Dysmenorrhea

At the age of 15, when I began my period the pain during my menstrual cycle I always knew as painful. Gradually it grew more and more painful until I would have to stay home from school/work. I had friends who were diagnosed with Endometriosis, Relatives with Endometriosis as well… but when I went to the Dr. as a teenager, they always just told me that I’m ‘normal’ and I just have “painful periods” and that is that.

It wasn’t until after I was married that my pain felt SO bad I literally believed that this is what it MUST feel like to be in labor. My husband would be so concerned, I felt that I was in the delivery room and he was coaching me as I breathed “heee heee hoooo hooo heee heee hooo hooo”. :) I knew it wasn’t just “painful periods” there had to be a name for this type of excruciatingly painful period every month.

Not only was the pain so horrible, but I could go anywhere from 30-43 days in between my cycles. Something is off its ticker! What is going on?

Finally I got on some good Health Insurance and I scheduled an appointment. After the exam my OBGYN diagnosed me with Dysmenorrhea and Oligomenorrhea.

Below are my findings of my diagnosis. I do not plan to own this label of pain/disease for the rest of my life as I strongly believe in self-healing. Last year (2008) I suffered from extreme Anxiety and I can now officially say that I am Anxiety – Free. It took a lot of work, but I believe that you have to discover the roots of all that binds you down before you can free yourself from those chains. I now have a name to the pain and I plan to study it out and take care of it.

Nothing is impossible, EVERYTHING is possible. With enough love ♥, we can move mountains – and this ‘mountain’ of mine I plan to plow right through ;)

***

Dysmenorrhea GirlDysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe uterine pain during menstruation. While most women experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or require medication.

Symptoms

Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thighs and lower back. Other symptoms may include nausea and vomiting, diarrhea, headache, fainting, and fatigue. Symptoms of dysmenorrhea usually begin a few hours before the start of menstruation, and may continue for a few days. [1]

Cramps

When the menstrual cycle begins, prostaglandins (chemical substances that are made by cells in the lining of the uterus) are released by the endometrial cells as they are shed from the uterine lining, causing the uterine muscles to contract. If excessive prostaglandin is present, the normal contraction response can become a strong and painful spasm. As it spasms, the blood flow is cut off temporarily, depriving the uterine muscle of oxygen and thus causing a “cramp.” The cramps themselves help push out the menstrual discharge.

Excessive prostaglandin release is also responsible for contraction of the smooth muscle in the intestinal tract; hence the diarrhea, nausea and vomiting. Headache and dizziness may also be the result of high prostaglandin levels. [2]

Treatment

Diet

Both a low-fat vegetarian diet and fish-oil supplements have been reported to reduce menstrual pain in some women. [2]

Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms.

Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA. nbarnard@pcrm.org

OBJECTIVE: To test the hypothesis that a low-fat, vegetarian diet reduces dysmenorrhea and premenstrual symptoms by its effect on serum sex-hormone binding globulin concentration and estrogen activity. METHODS: In a crossover design, 33 women followed a low-fat, vegetarian diet for two menstrual cycles. For two additional cycles, they followed their customary diet while taking a supplement placebo pill. Dietary intake, serum sex-hormone binding globulin concentration, body weight, pain duration and intensity, and premenstrual symptoms were assessed during each study phase. RESULTS: Mean (+/- standard deviation [SD]) serum sex-hormone binding globulin concentration was higher during the diet phase (46.7 +/- 23.6 nmol/L) than during the supplement phase (39.3 +/- 19.8 nmol/L, P < .001). Mean (+/- SD) body weight was lower during the diet (66.1 +/- 11.3 kg) compared with the supplement phase (67.9 +/- 12.1 kg, P < .001). Mean dysmenorrhea duration fell significantly from baseline (3.9 +/- 1.7 days) to diet phase (2.7 +/- 1.9 days) compared with change from baseline to supplement phase (3.6 +/- 1.7 days, P < .01). Pain intensity fell significantly during the diet phase, compared with baseline, for the worst, second-worst, and third-worst days, and mean durations of premenstrual concentration, behavioral change, and water retention symptoms were reduced significantly, compared with the supplement phase. CONCLUSION: A low-fat vegetarian diet was associated with increased serum sex-hormone binding globulin concentration and reductions in body weight, dysmenorrhea duration and intensity, and premenstrual symptom duration. The symptom effects might be mediated by dietary influences on estrogen activity. [3]

The Naturopathic Alternative

Diet has always been the mainstay of healing within the naturopathic world. Addressing the consumption of foods most likely to aggravate existing conditions is the basis of optimal healing. In the case of menstrual cramps, eliminating foods high in arachidonic acid is the key to dealing with cramping. This fat produces a type of prostaglandin (specifically PGE2) that increases inflammation within the body. Dairy products, beef, pork, chicken, and turkey are all high in arachidonic acid. While decreasing PGE2 production, increasing healing prostaglandins will help. PGE1 and PGE3 are anti-inflammatory and anti-spasmodic. These are found in fish such as salmon, tuna, and sardines. Many nuts and seeds such as flaxseeds and pumpkin seeds can help in the production of the “good” prostaglandins.

Specific nutrients have also been shown to help in relieving menstrual cramps. Vitamin B3 (niacin) has been proven to help ease pain in 87.5 percent of women involved in one study. Women were given 100 mg of niacin twice a day for one month and then every few hours during menstruation. The mechanism of action is believed to increase blood flow to the uterus thereby relieving the pain. (Please note that the study used niacin and not niacinamide; therefore, one may experience the “niacin flush” when using high doses of vitamin B3.) Adding vitamin C and rutin (a bioflavanoid) each day seemed to increase the effectiveness of the niacin in relieving cramping. [4]

Homeopathic Remedies

Herbal Remedies

Traditionally, many herbs have been used to treat dysmenorrhea. Black cohosh (Cimicifuga racemosa) is known to alleviate menopausal symptoms and has also been used to treat dysmenorrhea throughout the world. Tincture doses or capsules every two to four hours have been effective by helping to relax the uterus.
Another popular group of herbs is the Viburnum sp, such as crampbark or black haw. Both herbs have proven in animal and human studies to be a uterine anti-spasmodic. Crampbark specifically should be used if the cramping is of a congestive nature (bloating or nausea) and includes pains radiating down either the back or thighs. While black haw is more indicated for heavier menstrual flow, both can be used in either tincture or capsule form.
Menstrual cramping for many women can be managed through non-invasive techniques. Simple changes in diet and supplementation of nutrients and/or herbs can bring relief. If you would like to choose these avenues of healing, consult a qualified health-care practitioner such as a licensed naturopath or herbalist to rule out other pathologies thereby addressing the totality of your health. [4]

Other Herbal Remedies:

  • AltMed -Herbal Remedies for Dysmenorrhea
  • PeaceHealth -Dysmenorrhea (Painful Menstruation) — Homeopathic Remedies

 

 

 

Medication

Treatment of primary dysmenorrhea is directed at providing relief from the cramping pelvic pain and associated symptoms (eg, headache, nausea, vomiting, flushing, diarrhea) that typically accompany or immediately precede the onset of menstrual flow. The pelvic pain can be distressing and occasionally radiates to the back and thighs, often necessitating prompt intervention. To date, pharmacotherapy has been the most reliable and effective treatment for relieving dysmenorrhea. Because the pain results from uterine vasoconstriction, anoxia, and contractions mediated by prostaglandins, symptomatic relief can often be obtained from use of agents that inhibit prostaglandin synthesis and have anti-inflammatory and analgesic properties.

NSAIDs and combination OCs are the most commonly used therapeutic modalities for the management of primary dysmenorrhea. These agents have different mechanisms of action and can be used adjunctively in refractory cases. The lack of response to NSAIDs and OCs (or the combination) may increase the likelihood of a secondary cause for dysmenorrhea.

Other therapies for dysmenorrhea have been proposed, but most are not well studied. These include thiamine, vitamin E, omega-3 fatty acids, magnesium, acupuncture, acupressure, various herbal medicines, transdermal nitroglycerin, calcium-channel blockers, beta-adrenergic agonists, antileukotrienes, and transcutaneous electrical nerve stimulation (TENS) units. Use of topical, continuous, low-level heat may be beneficial for some patients.

Treatment of secondary dysmenorrhea involves correction of the underlying organic cause. Specific measures (medical or surgical) may be required to treat pelvic pathology (eg, endometriosis) and to ameliorate the associated dysmenorrhea. Periodic use of analgesic agents as adjunctive therapy may be beneficial. [2]

UPDATE July ‘09:

… I never thought of doing breathing exercises to alleviate stress FOR Dysmenorrhea (when I read that stress plays a role in the amount of pain – this is when I realized that stress has been a pattern as I recall back to when my periods have been at their worst), and yoga to strengthen my lower muscles and to help relax my body and mind. To add more Magnesium in my diet, fish oil and Vitamin E. Here are the links we found:

Sources:

1. Wiki – Dysmenorrhea

2. eMedicine – Dysmenorrhea Treatment

3. NCBI – Pub Med – Low Fat Vegetarian Diet reduces Dysmenorrhea

4. Alive – Dysmenorrhea – The Naturopathic Alternative

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