ENDOMETRIOIS AND DYSMENORRHEOA – MANAGING PELVIC PAIN AND PERIOD PAIN WITH NATURAL THERAPIES.
Endometriosis and Dysmenorrhoea (PAINFUL PERIODS)
I have had both for as long as I can remember. My earliest period memories are of being in agony, bleeding to death and constantly have a hot water bottle on my belly. Back then, like now, we often were told “have a baby it will get better”. There wasn’t much on offer and not much sympathy from the mothers because their life was equally as tough. It was a bit of a “suck it up” and keep going type of approach. I wish I had known then what I know now because I think the amount I suffered would have been substantially less. There are things we can do to influence our symptoms and to manage the (quite common) pain that comes along with having ENDO or painful periods.
So, what causes the pain?
Great question-Just to remind you endometriosis occurs when pieces of the uterine lining (endometrium) translocate to places outside of the uterus. The tissue still behaves in the same way as it would inside of the uterus: growing during the menstrual cycle in response to oestrogen and shedding at the time of menstruation. However, because it is located in places outside of the uterus it cannot leave the body in the same way as the rest of the uterine lining does during menstruation.
What kind of pain can you experience?
· Painful periods: pain starting at onset of bleeding and continuing for a day or two after bleeding ceases
· Pain anywhere in your pelvic region at any time during the month
· Vaginal pain – anytime
· Rectal pain and pain during bowel movements at any time during the month
· Bladder discomfort, increased risk of UTI, increased frequency of urination
· Pain in your legs – a sense of heaviness or pain, sometimes during sex. Endo can grow in or near your sciatic nerve.
· Lower back pain
Endo pain is categorised as having gone on for longer than 6 months, the pain is severe (sometimes OTC medications aren’t effective) and it’s somewhat predictable – you recognise the pain, and it shows up repeatedly. For some people this is more common in and around menstruation but for others the pain is evident at different times throughout the month (that was my experience).
Howard, F, 2016 in the Journal of minimum invasive gynaecology explained the pain of endo well when he outlined”
“Endometriosis remains an enigmatic disorder in that the cause, the natural history, and the precise mechanisms by which it causes pain are not completely understood. The pain symptoms most commonly attributed to endometriosis are dysmenorrhea, dyspareunia, and chronic pelvic pain. Pain may be due to nociceptive, inflammatory, or neuropathic mechanisms, and there is evidence that all 3 of these mechanisms are relevant to endometriosis-associated pelvic pain. It is proposed that the clinically observed inconsistencies of the relationships of endometriosis severity and the presence or severity of pain are likely due to variable roles of different pain mechanisms in endometriosis. “
The executive summary of this is: so far how we get ENDO is not exactly understood and the pain associated with ENDO does not always relate to the severity of lesions. Each person’s pain and cramping experience is totally unique and is contributed to by the inflammatory chemicals released (prostaglandins), location of ENDO lesions and your individual pain experience which is both anatomical (your spine receiving those messages and your brain interpreting). There is a consensus that stress and fatigue can aggravate your pain experience so this is something to be aware of and existing inflammation from digestive issues, parasites, toxins, heavy metal toxicity, poor diet, excess alcohol and more can mean the endo inflammation adds into an existing inflammatory cascade. That does not sound great does it?
I’ve given you the above info because I do think it helps if you understand the WHY behind the WHAT. What is pain and what is causing it and how can I help myself. It gives you more power and I am all about that.
Okay so here’s what you can do:
1. See previous blog about diet and lifestyle factors which should form the foundation of your management strategy. (here)
2. Yoga: yoga. One study from 2017 found that yoga practice (2 x 90-minute sessions per week for 8 weeks) was associated with a reduction in levels of chronic pelvic pain and an improvement in quality of life in women with endo. Don’t get scared – you don’t have to do 90 minutes or even 2 sessions. Any yoga you add into your life will be beneficial. Look out for my short yoga sequences on my (new) YouTube channel.
3. HEAT PACKS! These were a LIFE SAVER during my life. I would be up all-night microwaving them (and now my daughter does it) and popping Nurofen. Fun times (not). My recommendations
· Wili heat bags (wiliheatbags.com): These locally made, beautifully designed heat bags are not filled with stinky wheat but LUPINS, a type of legume. These heat bags last for a long time and don’t smell like wheat bags do after a short time.
· Infrared heating mat/pad: continuous infrared heat
4. Breathing: when you are in pain you scrunch up into a ball and this sometimes makes things worse. Try listening to a meditation app and focusing on your yoga breathing (no guarantees on this one. It may work sometimes and other times no)
5. Tens machine: you can hire a tens machine and see if this works for you.
6. Essential oils: both for inhaling and applying topically via a massage carrier oil. Try 2-3 drops in your diffuser or 5 drops of clary sage with 5 drops of a carrier oil. NOT SUITABLE DURING PREGNANCY.
Traditional pain relief
I am not against pharmaceutical medications, but they usually have side effects. Paracetamol and NSAIDS are no different. Both can have effects on your microbiome, and it is imperative that we optimise the health of the microbiome (see separate post all about the microbiome as an organ to support your health). They can cause or contribute to leaky gut, peptic ulcers, digestive discomfort, ulcers, heartburn, and alterations to your microbiome. This stuff is usually not discussed, and we reference pain medication as if it has benign side effects. That said, if you need it you should take it under the advice of your Dr and the pharmacist – but it is not getting to the root cause of the issue or doing anything to improve what is driving the pain.
Track your pain
As well as using an app to track your period cycle it’s also good to use an app to track your diet and lifestyle and your pain experience month to month so you can draw some correlations between diet, exercise, stress, sleep and your pain experience. This will give you valuable information and possible motivation to make the changes that you probably should
What else should you be aware of
1. Try not to get constipated: it makes the pain worse and increases your risk of haemorrhoids (also extremely painful!). If you notice you get more constipated around period time, there are some useful supplements you can take to help you along. Don’t take all of them, try 1 and see if that helps.
· Magnesium citrate – try a dose of around 350mg 1 x per day. This dose is safe to continue daily.
· Vitamin C – a great antioxidant and known to cause loose bowels at higher doses. Try taking 1000mg per hour until bowel tolerance (do not exceed 10000mg in a day).
· Iberogast: a well-known herbal remedy for constipation
· Lactulose: available from your chemist
· Fish oil: try Melrose Omega Cod liver oil (if you don’t have a seafood allergy!). 1 tsp per day with dinner
· Fibre: try increasing your fibre intake to a minimum of 30grams per day to stimulate your bowels and help detoxify your body.
· Warm water with a squeeze of lemon juice can be stimulating for the bowels.
· Ensure adequate water intake throughout the day (not just guzzling 2 litres at once). Try for at least 2-3 litres per day.
· Take an evidence-based strain of probiotic. Evidence based means that that strain has been clinically tried to be effective for that specific condition/symptoms. Researched strains include Lactobacillus reuteri DSM 17938 and Bifidobacterium lactis Bb12 and Bifidobacterium lactis HN019 and Lactobacillus Acidophilus NCFM.
There are some other remedies that can be tried but they should be part of a broader conversation about what is happening for your digestively rather than just continuing to treat the symptom.
2. Other supplements to help overall health which may correlate with better pain outcome:
· Calcium – given with magnesium. 2:1 dose. 500-1000mg calcium in supplement or from foods. Deficiency is associated with muscle spasm and cramping
· B complex (activated B’s if you have the mthfr gene)-essential for a whole range of metabolic functions including cellular growth, neurotransmitter production and liver detox (to name a few).
· Essential fatty acids: mentioned above. Endo dosing: 1080 mg day EPA 720 mg day DHA 165-350mg day GLA (evening primrose oil)
· Ensure iron adequacy
· Probiotics: depending on purpose of probiotics you can take a “general” probiotic like Lifespace triple strength probiotic and some prebiotics to optimise your overall gut health, but this is not a specific ENDO treatment with evidence-based strains.
· Selenium- 200mg day (2 brazil nuts): influencing inflammation via it’s antioxidant work.
· Silica: 20-30mg day- bananas, mangos, green beans, whole grains, brown rice, oatmeal, spinach.
· Vitamin D: 1000IU minimum per day – get this tested to determine current levels for supplementing. If you are desperately low 1000IU is not likely to increase your levels by much.
· Zinc: 20-25mg 2 x per day. Good food sources: Meat, shellfish, legumes, nuts/seeds, dairy, eggs, wholegrains, dark chocolate (woo hoo!)
· Vitamin C-at least 1000mg 2x per day or less if you have a vitamin C rich diet.
· Vitamin A: Can take in supplement form: 5000mg per day minimum or food: liver, cod liver oil, salmon, tuna, goats’ cheese, butter, cheddar cheese, camembert, hard boiled egg, trout, goose liver pate.
· Vitamin K: essential to regulate blood clotting: take in supplement form with your vitamin D or get from food: natto, broccoli, kale, beef liver, pork chops, chicken, Brussel sprouts, prunes, kiwi fruit, cheese, avocado.
3. Eat a clean diet – read the last blog for the details but choose organic or low spray fruit and veg, the best quality protein you can and keep white foods to a minimum (bread, rice, flour, bakery goods etc). This type of diet is anti-inflammatory, manages your blood sugar and reduces the detox load on your liver keeping it available to get rid of oestrogen.
WHEN SHOULD YOU SEE A HEALTH PROFESSIONAL?
· Anytime you think you should – trust yourself. Seek help if you need it.
· Your GP will be able to either diagnose Endo or refer you to a specialist for a diagnosis. They can request coeliac testing and food allergy testing to exclude these as contributing factors. I think it’s important to know what you are dealing with. I had every investigation and invasive test possible and two surgeries. None of this fixed my Endo or seemed to speed up the time it took to get pregnant (but who knows?) – but it did give me a good idea of what I was dealing with. It also excluded anything else more serious/noxious.
· Various allied health professionals can help with different aspects of your support.
Nutritionist (like me) or Naturopath: evaluates all of the lifestyle and nutritional influences on your symptoms and provides advice and recommendations on how to optimise all of these areas. Can recommend specific testing like hormone testing or digestive testing to get more information. Partners with your GP and other allied health professionals to support your care.
Fitness professional (me too): can provide advice on the right type of exercise (even providing recommendations around what type of exercise would be best at what time during your cycle)
Women’s health physio: can provide treatment to ensure that the tissues in and around your pelvis remain functional (not all stuck together like scar tissue) which makes pain worse. Can help with flow on effects like pelvic floor dysfunction, incontinence, vaginal adhesions etc.
Chinese medicine prac/acupuncturist: Can provide acupuncture and Chinese herbal medicine to support healing and manage pain
Chiropractor: support optimal health of pelvis and spine.
Knowledge is power. The more you understand your body, your periods (how they work, the hormones, the pain, possible pain causes, treatment options) and your pain, the more you can identify what options resonate with you and start finding out what works (for you). You are unique, your periods, hormones, genetics, detoxification potential, nutrient status, etc are all unique to you and they are the things that can be modified to help you live your best life. Reach out for help if you need it – there are also lots of amazing support groups and resources that can help you be better equipped to manage your own health.
Facebook groups: Endometriosis Australia education and discussion group, Endometriosis support SA, Endo sisters support group South Aus, Endometriosis support australia
Instagram: larabriden, drjolenebrighten
Books: Lara Briden: “The Period Repair Manual” and “Hormone Repair Manual”
Dr Jolene Brighten “Beyond the pill”
DISCLAIMER: This article is not intended to diagnose or treat a disease. This article is general in nature and does not provide specific health advice to any one individual. It is written to provide as much help as possible providing evidence based therapeutic dosing of nutrients to provide you with the best possible chance of success. It is possible for people to have reaction to vitamins, minerals, oils and other natural products etc so it is imperative that if you purchase any supplements you carefully check the ingredients labels for any additives or ingredients that you may be allergic or intolerant to. Every product is unique in this sense. It is also important to cease taking any new supplements if you feel like you are having a reaction and consult your heath practitioner or GP to discuss your concerns. Ideally you partner with a health professional but I understand that the cost is prohibitive for some people so want to support you to the best of my ability whilst keeping you safe. If in doubt, consult your GP. Your health is your responsibility so get help if you need it.
Make your nutrition a priority and live your best life!
Bek Di Mauro