for the use only of
registered medical practitioners or a hospital or a laboratory
an approach
to DYSMENORRHOEA
tablet Aloes Compound (Alarsin)
PRIMARY DYSMENORRHOEA IN THE UNMARRIED TREATED WITH ALOES COMPOUND
by
Miss GITA BHATIA
M.D. (Bom.), F.C.P.S., D.G 0., D.F.P. (Bom.)
Consulting Obstetrician and Gynaecologist
Honorary Obstetrician and Gynaecologist of
Chandrika Bhalia Memorial Clinic, Sion, Bombay
Rashtriya Sewa Samiti, Girgaum, Bombay
Melville Diagnostic Centre, Mazgaon, Bombay
Mongol Mahila Samiti, Marine Lines, Bombay
Current Medical Practice Vol. No. l5, Page 7I5 to 717 No. 4 April I971
‘Dysmenorrhoea’ literally means difficult menstruation : (Dys: difficult; men : month; rheein: to flow). But in practice the term is applied to disabling menstrual pain of obscure etiology which does not allow the patient for hours or for days her normal mode of living and working.
Primary Dysmenorrhoea :
Dysmenorrhoea may be primary or secondary. It is considered primary (essential, intrinsic, idiopathic) when there is no gross pathologic conditions in the pelvic organs. It is termed secondary (acquired, extrinsic) when it is the result of endomotrosis, intramural leimycmas of the uterus.
The uterine colic is often associated with other symptoms such as headache, nausea, vomiting and general malaise.
Psychogenic factors
Even if an organic etiology were to be found or an inherent sensitiveness of the upper cervix demonstrated in primary dysmenorrhoea, there would still remain a complex psychogenic overlay
more evident in some girls.
CURRENT TREATMENT
At present there is not a single drug or measure that can guarantee a permanent cure even in a minority of cases. As medical measure to inhibit or alter the ovulatory process hormones-estrogen and progestogen are given. Surgical treatment consists of prolonged dilatation of the cervix by stem pessary
(Wylie drain), transaction of uterosacral ligaments and resection of presacral nerve. Once injection of alcohol were given into the Frankenhanson’s plexus. These are now replaced by stem pessary.
As omnibus measures bed rest, postural exercises, heat to lower abdomen, analgesics, antispasmodics; explanations and reassurances are adopted. As a last resort change of environment, marriage and pregnancy is suggested.
The drug Aloes Compound
Before the advent of hormone-age, aloes was used along with other herbal drugs since centuries both in the West and the East for menstrual disorders and dysmenorrhoea. In fact combinations of Aloes et Ferri and Aloes et Myrrh were British Pharmacopeal drugs for a number of years.
Each tablet of Aloes Compound(Alarsin) contains :-
Aloes ( Aloes indica) 60 mg.
Myrrh (Bol) 60 mg.
Manjistha ( Rubia cordifolia) 30 mg.
Hurmal (Peganum hurmala) 30 mg.
Loha bhasma (Iron ‘ash’) 30 mg.
It appears that this combination synergestically acts most probably through nervous systems by relieving spasms of uterine musculature and also gives general tone and sedation to the uterus. It induces menstruation. It has also liver corrective, digestive and haematinic properties which relieve associated
complaints of loss of appetite, constipation, gastric disturbances and general malaise.
METHODS AND MATERIAL :
The unmarried of primary dysrnenorrhoea with history of unbearable progressive menstrual pain from the menarche or after a few years of painless menstruation without detectable organic use were selected from out-door patients attending “Chandrika Bhatia Memorial Clinic” at Sion, Bombay, during a period of over three years. Age groups of 100 cases included for this study are given in Table 1.
Dose Adopted:
Treatment with Aloes Compound was started 5 days before the expected date of menstruation till the onset of menses. This was repeated for next 3 periods. In cases with severe pain
2 tab. q d.s. and in others 2 tab td.s. were given. If there was complete relief at the end of the three periods, the treatment was discontinued. In those who had partial relief it was repeated for
next 2-3 periods. Those with complaints of irregular and or scanty menstruation were asked to continue the tablets during menstrual days also.
Table 1
Age Group No. of Cases
15 to 20 years 55
20 to 25 years 30
25 to 35 years 15
Duration of dysmenorrhoea varied from 6 months to 10 years. Most of them were previously treated on usual lines of analgesics, antispasmodics, and / or hormones, without satisfactory improvement. 65 of them had complaints of irregular and / or scanty menses of varied duration and extent.
RESULTS :
The results were assessed on the basis of relief in the severity and duration of pain and disability and were assessed as complete relief if no bed rest was required and normal mode of living and
work was possible and the patient herself felt complete relief. Partially relieved if no bed rest was required but could attend to normal work partially and when patient also felt only partial relief. And as no relief if there was no relief at all according to the patient.
Table 2
Results Relief No. of Cases
Complete relief 30
Partial relief 55
No relief 15
The relief was most remarkable in teenage group. There was improvement: in regularity and flow in 60 out of 65 patients who complained of irregular and [or scanty menses.
DISCUSSION :
It is not possible to have exact evaluation of any treatment for primary dysmenorrhoea as the symptom is subjective and because of several phychogenic and environmental factors involved.
In the unmarried teenagers, mothers require handling as well as daughters. Over anxious parents, relatives and at times fussy physicians make the condition more difficult to treat. It helps to suggest and impress them in a confident tone that this type of menstrual pain is a sign of good health and occurs in healthy girls.
ln a majority of cases reassurances, reorientation of their outlook on problems of adolescence and improvement in general health are all that is necessary. But for this only a few can spare time in a busy private or hospital practice. Habit forming drugs like pcthedine should be avoided. Injections for relief of pain, surgical measures or gynaecological investigations and examinations are likely to make the young girls more introspective and should be avoided.
In primary dysmenorrhoea empirical use of hormones and surgical measures are not desirable particularly in the teenagers. Their use better be reserved for more other serious conditions which may arise in future. Moreover, in primary dysmenorrhoea once a patient has had previous treatments without relief, cure rate falls perhaps because of strong psychogenic barriers.
As the medical saying goes ‘pregnancy and labour often permanently cure dysmenorrhoea.’ Even if this saying is of therapeutic value before the girl can get married and can get pregnant and can undergo labour pains, it is necessary to induce painless periods by preventive measures as soon as possible.
The patient has to be assured that a cure is possible and thereby minimize psychogenic overlay.
CONCLUSION :
Gynaecological examinations and investigations are not possible or desirable in the teenagers and the unmarried women. This is so in general practice where most of these patients first go for help. Injections, or surgical measures are psychologically harmful and before resorting to them herbal drugs like Aloes Compound which do not disturb the hormonal balance have their usefulness because of simple and safe dosage and their efficacy in primary dysmenorrhoea whose etiology is not known and for which no specific treatment is available today.
SUMMARY :
1. Aloes Compound was tried in 100 cases of primary dysmenorrhoea in the unmarried girls and women.
2. There was complete relief in 30, partial relief in 55 and no relief in 15 cases.
3. No toxic or adverse side effects were reported. In the unmarried before resorting to empirical use of injections, hormones or surgical measures, use of tablet Aloes Compound is suggested.
ACKNOWLEDGEMENT :
I am thankful to Superintendent, Chandrika Bhatia Memorial Clinic and to Shri Partap Shukla of Alarsin Pharmaceuticals, Bombay, for their co-operation, assistance and help in this trial.
REFERENCES :
1. Chopra R. N. (1958) : Indigenous Drugs of India, 2nd Edition.
2. Ghose R. (1957): Pharmacology, Materia Medica Therapeutics, 2oth Edition.
3. Nadkarni K. M. (1946): Indian Materia Medica 3rd Edition.
4. Masani K. M. (1966) : Psychosomatic Problems in Gynaecology. Sir Kedarnath Das Memorial Oration 1966. Journal 0 & G, Ind. 17 : 2, 113.