Up to 85% of women experience some degree of menstrual pain in their lives, one in four to the point that they miss school or work and need to take medication. This is an astonishingly high number, especially taking into consideration that women often dismiss painful periods as normal, or even expected. Dysmenorrhea is usually defined as pain associated with menstruation that is above and beyond normal light cramping. It is categorized into "primary," which is painful cramping in the absence of disease, or "secondary," which is pain associated with a condition like endometriosis, adenomyosis, uterine fibroids, and infection.
Endometriosis is an interesting condition in that it is very frequently missed by physicians, because it can only be formally diagnosed with a surgery called an abdominal laparascopy, which involves an exploration of the abdominal and pelvic cavity by a surgeon to look for endometrial lesions. Endometriosis is a condition where uterine tissue actually grows OUTSIDE of the uterus, implanting in various locations like the ovaries, fallopian tubes, vagina, abdominal wall, intestine, and more. Studies on prevalence vary, but it is estimated that up to 14% of women have this condition. These implants become inflamed and bleed in response to hormonal cues, causing excruciating abdominal pain, pain with sex, infertility, and numerous other symptoms.
Regardless of whether or not a client with painful periods has a formal diagnosis that explains her condition, in my practice I have two major goals:
1. Reduce inflammation
2. Achieve normal hormonal balance
Inflammation and abnormal hormone balance (frequently referred to as "estrogen dominance," although this is an over-simplification) are absolutely tied together to the extent that I believe it is impossible to separate them. These two systemic abnormalities, once initiated, feed off each other in a vicious cycle that is difficult, if not impossible, to address using pharmaceuticals alone.
Therefore, when I say "natural hormone balancing strategies," what I am really saying is "strategies for both reducing inflammation and balancing hormones." Natural hormone balancing in this context refers to encouraging the body's endocrine (hormone-producing) system to normalize itself using diet and other lifestyle interventions like sleep and exercise, and very specific nutritional supplements and botanical medicine. Occasionally, other practitioners will use the same phrase to describe bioidentical hormone replacement therapy, or the use of hormones that are identical on a molecular level to those naturally made by the body. This is in contrast to synthetic hormones, which are similar but not identical to our own endogenous hormones. Despite their differences, these two approaches come down to the same basic concept: handing the body pre-made hormones to drastically reduce the need for the body to make its own.
To be clear, in some instances, using synthetic or bioidentical hormones to treat disease diagnosed by a physician is absolutely necessary. Birth control pills, which are themselves synthetic hormones, are a reliable and convenient way to prevent conception. Balancing hormones naturally versus synthetically is not a competition of "which is better." The best option is ALWAYS the one that works best for the INDIVIDUAL. Both options have associated risks and benefits which should always be carefully considered before making a choice.
For some women, hormone therapy isn't an option because of personal preference, religious beliefs, side effects, and sometimes downright inefficacy. Many women who I see in my office have already tried all the conventional options available to them to no avail, which is why they made an appointment with me in the first place! Based on the needs of the client, I work up a very specific and customized health plan that focuses on removing the underlying causes of inflammation and hormone imbalance, optimizing lifestyle factors like diet, exercise, and sleep, and using high quality supplements and botanical medicine to address the imbalance as well as the specific set of symptoms. While it's my preference to always customize my wellness plans, there are five strategies I believe any woman can take to reduce inflammation, establish healthy hormonal balance, and mitigate symptoms.
1. Nutrition (1) (2) (3)
As a naturopath, I believe the cornerstone of health is diet. Eating a diet that reduces the body's tendency to make inflammatory mediators (compounds that cause illness and pain) and provides proper amounts of vitamins, minerals, and cofactors is paramount. With every bite you take, ask yourself, "Am I eating for health, or am I eating for enjoyment?" Are those cheese fries really worse missing two days of work due to menstrual pain?
Here are some basic guidelines to eating for health:
Add these foods:
-Dark leafy greens: aim for one large salad daily
-Cruciferous veggies: try 2-3 cups daily
-Omega-3 fatty acids: in high amounts in salmon and trout
-Fiber: whole grains, vegetables, and fruits
Eliminate or significantly reduce these foods:
-Saturated and trans fatty acids
2. Exercise (4) (5) (6)
Believe it or not, exercise is actually categorized as an analgesic (pain-killer) in the literature for painful periods! Regular, moderate intensity exercise increases circulation to the pelvic organs, bringing oxygen and nutrients in, and carrying metabolic waste and inflammatory mediators out. Exercise also increases the prevalence of endorphins, hormones which make you feel happy! Try one or more of the following, and more importantly, find something that you LIKE doing.
-Take a brisk walk daily on the days leading up to your period, and for the first three days of your period, if at all possible
-Take a yoga class 1-2 days per week
-Take a boot-camp or strength style class, or lift weights 2-3 days per week
3. Supplements to reduce inflammation (7) (8) (9)
Omega 3 fatty acids from fish and flaxseed oil
1.5-3 grams daily
(Click here to read my blog post on the benefits of vitamin D)
2,000 IU daily
500 mg daily
4. Support progesterone balance (10) (11) (12)
Hormonal imbalance involved in dysmenorrhea and endometriosis often favors estrogen over progesterone. This "estrogen dominance" refers to the ratio of estrogen to progesterone, meaning either estrogen is in excess, or progesterone is relatively deficient. Either way, supporting progesterone production can be beneficial to the big picture of regulating hormonal balance.
Chaste tree berry
This herbal formulation is often found as a standardized extract. Take as directed on the label, and with the guidance of a healthcare professional.
The main constituent of this botanical, diosgenin, is anti-spasmodic as well as hormone-balancing. Take as directed on the label, and with the guidance of a healthcare professional.
Organic soy products
There is a lot of controversy surrounding soy! It is my opinion that for women's health conditions, organic soy is a good option. The isoflavones found in soy bind WEAKLY to estrogen receptors, blocking estrogen hormone from docking. This can shift the balance in an estrogen-predominant state.
-Eat 1-2 servings daily
5. Supplements to reduce pain and cramping
Omega 3 Fish Oil
Try 1.5 daily, go up to 3 grams on days you are in the most pain. One study found that fish oil is actually superior to ibuprofen for menstrual pain relief!
Raspberry leaf tea
Try 2-3 cups daily as needed to reduce cramping
Scopoletin is the constituent found in this botanical that has uterine relaxant and antispasmodic qualities. Take as needed as directed on the bottle, with the guidance of a healthcare professional.
Note: The supplement links provided in this article are intended to give you an idea of what type of product to use. I cannot guarantee the quality or efficacy of any of the supplements listed! You should always get advice from your healthcare provider before taking any supplement. If you would like more specific recommendations with guaranteed quality, please make an appointment!