YOGA , DYSMENORRHEA AND PROGESTERON LEVELS



YOGA, DYSMENORRHEA AND PROGESTERONE LEVELS

A PROBLEM RELATED TO MENSTRUATION IN YOUNG MEDICOS.

A RANDOMISED STUDY

ORIGINAL ARTICLE

USHA NAG, M.D [OBG] PG Dip , M.Sc [YOGA] 1

V. KALYAN CHAKRAVARTHY M.D 2[Pathology]. Dr. G. VENKATARATNAM,M.D3 CHANDRA SHEKHAR4

DEPT OF OBG AND PATHOLOGY

DR. PINNAMANENI SIDDHARTHA INSTITUTE OF MEDICAL SCIENCE AND RESEARCH FOUNDATION, VIJAYAWADA

1. Assoc. Prof, 2.Assoc.Prof, 3 Prof . 4. statistician

ORIGINAL ARTICLE

ABSTRACT

OBJECTIVES Assay of pre menstrual progesterone levels was done before and after yoga in young medical volunteers suffering from primary dysmenorrhea to see if the progesterone levels altered in the cases that reported with complete pain relief after yoga.

METHODOLOGY In this study 60 medicos were made to do certain yogic exercises. Pre menstrual serum progesterone was taken. Yoga was continued for 3 months. Pre menstrual serum progesterone was assayed again after yoga . In the present study 95% subjects reported 100% pain relief but their progesterone levels were still low.

RESULT This result infers that yoga relieves pain of dysmenorrhea , but not through altering the progesterone levels.

P = 0.0027 using the U test of Mann Whitney

Key words dysmenorrhea, yoga asanas, progesterone

CONCLUSION

It can be concluded that yoga can be safely used as an alternative therapy for pain relief in dysmenorrhoea and this action is not mediated through the hormones.

INTRODUCTION Dysmenorrhea derived from the Greek word means a painful menstration .It is one of the most important causes of school absenteeism amongst adolescent girls .1

Dysmenorrhea and PMS is highly prevalent among female medical students, it is related to college/class absenteeism, limitations on social, academic, sports and daily activities. Maximum participants do not seek medical advice 3

In primary dysmenorrhea towards the late luteal phase a drop in progesterone was seen followed by an increase in the prostaglandin levels, which was responsible for the pain of dysmenorrhea.

Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells. Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract.4 These substances are thought to be a major factor in primary dysmenorrhea. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experienced during menstruation.

Compared with other women, females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.

Yoga is known to produce a complete relief of pain.14 This study was taken up to see if yoga altered the premenstrual progesterone levels in the late luteal phase in all those cases who reported with complete relief of pain. No rise in the progesterone levels were observed in all the cases who reported a complete relief of pain .This indicates that Yoga produces pain relief which is not related to progesterone levels.

MATERIAL AND METHOD The study included 60 young medical volunteers from DR.PINNAMANENI SIDDAHRTHA INSTITUTE IF MEDICAL SCIENCE AND RESEARCH FOUNDATION. All were between the age group of 19 – 23 yrs.

All had primary dysmenorrhoea. Some had associated menorrhagia (20), some had PCO (10). This study did not have any obese subjects. They were all moderately built with an average weight of 48.5 kgs.

35%[113] of subjects had stress factor. Stress of education ,exams and some had additional family stress. It has been studied by S.D. Soule, M.D that stress has a role in dysmenorrhoea. Plass states that dysmenorrhoea is purely subjective complaint. Mathiew notes that pain has to do with the uterus

They were made to do yoga exercises and meditation for 3 months. Premenstrual blood was taken for progesterone level. Assessment of progesterone was done by immunofluroscence method. The intensity of pain was evaluated every month .It was a qualitative analysis, taking an opinion from the subjects about the intensity of pain under 3 categories. Mild, moderate and severe. These values were evaluated pre Yoga and post yoga .By the end of 3 months 95 % reported a 100% pain relief .Progesterone levels were reassessed after yoga training. The levels were found to be low despite complete pain relief in the individuals.

The subjects did not take any medication for pain relief when compared with the control group who took medication for pain relief. Pain was evaluated using the Mann Whitney technique.

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RESULTS

After the first month of yoga 45% [27 subjects] had 100% relief from pain.

After the 2 months 50 % [30 subjects] had 75% pain relief .

By the end of 3 cycles 95% of the subjects [51 subjects] had 95% pain relief. Of the remaining 5 % [3 subjects] took occasionally 1-2 tabs for pain relief. All subjects reported pain relief and a better quality of life. The subjects who earlier were absent from classes due to pain attended classes reducing the incidence of absenteeism during the menstrual period. On an average 3-4 classes were missed every cycle before the Yoga Therapy. The levels of progesterone before and after yoga did not show any variation. Thus the Hypothesis was proved wrong. The conclusion is different from the tentative Hypothesis.

STATISTICS The pain factor was analyzed using the U test of Mann Whitney

P = 0.0027

NON YOGA PERFORMERS

|  | YES| NO |

|Stress Factor |49 |8 |

|Absenteeism |30 |12 |

|Physical activity |8 |80 |

[pic]

G2 [control] G1 [study group]

YOGA PERFORMERS

[pic]

YES NO

|Stress Factor |11 |65 |

|Absenteeism |10 |34 |

|Physical Activity |80 |10 |

DISCUSSION In the present study 320 subject were surveyed.Out of them 129 [43 %] suffered from primary dysmenorrhea1. 113 [35% ] of the subjects had additional stress as a factor 6. Similar reports of primary dysmenorrhea were reported by Nag [33.84%], Mackay and Dean [67%] Harlow & Park [71.6 %] Sandel et al [67%] primary dysmenorrhea may affect as many as much as 40% of all adult women temporarily disabling one tenth of them. The etiology of this condition may be related to excess production of prostaglandins by the endometrium following decline in progesterone levels . It is proposed that increased prostaglandin levels produce increased myometrial contractitity and uterine ischemia and sensitization of pain fibers, resulting in pain . 3

.

Current evidence suggests that the pathogenesis of primary dysmenorrhoea is due to prostaglandin PGF2 α, a potent myometrial stimulant and vasoconstrictor in the secretary endometrium.The response to the prostaglandin inhibitors in patients with dysmenorrhoea supports assertion that dysmenorrhoea is mediated through Prostaglandins .4

Elevated prostaglandin levels were found in the endometrial fluid of woman with dysmenorrhoea and correlated well with degree of pain. A 3 fold increase in endometrial prostaglandins occurs from follicular phase to leuteal phase with a further increase during menstruation.4 The increase in prostaglandin in the endometrium following the fall in progesterone levels in the late leuteal phase results in increased myometrial tone and excessive uterine contractions.

This study was taken up to see if yoga altered the premenstrual progesterone levels in the late luteal phase in all those cases who reported with complete relief of pain. No rise in the progesterone levels were observed in all the cases who reported a complete relief of pain .This indicates that Yoga produces pain relief which is not related to progesterone levels.

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The posterior pituitary hormone vasopressin may be involved in myometrial hyper sensitivity, reduced uterine blood flow, and pain in primary dysmenorrhoea . Vasopressin role in the endometrium may be related to prostaglandin synthesis and release.8.

OVERVIEW OF ALTERNATIVE THERAPY

An alternative approach to menstrual cramps needs to provide effective pain relief while at the same time correcting the underlying dysfunction. Stress reduction can help us not to store tension in low back and pelvic area which can worsen menstrual cramps.12

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Because we are dealing with a functional problem and not a disease state that is causing pain, we can truly focus on a holistic approach by looking for aggravating factors in diet, life style, and emotional environment.16

In the present study meditation was used to decrease the stress levels in the subjects.

Dietary principles emphasize good nutrition, elimination of junk food, saturated fats and increasing whole grains, fruits, vegetables, provide a range of nutrients to prevent menstrual cramps .

Mild and moderate level of pain are better tolerated with natural therapies than acute severe pain.

MORTALITY AND MORBIDITY:

Dysmenorrhoea can disrupt personal life and is a significant public health problem associated with substantial work loss related to work absence .10% of these subjects have severe pain that can be incapacitating. In the US, the annual economic loss has been estimated at 600 millions work hours and 2 billion dollars .5,6 The findings of the present study showed the incidence of primary dysmenorrhea [43% ] Similar findings were reported by Nag (33.84%), Mekay & Deives (67%) Horlow & Park (71.6%) Sundel et al

CONCLUSSION Primary dysmenorrhea is a common problem in young medicos. The pain is due to an increase in the prostaglandin levels just before the onset of menses

Yoga relieved pain of dysmenorrhea in 95% of the subjects. All these subjects despite a 100% pain relief showed a low progesterone levels. So yoga does not relieve pain through hormones. It can be used as a alternative treatment in primary dysmenorrhoea

ACKNOWLEDGEMENT:

Principal, Dr. PSIMS & RF. For granting permission to carry out the study

All subjects of the study for their co operation in the successful completion of the study.

REFERENCES

1. LINDA FRENCH, M.D., Michigan State University College of Human Medicine, East Lansing, Michigan Am Fam Physician. 2005 Jan 15;71(2):285-291

2. Campbell M, McGrath P. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med 1997; 151: 905–912. Indian J Physiol Pharmacol 2008; 52(4) Prevalence and Severity of Dysmenorrhea 397

3. eMedicine Specialties > Dysmenorrhea Authors: Andre Holder, Laurel D Edmundson, Mert Erogul. Updated: Dec 31, 2009

4. Wilson C, Keye W. A survey of adolescent dysmenorrhea and premenstrual symptom

frequency. J Adolesc Health Care 1989; 10: 317–322.

5 . Harlow SD, Park M.: A longitudinal study of risk factors for the occurrence, duration and

severity of menstrual cramps in a cohort of college women. Br. J Obstet Gynaecol 1996; 103: 1134–1142.

6. Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982; 144: 655–660.

7. Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatr Adolesc Med 2000; 154: 1226–1229.

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Acta Obstet Gynecol Scand. 2006;85(2):207.

9. Cakir M, Mungan I, Karakas T, Girisken I, Okten A.Menstrual pattern and common 938–942. menstrual disorders among university students in Turkey. Pediatr Int 2007 Dec; 49(6):

10. R Jerry, MD Klein, F Iris, MD Litt. Epidemiology of Adolescent Dysmenorrhea. Pediatrics 1981; 68: 661–664.

11. Ng TP, Tan NC, Wansaicheong GK. A prevalence study of dysmenorrhoea in female residents aged 15–54 years in Clementi Town, Singapore. Ann Acad Med Singapore 1992; 21: 323–327.

12. Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990; 97: 588–594. Dysmenorrhea

13.Occupational Stress and Dysmenorrhea in Women Working in Cotton Textile Mills. Christiani DC, Niu T, Xu X. Source Harvard School of Public Health, 665 Huntington Avenue, I-1405, Boston, MA 02115, USA.. .

14 . Information Articles Yoga for PMS (Pre-menstrual Syndrome) and Menstrual Cramps By Patricia | April 16, 2009

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