Why We Need to Question Period Pain

Do you struggle with Painful Periods? And if so, perhaps you’ve been told it’s just a normal aspect of existing in a female body? 

In today’s world, it is very common for women struggle with with pain and cramping during their periods. The official term for pain during menstruation is “dysmenorrhea”, and there are two types of dysmenorrhea, primary and secondary. Primary dysmenorrhoea is a painful menstruation with no detectable organic disease and is more common in adolescent women. Secondary dysmenorrhoea is painful menstruation that is frequently associated with a pelvic pathology.

Period pain and cramping has often been written off as part of existing in a female body. So many women experience pain during their periods every month for decades, and still, the majority of don’t know why. Most women also seem to be unaware that they can do something about it. When I tell clients that their periods are not meant to be painful, many of them are really surprised…

Dysmenorrhea, of pain related to your period, is not normal. It is an indicator that something is out of balance, to a larger or lesser degree, in your body. 

FINDING THE ROOT CAUSE

Painful periods might be related to nutritional deficiencies or dietary issues (allergies and intolerances), be due to hormonal imbalances, stress, emotional turmoil, or trauma. It can also be an indicator of a more serious underlying condition such endometriosis, adenomyosis or pelvic inflammatory disease. In a completely healthy woman, periods come with no pain, and cause minimal discomfort. 

If you suspect something is not quite right in your body, and you are not getting the support you need from your healthcare practitioner, I would encourage you to seek help elsewhere. Getting a second and third opinion may be very valuable. Health practitioners specialised in women’s health, naturopaths, Ayurvedic practitioners, herbalists and dieticians are just some of the options you may wish to consider. Ideally you want to see someone who can approach your issue from several angles.

Some examples of hormonal and dietary causes of period pain include:

* Magnesium deficiency (resulting in cramping of the uterine muscle)

* Estrogen excess (resulting in heavy menstrual bleeding: the uterine muscle needs to work harder to expel the blood)

* Inflammation in the body (due to increased production of inflammatory prostaglandins; hormone-like compounds that cause contractions and pain the uterus)

* Zinc deficiency (associated with heightened sensitivity to pain and increased production of inflammatory prostaglandins)

In the case of a nutritional deficiency or dietary issue, correcting the issue may greatly, or even completely, help alleviate dysmenorrhea. Food allergies and intolerances can contribute to period pain for various reasons (such as gluten intolerance causing inflammation), so removing certain foods from your diet for a window of time may be recommended.

PROSTAGLANDINS

Menstrual cramps are sometimes caused by an excess of prostaglandins. Prostaglandins are hormone-like compounds that are released from the uterine lining (the endometrium) as it prepares to be shed as your monthly bleed. Prostaglandins help the uterus contract and relax, in order for the endometrium to detach and flow out of your body. Prostaglandins are a necessary part of the process, however, when they are in excess they may cause pain if the uterus contracts strongly, blood flow is reduced, and the supply of oxygen to the uterus muscle tissue decreases.  The production of prostaglandins is related to inflammation, and inflamed tissue tends to produce more prostaglandins. Addressing inflammation in the body may for some people be a key element in treating dysmenorrhea. In such a case, an anti-inflammatory diet may be prescribed. You may be recommended to increase you intake intake of anti-inflammatory foods, such as leafy greens, turmeric, algae and foods high in omega 3 fatty acids, with the aim of decreasing production of inflammatory prostaglandins to lessen pain. 

HORMONAL IMBALANCES

In the case of hormonal imbalances, in particular an excess of estrogen (or insufficient progesterone-to-estrogenlevels ) this issue needs to be corrected, and again, we may approach it from different angles. Estrogen excess and progesterone deficiency may occur due to increased production of estrogen, reduced clearance of estrogen, reduced production of progesterone, or a combination of all three.  Say the issue is increased estrogen production. In this case we must address the factors that may be causing this, such as diet and exposure to endocrine-disrupting chemicals.  We may also look at supporting the body’s ability to clear estrogen from the body, through strengthening the organs responsible for detoxification; particularly the liver and bowel. The practitioner may suggest some diet modifications, alternative treatments such as acupuncture, as well as looking into what herbs may support the organs in their detoxing-abilities. 

When seeing a health care practitioner, some investigations that may be suggested include blood tests, imaging (such as ultrasounds), and creating a case report through conversation and questioning to understand more about the severity, timing and type of pain that is occurring, and what may be causing the underlying issue(s). From there, further investigation may or may not be needed, such as with a laparoscopy, MRI or pelvic exam. It is only when the underlying issue has been identified we can take steps to rebalance the body and create sustainable and lasting change that goes far beyond symptom management. Areas to be considered are the persons diet (potential nutritional deficiencies or food allergies), supplements and supportive herbs, lifestyle and stress levels, mental health, potential past trauma and ruling out more serious illnesses such as endometriosis or adenomyosis.

A note on Medical Conditions that may cause dysmenorrhea

• Adenomyosis is a condition in which the cells that normally form a lining in the uterus also grow in the muscle wall of the uterus.

• Endometriosis In endometriosis, the uterine lining grows outside of the uterus, such as in the abdominal cavity or bowel, which may cause severe pain, heavy menstrual bleeding and inflammation. Other indicators endometriosis include pain during sex, pain during urination, bleeding between periods, and struggling to conceive. If you suspect that you may have endometriosis it is important to have further testing and investigation done.

• fibroids – non-cancerous tumours that can grow in or around the womb and can make your periods heavy and painful

• pelvic inflammatory disease – where your womb, fallopian tubes and ovaries become infected with bacteria, causing them to become severely inflamed
  

An intrauterine device (IUD) is a type of contraception made from copper and plastic that fits inside the womb. It can also sometimes cause period pain, particularly during the first few months after it is inserted.

Photography by Leigh Stenson @she.is.water