Dysmenorrhea, defined as painful menstruation, affects 50 to 90% of menstruating women. It can significantly negatively impact the quality of life, with up to half of women missing school or work at least once during their lives. Painful periods have become normalized, and women struggling with this issue often accept it as something they must deal with. Well, thankfully, that doesn't have to be the case. Painful periods aren't normal, and there are many options, both conventional and natural, that can provide relief.
A Functional Medicine Dysmenorrhea Protocol involves identifying a root cause for the pain and using a targeted treatment plan that includes lifestyle modifications, supplementation, and additional therapies to support your healing journey.
This article will cover dysmenorrhea, its symptoms, testing to help uncover the root causes, and the available conventional and Functional Medicine treatment options.
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What is Dysmenorrhea?
There are two types of dysmenorrhea: primary and secondary.
Primary dysmenorrhea is recurring menstrual pain that is not caused by an underlying medical condition. It's associated with elevated inflammatory chemicals that cause the menstrual cramps and pain you may be familiar with. Primary dysmenorrhea accounts for the majority of cases of painful periods. Pain typically begins with menstrual flow, although some women experience discomfort before their period starts, often lasting from 8 to 72 hours. This type of dysmenorrhea often begins within 6 to 12 months of menarche (the first occurrence of menstruation). It can continue throughout menstruating years, although pain usually improves in the third decade of a woman's reproductive life and after childbirth.
Secondary dysmenorrhea is menstrual pain that is caused by an underlying medical condition. This type of dysmenorrhea can begin anytime after menarche as a new symptom, with the onset of the underlying condition causing it.
Dysmenorrhea Symptoms
Dysmenorrhea is characterized by severe lower abdominal pain that is cramping in nature. It's often accompanied by low back pain, pain radiating to the thighs, nausea, vomiting, headache, diarrhea, and fatigue. Sleep disturbances are common in women with severe dysmenorrhea.
Dysmenorrhea is also associated with an increased risk of premenstrual syndrome (PMS), depression, anxiety, or heavy menstrual bleeding.
Secondary dysmenorrhea is more likely to be associated with menstrual pain that progressively worsens, abnormal uterine bleeding, or mid-cycle pain.
What Causes Dysmenorrhea?
There are two types of dysmenorrhea; Primary & Secondary:
Primary Dysmenorrhea
Primary dysmenorrhea is caused by an increase in inflammatory chemicals during menstruation, such as prostaglandins and leukotrienes. These chemicals cause the uterus to contract, restricting blood flow, and stimulating pain receptors, resulting in cramping and abdominal pain.
Various factors have been shown to increase the risk of developing dysmenorrhea, which includes family history, high stress, smoking, heavy menstrual bleeding (menorrhagia), PMS, sexual abuse, and psychological symptoms.
The dietary pattern associated with an increased risk of moderate to severe dysmenorrhea includes high consumption of salty snacks, fruit juices, sweets and desserts, added fats, and fast food. Skipping breakfast is also associated with a higher incidence of dysmenorrhea.
Certain vitamin and mineral deficiencies may play a role in dysmenorrhea, including magnesium, Vitamin B1, omega-3, Vitamin E, and zinc. Vitamin D deficiency is associated with an increase in the severity of symptoms in primary dysmenorrhea.
We often hear of the impact of the gut microbiome on various aspects of health. However, we also have a vaginal microbiome, which appears to play a role in dysmenorrhea. In women with severe dysmenorrhea, there is a higher abundance of pro-inflammatory bacteria (Prevotella, Atopobium, and Gardnerella) in the vaginal microbiome during menstruation.
Secondary Dysmenorrhea
Secondary dysmenorrhea is caused by issues with the reproductive organs. The most common cause is endometriosis. However, other potential causes include adenomyosis, ovarian cysts, uterine polyps, uterine fibroids, pelvic infection, cervical stenosis, and pelvic adhesions.
An imbalance between estrogen and progesterone is often an underlying factor in many of the conditions known to cause secondary dysmenorrhea.
Functional Medicine Labs to Test for Root Cause of Dysmenorrhea
No objective tests, such as lab work or imaging, are available for diagnosing primary dysmenorrhea. In conventional care, if your doctor suspects primary dysmenorrhea, a detailed history and physical examination will likely be the extent of your evaluation.
If your practitioner suspects secondary dysmenorrhea, a pelvic examination and imaging (such as ultrasonography) may be performed to identify the underlying condition causing your painful menstruation.
While conventional medicine doesn't have any specific lab tests for primary dysmenorrhea, your Functional Medicine practitioner may run functional lab tests to better understand the imbalances in your biology associated with your painful menstruation.
Micronutrient Testing
SpectraCell's Micronutrient Test is a valuable tool in determining whether vitamin and mineral deficiencies or insufficiencies may be playing a role in your overall health status. This information helps create a targeted and individualized plan.
Hormone Testing
The DUTCH Cycle Mapping™ PLUS test evaluates the patterns of progesterone and estrogen throughout the month to give insight into the balance between these hormones. This test also evaluates other steroid hormones, including the stress hormone cortisol, which is helpful information in identifying a root cause, as stress can be a factor in developing painful periods.
Vitamin D
The SpectraCell's Micronutrient Test does assess Vitamin D levels. However, Vitamin D is also available as a stand-alone test to identify whether Vitamin D should be included in the treatment plan. A third option is to test Vitamin D via the Inflammation Panel by Ayumetrix since Vitamin D level is associated with inflammation. This panel measures Vitamin D and hs-CRP, an inflammatory marker. Since primary dysmenorrhea is associated with increased inflammation, assessing inflammatory markers could be beneficial.
Vaginosis Testing
The Doctor's Data Vaginosis Profile is a great option for assessing the vaginal microbiome. This test will provide insight as to whether vaginal infections or imbalances in the vaginal microbiome are contributing to dysmenorrhea.
Conventional Treatment for Dysmenorrhea
Conventional treatment of dysmenorrhea includes non-steroidal anti-inflammatory drugs (NSAIDs). This type of medication reduces the production of inflammatory chemicals (prostaglandins) known to cause primary dysmenorrhea. Hormonal contraceptives are also utilized in the conventional treatment of painful menstruation.
Functional Medicine Dysmenorrhea Protocol
A Functional Medicine protocol for dysmenorrhea involves a targeted and unique approach for each individual based on your history, examination, and findings of the functional testing performed to identify a root cause. A well-rounded approach to support women with painful periods includes healthy lifestyle practices, supplements, as well as other therapies known to be effective for this issue.
Lifestyle Practices
Exercise has proven benefits for so many aspects of our health, and menstrual pain is no exception. Regular exercise is shown to reduce menstrual pain intensity in women with primary dysmenorrhea.
It's important to prioritize sleep, smoking cessation, and stress management if these factors are contributing to the root cause of your menstrual pain.
Nutrition
An anti-inflammatory diet is an excellent way to support overall health and a healthy menstrual cycle. This type of diet includes adequate protein and healthy fats (such as omega-3 fatty acids), is high in fiber, and is rich in vitamins, minerals, and phytonutrients.
A high-fiber diet is known to support a healthy microbiome, and it's also been shown to be associated with lower menstrual pain. Focusing on foods high in prebiotics and probiotics can also be a helpful way to support the microbiome, inflammation, and hormone health.
Women with painful periods should focus on eating a nourishing breakfast since skipping breakfast is associated with dysmenorrhea.
It's important to avoid the inflammatory foods associated with dysmenorrhea, including sugary and salty snacks, sweets and desserts, fruit juices, and fast foods. Avoiding caffeine and alcohol may also help relieve menstrual pain.
Vitamins and Minerals
Various vitamins and minerals are shown to be associated with dysmenorrhea and have proven effective in reducing symptoms. This includes magnesium, Vitamin D, Vitamin B1, omega-3 fish oil supplements, Vitamin E, and zinc. Your micronutrient test results will determine what specific vitamin and mineral supplements will be best to incorporate into your individualized healing plan.
Herbal Supplements
Certain herbal supplements are shown to be effective in reducing menstrual pain, including ginger, Nigella sativa (black seed) oil, and fennel.
If hormone testing indicates an imbalance in stress hormones or female hormones, herbal supplements such as ashwagandha or chasteberry may be recommended by your Functional Medicine practitioner to help support hormone balance and healthy menstrual cycles.
If imbalances in the vaginal microbiome or vaginal infections are identified as a cause for your dysmenorrhea, your Functional Medicine practitioner may suggest an oral garlic supplement or oral and/or vaginal probiotics with the Lactobacillus strain of beneficial bacteria to restore balance to the vaginal microbiome.
Complementary and Alternative Therapies
Various therapies have shown effectiveness in reducing menstrual pain, including heat therapy (applying heat over the lower abdomen or low back), transcutaneous electrical nerve stimulation (TENS), acupressure, relaxation, and yoga.
While larger studies are still needed, the Traditional Chinese Medicine (TCM) treatments of moxibustion (a treatment involving the burning of mugwort leaves near the body) and acupuncture (inserting tiny needles at specific points on the body to restore wellbeing) have been shown in small studies to effectively relieve discomfort in women with primary dysmenorrhea.
Self-massage of the lower abdomen with a combination of essential oils (lavender, clary sage, and marjoram) diluted in an unscented cream has been shown to provide relief and reduce the duration of menstrual pain.
Summary
Dysmenorrhea, or painful menstruation, is an extremely common issue women experience that can significantly impact their quality of life. If painful periods are something you struggle with, you may find comfort in knowing there are several lifestyle practices and conservative treatment options available that can provide relief.
A Functional Medicine dysmenorrhea protocol involves tailoring a treatment plan to each individual based on history, examination, functional lab testing, and patient goals. It can address those factors identified as contributing to the root cause through lifestyle practices, a healthy diet, targeted supplements, and utilizing additional therapies for relief.
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