Menstrual Pain
Menstrual pain affects between 50-90% of the menstruating world, at some point in their lives.
What Is Menstrual Pain?
Menstrual pain, also known as dysmenorrhea, refers to the discomfort or pain that many individuals experience before or during menstruation (the monthly menstrual bleed). This pain is commonly felt in the lower abdomen, although it can also radiate to the lower back and thighs and other parts of the body.
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Primary dysmenorrhea is menstrual pain which occurs in the absence of pelvic/gynecological pathology or disease. It’s characterized by abdominal pain and cramping occurring shortly before or during the onset of menstruation. These may be sharp, intermittent spasms, or dull pain in the abdomen and lower back. Other symptoms may include nausea, vomiting, diarrhea, fatigue, fever, headaches and migraines, breast tenderness, joint pain, abdominal bloating, and lightheadedness.
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Secondary dysmenorrhea is menstrual pain which results from identifiable organic diseases. This pain may not be limited to menstruation itself but may present as pelvic pain at any time during the cycle.
Our Culture Normalizes Menstrual Pain
Considered “normal”
Young people are told to expect pain from their first menstruations, not given any resources to understand menstruation, and then are told to medicate their pain (or menstruation entirely) away
Menstrual pain is often only studied in relation to a loss of productive output (capitalist work ethic)
The acronym “PMS” is commonly likened to menstruation, as if to say that abdominal pain and cramping are synonymous with menstruation itself.
It is expected that people who menstruate bear the brunt of pain because this is “just how our bodies work”
Cultural expectations are exacerbated by menstrual product marketing for disposable menstrual products, menstrual relief medications, and contraceptives.
Women, girls, and menstruating people are told to aspire to have bodies who do not menstruate, who aren’t affected by menstruation.
Campaigns often reinforce that a menstrual cycle is a negative aspect of your life, as a useless, messy, and painful burden. We are affected by the way menstruation is portrayed not just in advertising, but also in film and tv, through social media, and other cultural mediums.
Body Literacy Teaches Us That
Menstrual Pain Is Commonplace…
But Not Normal Physiology
Root Causes of
Primary Dysmenorrhea
Primary dysmenorrhea is easily treatable and reversible. Finding the root cause is paramount to finding the correct treatment.
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Description text goeare a group of active lipid compounds made by almost every cell in the body that function similar to a hormone. They perform multiple functions, including dilation/constriction of blood vessels, regulating acute inflammation, and act as smooth muscle contractors (and relaxers) which begin their action a few days before menstruation, building up to aid in the expulsion of the endometrium, a part of the natural process of bleeding. Prostaglandins do their job and then are broken down quickly by the body. They only carry out their actions in the immediate vicinity of where they are produced which helps to regulate and limit their actions. Prostaglandins are a part of your body’s healing defense, and do not inherently cause pain, but combined with other pelvic issues, high levels of prostaglandins can result in painful cramping.
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Blood supply is rarely discussed when it comes to menstruation but its impact cannot be understated. Let’s talk about the physiology of the body for a second. Your fresh blood supply is pumped from the heart into the aorta, where it travels downward, through the diaphragm, and descends through the abdominal aorta. The abdominal aorta is then what is feeding all of your abdominal organs (if you think about it, that’s everything except the brain, lungs, and heart pretty much). This is not only oxygenated rich blood, but also responsible for circulating your hormones, and bringing in essential nutrients to your cells. When we improve the blood flow, the plumbing of the body we allow the body to do what it knows how to do. If they aren’t getting the proper nutrients they can’t always perform their intended purpose. So the abdominal aorta is what brings blood to all your internal reproductive organs, but when the diaphragm which it must pass through is in a constantly constricted state (due to stress, anxiety, or other factors) you can actually have a situation where the blood flow is restricted to these vital areas. Ovarian arteries and veins also lie right along the psoas muscle (a deep seated core muscle that is a part of the hip flexors). So there can be some physiological reasons why blood might not be flowing well enough to your pelvis and reproductive organs.
This leads to the concept of a congested uterus: most people have never heard of this, but signs of it include painful menstruation, dark blood at the beginning or end of their cycles, and lots of clotting present in the blood. And the root cause of this is an abdominal imbalance due to a restriction of pelvic blood flow.
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The alignment of the organs is the other big missing piece when it comes to discussing painful menstruation. The uterus is an organ that is intended to be flexible at different times in the menstrual cycle and of course during pregnancy, labor, and birth. The uterus can shift out of its normal anatomical position, behind the bladder in the center of the pelvis about 1.5 inches above the public bone. It’s held in position only by the vaginal wall and ligaments which are elastic. If the ligaments and muscles are weakened, the uterus can fall down (inferior) forward (antero) backward (retro) or to either side. This can be caused by a number of factors such as impacts on the lower back, sacrum, and tailbone, car accidents, difficult labor, poor pelvic bone alignment, high impact dancing, aerobic exercise, high heeled shoes and more. Keeping these physiological elements to dysmenorrhea in mind are important to getting to the root cause of why you’re feeling pain.
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Lastly, unfortunately there is no regulation on what materials can be used in conventional menstrual products. Endocrine disrupting chemicals saturate our environment, personal care products, and menstrual products are no exception. Cotton products like tampons certainly have some level of pesticide exposure, cotton is one of the worst crops for pesticide contamination because almost all of it is genetically modified and what we call “round up ready”: specifically, the chemical in question is called glyphosate, a known carcinogen. The bleaching process of cotton and rayon creates dioxins and furans, both known for their impact on hormones. Fragrances used in menstrual products are full of proprietary undisclosed chemicals. So yet another possible cause of primary dysmenorrhea should include a discussion about the quality of menstrual products - and whether they cause more infections, cancer risks, and endocrine disruption - which to be clear, we do not have enough evidence outside of anecdotes and a few court precedents (which is not to say that there is no risk, but rather that not enough science has been done! Let’s be clear that scientific inquiry is just as important when we have historically been left out of science, this type of investigation is how we get more studies funded. Someone must always ask a question first in order for research to be done. When we observe issues happening to us in real time, this means they ARE deserving of further investigation.)
Root Causes of
Secondary Dysmenorrhea
Secondary dysmenorrhea requires proper treatment to address the underlying disease or condition.
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This inflammatory disease effects an estimated 176 million people worldwide, is often under diagnosed or misdiagnosed, with up to a 10 year delay in proper diagnosis. It’s characterized by chronic, debilitating pelvic and menstrual pain, heavy or long menstruations, bowel and urinary disorders, painful sexual activity, lower back pain, allergies, migraines, and fatigue. Endo is still so unexplored we don’t have all the info on how it works, but here’s what we do know. With endo there is the presence of tissue growing outside of the womb - the name can be misleading because this tissue is structurally different, and behaves differently than normal endometrium uterine lining. Immune dysfunction seems to be a core component, preventing the body from clearing endometrial lesions and allowing them to proliferate. The question is why this happens. Current theories include a genetic component, exposure to toxins, and intestinal permeability leading to bacterial translocation to the reproductive organs or elsewhere in the pelvis. Endo causes a reduced quality of life, infertility, and chronic pain, sometimes even beyond the pelvic area.
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A similar disease to endo where this dysfunctional tissue grow into the muscular walls of the uterus, causing them to thicken. This leads to not only heavy menstruations but also pelvic pain because of the pressure of this enlarged organ pressing against others.
This leads to the concept of a congested uterus: most people have never heard of this, but signs of it include painful menstruation, dark blood at the beginning or end of their cycles, and lots of clotting present in the blood. And the root cause of this is an abdominal imbalance due to a restriction of pelvic blood flow.
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Fibroids are benign growths in or on the uterine muscle which cause pain, severe cramping, and sometimes frequent urination from the size of the fibroid pressing on the bladder. They are often reported with heavy bleeding but are not usually the cause of it, and have a connection to excess estrogen, as well as a possible genetic component.
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Sexually transmitted infections such as chlamidya can often cause pelvic inflammatory reactions. They are usually accompanied with other symptoms besides inflammation and pelvic pain, such as abnormal discharge, itchiness, and sometimes fever.
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Benign ovarian cysts occur when your ovarian follicles (which develop your egg to maturity) become abnormally large, filled with fluid, and only sometimes cause pain. They usually resolve on their own, but are most likely to cause pain if they rupture, in which case secondary symptoms like fever may be present.
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The main mode of action in both the hormonal and non hormonal IUD is inflammation. Your body is aware of the object inside your uterus and tells your immune system to rush to the area to assess the situation and clean up the mess. Thousands of immune cells rush to the area, thickening the cervical mucus and preventing fertility. This creates constant localized inflammation which sometimes results in pain. The body may even make attempts to expel the device through the process of cramping, which contrary to what your doctor may have told you, can occur for months beyond the initial insertion procedure.
Diagnosis
Menstrual pain can be diagnosed and understood through a variety of methods, both inside and outside clinical medicine.
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A healthcare provider will ask about an individual's medical history, including details about their menstrual cycle, the nature and severity of the pain, any associated symptoms, and any factors that may worsen or alleviate the pain.
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A symptom assessment like an intake form will allow you to check off the symptoms you experience. Clusters of certain symptoms may provide clues to underlying causes and the best options for treatment.
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Blood tests may be conducted to rule out certain conditions or infections that could contribute to pelvic pain.
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In some cases, imaging studies such as ultrasound or MRI may be recommended to visualize the reproductive organs and identify any structural abnormalities or conditions such as fibroids or cysts.
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Fertility awareness charts are unique bioprofiles for menstruating people to utilize on their own. They provide monthly insight into hormonal health as well as whole body health.
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A physical examination, including a pelvic examination, may be conducted to check for any abnormalities, tenderness, or signs of reproductive health issues. Reminder: physical exams are optional and elective. It is within your purview to decline them if pain is a concern.
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In some cases, additional diagnostic procedures, such as laparoscopy, may be recommended to directly visualize the pelvic organs and diagnose conditions like endometriosis.
Treatment Strategies
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Both primary and secondary dysmenorrhea are normally treated with either NSAIDs (pain relief medication) or COC’s (combined oral contraceptives). NSAID’s have a failure rate of up to 20% with alleviating dysmenorrhea among many adverse symptoms like damage to the gastrointestinal system, stomach ulcers, renal toxicity and more.
COC’s are another popular choice when the topic of menstrual pain comes up, even though very few randomized controlled trials have been conducted to demonstrate their efficacy. Besides the fact that there is little evidence to support its use for this purpose, contraceptives also come with many adverse effects like nausea, vomiting, headaches, risk of tenuous thrombosis and pulmonary embolism or myocardial infarction from estrogen use.
It needs to be said that neither of these interventions actually get to the root of someone’s menstrual pain. They can only suppress symptoms of that pain. This means that the longer someone relies on these, the longer they go without further investigation into the root cause of their dysmenorrhea.
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Practice menstrual mindfulness and an awareness of your infradian rhythm. Create your own rituals for the week before menstruation and learn to practice them. Resting more, modified stretching and meditation, vaginal steaming, warming foods, and respecting your need for time set aside for reflection can have positive impacts on your experience of menstruation.
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Focus on warm, whole foods, particularly animal foods with rich nutritious mineral content.
Minerals like magnesium and zinc, b vitamins, omega 3 fatty acids, and the anti-inflammatory herb turmeric are helpful. Drink mineral rich infusions like red raspberry leaf, and integrate berberine if you have signs of gut/immune dysfunction.
Avoid raw and cold foods before your bleed, avoid pasteurized cows dairy from Holstein cows, and possibly nightshade vegetables if they are inflammatory for you.
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Experiment with topical herbs which penetrate into the muscles and nerves to reduce pain like black cohosh, plantain, comfrey, CBD oil, and castor oil packs.
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If nothing else is working it may be time to meet with a practitioner to discuss a physiological component. Seek a trained Mayan abdominal therapist, pelvic floor therapist, or acupuncturist for more guidance in gyno-visceral manipulation techniques.
Menstrual pain is a complex condition with many different root causes. Treatment should reflect this.
PMS & PMDD
Menstrual pain is almost always studied as a physical phenomena, but mental health symptoms can be extremely disruptive during the premenstrual or menstrual phases.
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Premenstrual syndrome is said to affect somewhere between 30-80 % of menstruators with symptoms including headaches and migraines, irritability, anxiety, depression, anger or rage, feelings of being overwhelmed or sensitive to rejection, fatigue, as well as social withdrawal. In the days leading up to menstruation, the body’s hormones are dropping, especially progesterone, a calming anti-anxiety hormone.
Unlike the cultural stigma that proclaims people suffering from PMS are ‘hormonal’ it is actually a lack of your menstrual hormones (estrogen & progesterone) at this time that are causing these psychological changes. Our culture has portrayed the menstrual cycle in a way that stigmatizes people who experience it.
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Premenstrual dysphoric disorder is more severe, affecting 3 - 8 % of menstruators. The symptoms of PMDD may include depression, anxiety, severe irritability, crying spells, suicidal thoughts, and other severe mood swings that disrupt daily life and make it difficult to function with a normal quality of life. PMDD may be related to mast cells and histamines, altered sensitivity of GABA receptors to allopregnanolone (the metabolite made from progesterone), high prolactin levels, or mineral deficiencies.
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PMS/PMDD is studied only in relation to mental health symptoms, but we must remember that despite this, physical pain creates mental anguish.
We must push for PMS/PMDD to be studied in relation to a person’s whole body experience. And we must correct menstrual pain in order to address mental health issues around menstruation.
Healing Menstrual Pain is Possible
By supporting the individual: whole body and mind
By supporting the culture: a world that respects menstruation
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