause pain in the lower abdomen, extending to lower back or legs. The pain may manifest as cramps that come and go or a constant dull ache. Often, the pain starts shortly before or during the menstrual period, peaks after 24 hours, and subsides within two days. Other common symptoms include headache, nausea, constipation or diarrhea, irritability, nervousness, depression, abdominal bloating, and an urge to urinate frequently. When the pain is severe, vomiting may occur.

Standard medical treatment for primary dysmenorrhea usually involves nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen, and mefenamic acid. The treatment of secondary dysmenorrhea depends on the cause. Surgery may be utilized to widen the cervical canal, or in extreme cases, to sever the nerves to the uterus.

EDGAR CAYCE’S PERSPECTIVE

Edgar Cayce discussed the causes and treatment of dysmenorrhea in approximately 90 readings. Many of these cases would likely be diagnosed as dysmenorrhea by current medical criteria. The most frequently cited factor in the causation of dysmenorrhea as described by Edgar Cayce was nervous system dysfunction. Most often, pressure on nerves along the lower spine was the source of the problem. The twelfth dorsal (thoracic) vertebrae, and throughout the lumbar, sacral and coccyx (tailbone) areas were specifically mentioned in many readings. Nerves from these centers provide impulse to the organs of the reproductive system. Disruption of nerve impulse can disrupt the natural elimination process during menstruation:

(Q) Can the Forces suggest a remedy or cure for the painful and excess flowing during the menstrual period?
(A) Correct those conditions in the lower dorsal! (2261-1)

(Q) How is it that I suffer so during the first day of menstruation? Please give correction.
(A) This is according to the position of the organs of expulsion. This may be best aided by the use of hot salt packs, you see, during the first day; and then the general corrections osteopathically may overcome the condition entirely.
(Q) What specific osteopathic treatments would be necessary (to correct the position of the organs and prevent painful menstruation)?
(A) Those for the correction of subluxations existing in the last dorsals - 11th and 12th, and in the lumbar axis. (1431-2)

In several instances, pressure on the reproductive tract was traced to the colon. Poor eliminations through the lower bowel (constipation) was a direct influence on the menstrual process. Reading 911-6 seems to be describing a pre-mentrual component associated with poor eliminations through the alimentary canal:

(Q) What can I do to avoid severe body disturbances at the periods before menstruation, and pain at that time?
(A) If the colon is kept cleansed at or before such periods, this will relieve the greater part of the distresses that are usually indicated. There is pressure on the organs of the pelvis before such periods. It is well that there not be too much mental or physical exercise for the body at that time. (911-6)

The after-effects of cold and congestion was mentioned in several readings as a cause of dysmenorrhea. Reading 467-1 describes how cold and congestion, combined with nerve pressures along the lower spine, alters the position of the womb resulting in painful menstruation.

At a time back, during a period of menstruation there was cold and congestion in the body, so that the effect to the body was for a contraction in the pelvic organs, for the turning of the womb itself in such a position that the nerve influences have tended to keep the organ in this position by the manner of the affectation that has existed and does exist in the body itself.
This, then, produces a severe pain at the periods, and makes for the effect upon the activity of the kidneys, the organs of the pelvis, and the character of headaches experienced. Also there is the effect produced which is contributory to the digestive disturbances in body, the inability for the activities of normalcy through the periods, and the bearing down pains in the lower extremities when being long on feet; the ineffectiveness in creating proper digestive forces for the system, or for the body to be normal in its diet or desire for diet… (467-1)

The treatment plan for this woman included osteopathic treatment, hot packs, electrotherapy, a medicine (Tonicine) to work with the glandular system, and an alkaline diet to improve assimilation and eliminations.

Reading 288-38 contains some excellent suggestions for utilizing exercise, diet and positive mental attitudes for treating dysmenorrhea:

(Q) Should I MAKE myself take the evening exercises of the lower limbs, even when I'm so tired and heavy that I can't put any pep into it?
(A) The best way to acquire the correct amount of pep is to take the exercise!
(Q) When I don't walk during the day, are the evening exercises sufficient to equalize the circulation to the lower limbs?
(A) Provided the exercises are of sufficient duration and sufficient character to insure the activity in these portions of the system. Well that there be the riding of the bicycle; that is, the exercise of same from the shoulders and the limbs, upward, and movements as of riding, see?
(Q) Why do I always suffer menstrual pains?
(A) Owing to the incoordination as we have indicated in the adrenals and the caecum areas, making for pressures during the periods. These, then, require that the exercises and that the positions of the body in its activities make for the proper coordinations.
Through diet and exercise the greater portion of all disturbances may be equalized and overcome, if the right mental attitude is kept. (288-38)

The exercise is intended to relieve pressures much as the osteopathic manipulations recommended in other cases of painful menstruation. Diet and positive mental attitude were consistently emphasized in the readings for women suffering from dysmenorrhea.

BASIC TREATMENT RECOMMENDATIONS

Conceptually, the Cayce approach to dysmenorrhea focuses on assisting the body in healing itself by the application of a variety of therapies intended to provide symptomatic relief while also addressing the underlying causes of the condition. The mental and spiritual aspects of healing are emphasized from the standpoint of working with a spiritual ideal.

Here are some general therapeutic guidelines intended to address the underlying causes of dysmenorrhea:

MANUAL THERAPY (SPINAL MANIPULATION): Cayce often recommended spinal manipulations to correct specific problems which may be a primary cause of dysmenorrhea. It is difficult to obtain the osteopathic adjustments specified by Cayce. However, a chiropractor may be of some help. The frequency of the adjustments will depend on the recommendations of the individual chiropractor or osteopath. The use of an electric vibrator may also be helpful for individuals unable to obtain regular spinal adjustments.
DIET: The Basic Cayce Diet is intended to improve assimilation and elimination. The diet focuses heavily on keeping a proper alkaline/acid balance while avoiding foods which produce toxicity and drain the system. Essentially, the diet consists mainly of fruits and vegetables while avoiding fried foods and refined carbohydrates ("junk food"). Certain food combinations are emphasized.
INTERNAL CLEANSING: Because dysmenorrhea was often linked with poor eliminations, hydrotherapy is recommended to improve eliminations through the colon. Hydrotherapy includes drinking six to eight glasses of pure water daily and obtaining colonic irrigations to cleanse the bowel. Following the diet should also assist with internal cleansing. Abdominal castor oil packs used prior to the menstrual period assist with cleansing the the alimentary canal.
ELECTROTHERAPY: Although various forms of electrotherapy were recommended for problems associated with dysmenorrhea, the Radial Appliance is suggested in this protocol because it is safe and easy to use. Regular use of the Radial Appliance may be helpful in balancing circulation, increasing relaxation, and improving sleep. Radial Appliance sessions provide an excellent opportunity to meditate and decrease stress.
EXERCISE: Moderate regular exercise is suggested (such as walking or riding a bicycle). Specific stretching exercises taken morning and evening may be helpful in relieving pressures on the nerve centers, pelvic organs, and the alimentary canal.
ATTITUDES AND EMOTIONS: The mental and spiritual aspects of healing are frequently discussed in the Cayce readings. Particularly, an attitude of desiring and expecting to be healed is important. A positive mental and emotional attitude and can be created and maintained by focusing on a high purpose (spiritual ideal) for being healed.
SPECIAL RECOMMENDATIONS FOR SYMPTOMATIC RELIEF

The above general recommendations should be helpful for addressing the causes of dysmenorrhea. However for symptomatic relief, here are some specific recommendations which may help to relieve some of the numerous complaints which can be associated with dysmenorrhea:

MENSTRUAL PAIN: Edgar Cayce often recommended hot Epsom salts packs over the lower abdomen or lower back for acute menstrual pain. Sitz baths may also be helpful in relieving pelvic pain associated with dysmenorrhea.

BREAST FULLNESS AND PAIN: Gently massage cocoa butter into breast. Also spinal adjustments to the upper cervical vertebrae (especially third cervical) may be helpful.

INSOMNIA: Use of the Radial Appliance and/or the electric vibrator along the spine should improve the quality and quantity of sleep. Taking a glass of warm milk with honey in it at bedtime was also recommended by Edgar Cayce to help individuals get to sleep.

CONSTIPATION: Cayce recommended a variety of laxatives for relief from constipation. As a principle, Edgar Cayce typically advised that the same laxative not be used continuously because the body can develop a dependence upon that form. Alternating laxatives is recommended.