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Painful Periods -
Dysmenorrhoea
Primary dysmenorrhoea (painful periods)
usually starts around menarche (first period). Dysmenorrhoea affects
80% of women at some point during their life and for many it is
a regular monthly occurrence. For some the pain will be so severe
that it may interfere with their daily life and they are unable
to go to work or school.
The main site of pain is the lower
abdomen but may radiate to the lower back, sacrum,
hips and thighs.
In addition you may suffer nausea
and vomiting, dizziness, headaches and migraines, fatigue,
constipation and difficulty sleeping.
There are two types of dysmenorrhoea:
Primary dysmenorrhoea –
is defined as having no underlying gynaecological disorder which
may be causing the pain. It is thought to result from contractions
of the uterus. The blood supply to the muscle wall of the uterus
(myometrium) is reduced which causes more pain. A hormone-like substance
called prostaglandin is thought to be responsible for this process.
*If you are experiencing tenderness and sharp pain that does not
subside with
your menstrual flow, please see your GP right away.
Secondary dysmenorrhoea –
can be attributed to some underlying process or structural abnormality
either within or outside the uterus. The pain is not limited to
when you have your period. Examples of this include endometriosis,
pelvic inflammatory disease, ovarian cysts, fibroids.
Traditional chinese medical perspective
In Traditional Chinese Medicine primary dysmenorrhoea is normally
caused by a
lack of free movement of energy and blood in the lower abdomen.
Stress, frustration and repressed
emotions can have an impact on the circulations in the
body which can be a factor in dysmenorrhoea.
Cold in the lower abdomen and uterus
can cause constriction and a lack of
movement of both energy and blood, causing
pressure and pain.
There is often an underlying deficiency
of energy, blood, yin or yang which needs to be
addressed also in order to restore homeostasis (harmony and balance).
By stimulating acupuncture points and
addressing nutritional and lifestyle factors we are able to promote
the free movement of energy and blood, address deficiencies and
restore balance. Acupuncture also helps regulate the menstrual hormones
and acts as an analgesic by elevating levels of endorphins in the
blood.
A recent trial studying the effectiveness
of acupuncture in the treatment of primary dysmenorrhoea showed
a statistically significant decrease in occurrence of dysmenorrhoea
and use of pain medication on women lasting up to one year after
a series of acupuncture treatments (Habek et al, 2003).
Nutritional and herb perspective
Prostaglandins may play a key role in dysmenorrhoea. Prostaglandins
are hormone like substances and there are several produced by the
body.
There are two types of prostaglandins
implicated in dysmenorrhoea:
- PGE2: this is pro-inflammatory prostaglandin
and triggers muscle contractions and causes nerve endings to become
more sensitive to pain.
- PGF2 – alpha: is released from
the lining of the uterus wall (endometrium) during menstruation.
In women with dysmenorrhoea the levels of PGF2-alpha have been
found to be higher. PGF2- alpha also increases muscle contractions,
cause ischemia (lack of blood supply) to the myometrium (muscle
wall of the uterus) and increases pain.
These types of prostaglandins are
formed from Arachidonic acid (a type of omega 6
fatty acid) which is found in dairy products, meat, egg yolk, liver
and kidneys.
If you suffer from dysmenorrhoea it
may be important to limit dairy products significantly
(there are many other good sources of calcium available).
Where possible introduce more vegetarian
protein into the diet (beans, lentils, quinoa
etc), and organic fish and organic eggs (this doesn’t mean
giving up meat entirely). This will reduce
the amount of Arachidonic acid you consume and therefore decrease the
amount PGE2 and PGF2-alpha produced.
It is important to increase the production
of the prostaglandins PGE1 and PGE3, which are anti-inflammatory
and help prevent cramping and pain.
PGE1 are produced by another form
of Omega 6 called Linoleic Acid found in sunflower,
safflower, walnut, corn, and soya bean oils and Gamma-Linolenic
Acid found in evening primrose, borage and
blackcurrant oils.
PGE3 is produced by Omega 3 essential
fatty acids called Alpha-Linolenic Acid (which
can be found in oily fish, linseed (flax seed) and hemp oil, walnuts,
pumpkin seeds, soya and green leafy vegetables)
along with Eicosapentaenoic acid and Docosahexaenoic
acid found in oily fish.
There is a series of conversions that
the Omega 6 and Omega 3 essential fatty acids have to go through
in order to produce PGE1 and PGE3 and these conversions require
specific vitamins and minerals. Therefore vitamin and mineral deficiencies
can also underlie dysmenorrhoea.
The key to essential fatty acids is
balance. We need the right mix of Omega 3 and Omega 6 fatty acids
in order to keep the body in balance. While Arachidonic Acid in
excess can increase inflammation and pain it is also important for
many signalling and control functions in the body. Therefore balancing
your essential fatty acid intake is very important.
Stress and a diet high in sugar and
saturated fats will also impair the conversion of Omega
3 and Omega 6 essential fatty acids to PGE1 and PGE3.
Individual vitamins and minerals such
as vitamin B1, B6 and magnesium have been shown
to reduce dysmenorrheoa (Wilson & Murphy, 2001).
It is important to remember that vitamins
and minerals work in synergy therefore all supplementation
and dietary advice needs individualised diagnosis and recommendations.
Factors such as your medical history
and current medication will effect the recommendations
given.
There are Chinese and western herbs
which may help strengthen the uterus and control
cramping such as Dong Quai and Black Cohosh.
 Self
help tips
- Get regular exercise throughout
your cycle, gentle exercise whilst having you period is beneficial
but avoid vigorous exercise during your period. Exercise can increase
circulation of energy and blood and also reduce stress levels.
- Learn some form of relaxation technique
which works for you. Reducing your stress and learning to relax
will help with both PMS and dysmenorrhoea.
- For some women exposure to cold
and dampness can be a cause of dysmenorrhoea or irregular periods,
so avoid drinking cold beer, eating ice cream and swimming during
your period.
- Avoid inverted yoga positions during
your period.
- Eat plenty of fruit and vegetables.
- Eat plenty of foods containing Omega
3 and Omega 6 oils such as oily fish (organic is best), raw nuts,
seeds, olive oil hemp and linseed oil (best not heated but used
as dressing for salads and vegetables).
- Reduce your intake of saturated
fat, choose lean meat and reduce dairy products
- Eat more whole grains such as brown
rice, oats, quinoa, buckwheat, rye bread, wholemeal bread
- Keep well hydrated with water
- Reduce your intake of caffeine throughout
your cycle. If you have dysmenorrhoea or breast tenderness it
may be necessary to avoid caffeine altogether.
- Reduce alcohol
- Avoid sugar in your diet
References
Habeck, D. Cerkez Habek, J. Bobic-Vukovic, M. Vujic, B. 2003. “Efficacy
of Acupuncture for the treatment of primary dysmenorrhoea”
Gynakologisch-Geburtshilfiche Rundschu. 43(4). 250-253
Wilson, M. Murphy, P. 2001. “Herbal
and dietary therapies for primary and secondary dysmenorrhoea.”
Cochrane Database Systemic Review. 2001(3):CD002124
Disclaimer
The contents of this site are for information only and are intended
to assist visitors in identifying symptoms and conditions they may
be experiencing. This site is not intended to be a substitute for
taking proper medical advice and should not be relied upon in this
way. Always consult a qualified healthcare practitioner or doctor,
especially if you are pregnant, breastfeeding, or taking any medication.
Your situation will need to be looked at individually and you should
not attempt to self-treat. The site authors cannot accept responsibility
for illness arising out of the failure to seek medical advice from
a doctor. |
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