Period Pain

You get your period every month but dread those few days to a week every month because you know you will pretty much be at home, not be able to go anywhere and may need to use sick days at work or be absent from school.

Period pain and cramping is SO common that society has almost normalized it.  It isn’t normal to have cramping and pain every time you have your period that you feel like you can’t move for a few days or are throwing up.  Ideally, your period should show up and disappear in a few days with no pain or very little cramping but nothing that makes you double over in pain for a prolonged period of time or needing to take painkillers every couple of hours. Painful periods and/or heavy bleeding are a sign that something may be going on and should be investigated as it can be related to ovarian cysts, fibroids, endometrial cysts, adenomyosis, or endometriosis.  Let’s focus in on endometriosis because March was Endometriosis Awareness Month and according to the Endometriosis Network of Canada, the latest figures show that 1 out of every 10 girls and women will have or develop endometriosis in their lifetime [1].

Endometriosis - What Is It?

Your uterus has three layers to it with the innermost lining known as the endometrium.  The endometrial cells are responsive to estrogen and thicken the lining of your uterus in the follicular phase (first half of your cycle) to prepare for implantation of the embryo, and if you don’t conceive, the endometrial lining is then get shed resulting in your period.  Endometriosis, or fondly known as ‘endo’, is a condition where endometrial tissue is found in places outside of the uterus.  This can be in places such as on the ovaries, fallopian tubes, abdominal cavity, liver, gallbladder, and nose (nosebleeds).

‘Endo’ is commonly associated with estrogen dominance.  Estrogen dominance is where you have an increased amount of estrogen relative to progesterone levels – this can be an absolute increase involving above normal levels of estrogen or just a relative increase compared to progesterone where your estrogen is still normal.  Read more on estrogen dominance here.

Endometriosis is also often treated as an inflammatory condition and some experts consider it to be associated with autoimmune diseases.  Whether ‘Endo’ is an autoimmune condition is still undergoing research but a systematic review by Shigesi et al (2019) was conducted which showed four of twenty-six studies that supported a statistically significant association between endometriosis and a few autoimmune conditions. They mentioned the need to consider the co-existence of endometriosis and autoimmune conditions in a woman [2].  More research is needed in this new and emerging area though to investigate whether ‘endo’ increases the risk of autoimmune conditions or is one of the many products of autoimmune conditions [2].

Uterus - Endometriosis

What Can You Feel or Experience?

  • Menstrual painperiod cramps
  • Chronic pelvic pain
  • Back/leg pain during your periods
  • Increased frequency to urinate
  • Infertility or recurrent pregnancy loss
  • Trouble conceiving
  • Fatigue
  • Pain with sexual activity
  • Gas, bloating, diarrhea, or constipation
  • Pain with bowel movements
  • Pain with urination
  • Nosebleeds

Diagnosis & Treatment

Endometriosis can take years to diagnose and a female may end up seeing her family physician multiple times over a number of years before a formal diagnosis is obtained.  It is said that it can take 10 years for a formal diagnosis [1].  This is because there are no blood tests to diagnose it and an ultrasound may detect tissue but can’t diagnose it as endometriosis.  A minimally invasive laparoscopic procedure is required for confirmed diagnosis to obtain the tissue and perform a biopsy of the tissue to assess if it is endometrial tissue.

Recently, there has been research showing that measuring CA-125 via a blood test has high specificity (93%) to act as a non-invasive measure and provide a presumptive diagnosis in symptomatic women to begin medical management without having to wait to obtain the gold-standard laparoscopy for a confirmed diagnosis [3].  Due to poor sensitivity of 52% for CA-125, a negative result cannot rule out endometriosis as many with ‘endo’ may have levels within normal [3].  CA-125 should never be used alone to assume ‘endo’ and a pelvic ultrasound should also be done to assess for conditions like ovarian cancer and fibroids which can raise CA-125.

Conventional medical management typically involves anti-inflammatories like ibuprofen (Advil or Motrin) and Tylenol to manage the pain [1].  Hormonal medication, most commonly, the birth control pill is prescribed to “regulate your hormones” which essentially shuts your own production of estrogen and progesterone off and relies on exogenous hormones.  The IUD may be a better option but read more about birth control here.

The laparoscopic procedure used for diagnosis can be used for treatment to remove the endometrial lesions.

Ibuprofen
Birth control pill

Naturopathic Treatment and Management

From a naturopathic medical standpoint, we are always offering natural options to reduce inflammation and dealing with the pain while we focus on identifying and treating the root cause of what triggered your menstrual symptoms and endometriosis because inflammatory conditions, dietary changes, stress, and other factors can predispose one to a state of estrogen dominance.

There are a variety of herbs that can be recommended to reduce inflammation and also support the adrenals and your cortisol levels.  Acupuncture can be great for managing and reducing the pain along with IV treatments to reduce pain and support estrogen detoxification.  Rather than having to take the birth control pill, we have treatments to help with modulating estrogen and progesterone so you aren’t actually shutting down your own body’s production of the hormones leading to other health consequences.  I would love to share the herbal support options but there are many like vitex, shatavari, black cohosh, DIM, and, calcium-d-glucarate depending on your clinical picture so booking an appointment with a naturopathic doctor really helps tailor the prescription to your health situation.

Reviewing and treating any autoimmune conditions and/or digestive issues can also play a part in naturopathic endometriosis treatment plans because our hormone health and hormone balance really goes hand in hand with optimal digestive function and reducing inflammation in the body.

In my practice, I do a lot of hormone testing whether it is via blood tests or a more comprehensive hormone test because hormones are rarely ever tested by medical doctors and it sometimes feels like a “fight” with medical doctors asking them for blood tests to look at your hormones.

Naturopathic Medicine

Struggling to figure out what is going on behind your excruciating menstrual symptoms and/or want a different approach to management so you may not need to take the birth control pill or tons of Advil all the time? You are welcome to book a naturopathic discovery session or initial consultation via the link below and let’s get you some period relief so that you aren’t dreading that time of the month on a monthly basis.

REFERENCES: 

 

[1] The Endometriosis Network Canada (2022). Retrieved on April 4 2022 from https://endometriosisnetwork.com/

[2] Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update. 2019 Jul 1;25(4):486-503. PMID: 31260048.

[3] Speer L, MD. CA 125 relatively specific for diagnosing endometriosis. Am Fam Physician. 2017 Jan 15;95(2):122.

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