Painful Periods Are “Normal” in the US
Periods
In the United States girls and women expect to have pain with their periods. Even taking pain medicine for period pain does not raise an eyebrow.
Here’s the news.
Your period should not be painful.
If your period is painful something is off.
A painful period can indicate your uterus is out of place so the blood can’t get out well. Pain can also mean your nutrition or hormones are not well-balanced so your body is too inflamed.
Dr. Caroline Peterson will assess and treat the position of your uterus, and suggest supplements to help balance your nutrition and hormones.
What Causes Dysmenorrhea AKA Painful Periods?
Your period should not be painful. You should not experience breast pain, headaches, and mood changes.
All these symptoms indicate hormonal imbalance that is leading to inflammation.
Sometimes a uterus will be tipped and that can also contribute to painful periods.
Dr. Peterson can help you identify the underlying causes of your painful periods and offer solutions.
What Causes Menorrhagia AKA Heavy Bleeding?
Heavy bleeding is commonly related to estrogen dominance.
Estrogen dominance is sometimes an actual excess of estrogen, and sometimes because progesterone is low.
One of the most common reason for heavy bleeding (especially when accompanied by pelvic or abdominal pain) is endometriosis.
Bleeding begets bleeding.
When you bleed, your iron levels go down.
Iron is a clotter, so you will bleed more with low iron levels.
That said, iron-deficiency anemia can contribute to heavy bleeding.
Dr. Peterson can help you find out why you are experiencing heavy bleeding and what to do about it.
What Causes Oligomenorrhea or Polymenorrhea AKA Long or Short Menstrual Cycles?
A menstrual cycle length is measured from the first day you bleed to the last day you do not bleed.
Ideally this is a 28 day cycle.
If you have irregular periods or bleed less frequently than every 35 days you have oligomenorrhea or long menstrual cycles.
Polycystic Ovarian Syndrome (PCOS) is one of the most common reasons for a long cycle.
If you bleed more frequently than every 21 days, you have a short menstrual cycle.
Both a long and a short menstrual cycle make it hard to have a baby.
Both a long and a short menstrual cycle are important to investigate and optimize so your hormones are balanced and you are balanced.
What is Premenstrual Syndrome (PMS)?
PMS are symptoms that come up to three days before your period.
- Cramps
- Bloating
- Breast Tenderness
- Acne
- Headaches
- Insomnia or extra tired
- Anxious/sad/depressed
- Decreased sex drive
- Brain fog
- Food craving
How does natural medicine manage PMS?
First off, we take these symptoms seriously.
I definitely do not agree that only 3-8% of women have clinically significant PMS, as the biomedical literature suggests.
The PMS that women experience is significant to them, even if it doesn’t meet some unknown standard of clinical significance.
PMS is telling you your body is out of balance.
Take care of it now, naturally, so you have more of a chance to have an easeful menopause later.
We manage this constellation of PMS symptoms with tonifying herbs like vitex, essential fatty acids to sooth inflammatory prostaglandins, liver support to help clear out hormones, and adaptogenic herbs to balance.
What are Menstrual Migraines?
Headaches that come with your period are called catamenial migraines or menstrual migraines.
Almost half of all women with migraines experience migraines with their menses.
They may begin two days before your period and last three days into your period
There are two types of menstrual migraines:
1. Pure menstrual migraine (1-7% of all women)
- No aura
- No migraine any other time of cycle
2. Menstrually related migraine
- Migraine also occurs outside of cycle
Neurosteroids such as estrogen, pregnenalone, sulfate pregnenalone, progesterone, and testosterone assist in balancing neuroexcitation and neuroinhibition in the central nervous system. Migraines represent neuronal hyperexcitation.
What causes menstrual migraines?
Menstrual migraines are related to the drop of estrogen of greater than 10 micrograms. This means people with high estrogen are more likely to get menstrual migraines. The drop in estrogen causes increased sensitivity to prostaglandins and a release of other inflammatory neuropeptides and neurokinins. This causes changes in the microcirculation of the dura, serotonin and dopamine concentrations, and calcium/magnesium concentrations.
An aura does not occur with menstrual migraine because the aura is related to high estrogen, and the menstrual migraine is related to a drop in estrogen.
What if your menstrual migraines continue after menopause?
A subset of women with menstrual migraines continue to experience migraines after menopause. For these women, low allopregnenalone (produced from the cortex of the adrenal glands rather than the ovaries) appears to play a determining role. Allopregnenalone is neuroprotective and decreases inflammation in the central nervous system by working with GABA receptors and decreasing activation of microglia and astrocytes.
Similarly, low pregnenolone sulfate causes an upregulation of NMDA activity and contributes to menstrual migraines.
Treatment with perimenstrual estrogen decreases the incidence and severity of menstrual migraines, as does treatment with testosterone, soy isoflavones, dong quai, and black cohosh. Treatment with progesterone delays the period, but the migraine still comes.
Natural Treatment
1) Soy isoflavones to act as weak estrogens and block estrogen receptors so strong estrogens cannot attach.
If you do not tolerate soy, dong quai is an herb that acts as an adaptogenic phytoestrogen.
These adaptogens should prevent the big drop in estrogen at the start of the period
2) Vitex is a tonifier of the female reproductive tract and will help to optimize levels of estrogen and progesterone produced
3) Flax and sesame help to mop up recirculated estrogens in the entrohepatic circulation
4) Liver support including DIM help to support biohepatic breakdown of estrogen so less is circulating
What is Premenstrual Dysphoric Dysorder (PMDD)?
Premenstrual Dysphoric Dysorder (PMDD) is experienced by millions of women world-wide and is characterized by debilitating emotional, mental, and physical symptoms before your period.
DIAGNOSIS
Criterion A – You must meet one of the first four symptoms, and 5 of 11 total symptoms
- Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, feelings of being “keyed up” or “on edge”
- Marked affective lability (e.g. mood swings, tearfulness, sensitivity to rejection)
- Persistent and marked anger or irritability or increased interpersonal conflicts
- Decreased interest in usual activities (eg, work, school, friends, and hobbies)
- Subjective sense of difficulty in concentrating
- Lethargy, easy fatigability, or marked lack of energy
- Marked change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia
- A subjective sense of being overwhelmed or out of control
- Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.
Criterion B – symptoms severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning.
Criterion C – symptoms discretely related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although the symptoms may be superimposed on those of these disorders).
Criterion D – criteria A, B, and C confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.
ETIOLOGY
Estrogen and progesterone levels are the same in women with and without PMDD. This suggests the symptoms could be related to the body’s sensitivity to hormones, rather than the level of the hormones themselves.
WORKUP
- Rule Out Thyroid problems
- Rule out Anemia
- Rule out Electrolyte imbalance
Biomedicine Treatment
The gold-standard biomedical treatment of PMDD is selective serotonin reuptake inhibitors (SSRIs). 60% of women improve with SSRIs. The secondary approach is with GABA support.
Natural Medicine Treatment
- Essential fatty acids and Chaste tree can also help with associated symptoms by decreasing inflammatory prostaglandins that are associated with PMDD.
- Saffron is a natural SSRI
- Isoflavones like Genistein and Diadazin are phytoestrogens that are adaptogenic. They will block the hypersentive estrogen receptors with a weaker form of estrogen and thereby decrease the impact of estrogen
- Avoid gluten since gluten makes it hard to break down glutamate into GABA for some people
- If you are not sensitive to soy, consider adding actual non-GMO organic soy foods like tofu or tempeh into your diet several times a week since the isoflavones are more impactful in food form than in supplements.
