Excessive Menstrual Pain or Dysmenorrhea and PCOS

Is excessive menstrual pain interfering with your life? In Pain

Most women deal with the dull cramping pain (dysmenorrhea) in their lower abdomen during their period which can be quite unpleasant. However, about 10 percent of women have pain so excruciating every month it seriously hinders their daily lives.2 Menstrual cramps can actually be scientifically measured within the uterus, and the difference between mild and severe dysmenorrhea is considerable. The readings for normal periods are low pressure (50-80 mm HG) and can show 1-4 contractions every 10 minutes. A woman who has dysmenorrhea can produce readings of high pressure (over 400 mm HG) with contractions less than 15 seconds apart.5

Women can have two types of dysmenorrhea which have different underlying causes:

  • Primary dysmenorrhea:? This period pain is the most common type and is not caused by any underlying disorder. It mostly affects adolescent girls and can start within six months to a year following the first occasion of menstruation. Primary dysmenorrhea usually eases as the woman gets older or gives birth.4
  • Secondary dysmenorrhea:? Menstrual pain in this case is connected to some type of underlying medical condition (usually a disorder affecting the reproductive system) and can be relieved when the condition is treated. Secondary dysmenorrhea is most likely to develop in adulthood.2 Period pain is a common symptom of PCOS that can be considered to be an underlying condition, as well as endometriosis. If you have painful periods you need to discuss this symptom with your doctor to get a definitive diagnosis and embark on the best course of treatment.4

Causes

Most women get menstrual cramps during their period but why are yours so painful?

Menstrual CrampsMost women get menstrual cramps during their period but why are yours so painful? Period cramps (both mild and severe) are caused by the uterus contracting to help expel the uterine lining.5 This is a normal aspect of the menstrual cycle controlled by prostaglandins and other chemicals produced in the body. Dysmenorrhea becomes an issue when the level of prostaglandins is elevated.4 Severe uterine contractions can also constrict the blood vessels that feed your uterus, which produces pain comparable to angina resulting from blocked coronary arteries.3

Dysmenorrhea can be caused by different medical problems, such as endometriosis or PCOS, both of which can be treated to reduce the pain. If your painful periods aren’t caused by an underlying condition you could find they will disappear after you have a baby or they will simply lessen with age.3,4

Your risk for painful periods also can be influenced by:3,4

  • Early onset of menstruation (before 11 years old)
  • Irregular and heavy menstrual bleeding
  • Smoking
  • Obesity
  • Inactivity
  • If you are younger than 20 years old
  • Stress
  • Family history of menstrual irregularities, including dysmenorrhea
  • Never having a baby

Primary dysmenorrhea can be caused by:

  • Excessive levels of prostaglandins (the hormone that makes the uterus contract)
  • Tilted uterus
  • Stress

Secondary dysmenorrhea can be caused by:2

  • Adenomyosis
  • FibroidsFibroids
  • Tubo-ovarian abscess
  • Ovarian torsion
  • Sexually transmitted disease
  • Cervical stenosis
  • Ovarian tumor or cyst
  • Pelvic inflammatory disease (PID)
  • Intrauterine device (IUD)
  • Polycystic Ovarian Syndrome
  • Endometriosis

Painful periods can interfere with your daily life but have no real medical impact in themselves. However, many of the conditions that cause dysmenorrhea can cause serious health problems that can compromise your fertility and quality of life. Two common disorders that cause painful periods are endometriosis and Polycystic Ovarian Syndrome. Women who have endometriosis have cells that line the inside of the uterus implanting and growing outside it as well as on the bladder, fallopian tubes, bowels, and ovaries. The reason for this isn’t known but these cells are not shed during menstruation because they are not in the uterus so pain occurs.6

Endometriosis can be mistaken for PCOS or can occur in addition to PCOS, which muddies the diagnostic waters considerably. PCOS is influenced by Insulin Resistance. When you have Insulin Resistance your body has higher levels of insulin in the blood because the body is trying to reduce blood glucose levels. This increases androgen (male hormone) production by the ovaries which creates a slew of symptoms, including many that affect the menstrual cycle.2 As you can see, the causes of endometriosis and PCOS are very different so the treatment options and symptoms also vary considerably.

Symptoms

How do you know if you have dysmenorrhea?

Painful CrampsThe main symptom of dysmenorrhea is pain. This pain usually starts just before or at the onset of your period and lasts about three days, peaking at about 24 hours. Painful periods can be characterized by a dull deep ache or sharp knife-like cramps that can be felt in your lower abdomen and radiating to your hips, lower back, and even your thighs.4 You can also experience heavy bleeding and clots if your dysmenorrhea is associated with PCOS periods. Some women also experience dizziness, loose stools, vomiting, and sweating along with their period pain.3 If menstrual cramps impact your life negatively for several days a month or have just started being a serious concern, you should consult a doctor to rule out an underlying condition such as endometriosis.4

Endometriosis is a common cause of painful periods but it sometimes has very mild symptoms that don’t ring alarm bells or the symptoms will mimic PCOS. You have to rule out endometriosis if you suffer from dysmenorrhea because it can cause serious damage, even infertility, if not treated.6 Routine pelvic exams are a good proactive method to catch this disorder, as well as being aware of its most common symptoms.
Symptoms of endometriosis include:6

  • Painful menstrual cramps that tend to worsen with time. As the growth associated with this disorder increases, each period the pain will increase also.
  • Pain during intercourse
  • Heavy periods over short menstrual cycles of less than 27 days
  • Spotting in-between periods
  • Continuous pain in the back or lower abdomen
  • Fatigue
  • Infertility

Endometriosis is often confused with PCOS, and women who have PCOS can also have Endometriosis at the same time with overlapping symptoms. An ultrasound or laparoscopy might be required to differentiate between the disorders.6 Polycystic Ovarian Syndrome also presents with hirsutism, acne, weight gain, male pattern baldness, and other symptoms not associated with endometriosis. PCOS is also influenced by Insulin Resistance, which is not a factor in endometriosis. This confusion is the reason why it is important to pinpoint the cause of your painful periods so treatment can be tailored to fit your needs.

Natural Therapies

What are some natural options for the treatment of painful PCOS periods?

After your doctor rules out underlying conditions such as endometriosis, a course of treatment can be decided on, including natural therapies. Nutritional supplements can be successful options for managing menstruation-related irregularities stemming from Polycystic Ovarian Syndrome.
YarrowGood choices include:

  • Yarrow:? This botanical can help minimize symptoms such as heavy or painful periods associated with endometriosis, ovarian cysts, and PCOS.
  • Flaxseed:? This botanical assists with the symptoms of Polycystic Ovarian Syndrome by helping the body metabolize estrogen more effectively and increasing SHBG levels in the blood.1
  • Stinging Nettle:? Women with PCOS can sometimes have low levels of sex hormone- binding globulin (SHBG) in their blood, which can contribute significantly to the severity of menstrual issues like dysmenorrhea. The root of stinging nettle can help increase or normalize these levels.
  • Chaste Tree Berry:? This botanical is known to positively impact PCOS symptoms connected to hyperprolactinemia by helping to normalize prolactin levels. Chaste tree berry also helps normalize the hormones that are important during the luteal phase of the menstrual cycle.
  • Vitamin E:? This vitamin has been shown to be effective in improving primary dysmenorrhea when taken a couple of days before menstruation and a couple of days following the onset of your period. A good dose to consider is 500 mg/daily.1
  • Vitamin B12:? combined with fish oil – This combination has been shown to help reduce the severity of painful periods.1

Some other nutritional supplement choices that might reduce the severity of your painful periods are magnesium, vitamin B6, and Thiamine (Vitamin B1).4

LegumesWhat other natural therapies should you consider for painful periods stemming from PCOS?

If your dysmenorrhea is caused by Polycystic Ovarian Syndrome there are also natural therapies designed to improve that condition. Healthy diet choices, in particular, can provide a great deal of support for women with PCOS. Diets that help with weight loss are particularly effective for reducing PCOS symptoms like painful periods and boosting self-esteem, while addressing Insulin Resistance as well.2 A PCOS-friendly diet includes whole grains, lean meats, fresh fruits, vegetables, and healthy fats. It is also a good idea to avoid caffeine, alcohol, saturated fats, preservatives, and empty sugary calories. This type of diet will help regulate blood sugar levels and hormones which ultimately improves PCOS.

There are some very effective non-medicinal therapies to relieve period pain which include:2

  • Applying heat to your lower back and abdomen with a heating pad or hot water bottle
  • A warm bath
  • Mild exercise such as walking or yoga to improve blood flow
  • Lying on your back with your knees elevated
  • Gentle massage on the lower back or abdomen
  • Avoiding stress

You can also consider alternative therapies for both dysmenorrhea and PCOS such as acupuncture or hypnosis. Both have been found to help alleviate symptoms associated with the disorders.4

Treatment Options

What can you do if natural therapies are not effective?

The treatment options for primary and secondary dysmenorrhea will vary because the underlying target of treatments for secondary dysmenorrhea often addresses the base cause as well as the symptom of painful periods. Menstrual cramps and PCOS are treatable conditions and your doctor might recommend the following:

  • Doctor Giving PrescriptionNSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are used frequently to relieve the pain of dysmenorrhea.4 Over-the-counter NSAIDs are usually the first treatment option your doctor will suggest and they include ibuprofen (Motrin, Advil, Nuprin and Midol), ketoprofen (Orudis, Actron), naproxen sodium (Aleve, Anaprox), and acetylsalicylic acid (asprin). These drugs should be taken at the doses recommended by the manufacturer starting the day before your period begins. Your doctor also might prescribe NSAIDs such as Mefenamic Acid if the over-the-counter products are not effective in providing relief of your pain.5
  • Oral Contraceptives:? Birth control pills are used to help both Polycystic Ovarian Syndrome and dysmenorrhea. These drugs can be a combination of estrogen and progesterone or just progesterone. They are very effective in reducing the severity of cramps and improving menstrual irregularities.2 You should be aware of the side effects of oral contraceptives before taking them, and if you are trying to conceive this treatment option is obviously not the best choice.
  • Operating RoomMetformin:? Women who have PCOS pain can improve that symptom by treating Insulin Resistance. If the severity of your PCOS is lessened, then symptoms such as dysmenorrhea also get better. Insulin-sensitizers such as metformin were used for people with Type-2 Diabetes initially but have also been applied successfully in the treatment of PCOS. This drug makes the insulin available in the body more utilizable.
  • Surgery:? Removing abnormal tissue surgically is usually the last option on the list for most women with dysmenorrhea and only used when the condition is caused by disorders such as endometriosis or uterine fibroids. If these conditions have been ruled out, then other treatment options are usually better choices to relieve painful periods.6

References

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