Dysmenorrhoea (Period Pain)


Treatment Protocol for Dysmenorrhoea

Dysmenorrhoea, or painful periods is very common and painful, debilitating, cramping periods are one of the leading causes of female school and work absenteeism. Pain may begin before or at the start of the period, usually peaks after 24 hours, and decreases after 48 hours. It is most common during adolescence and tends to decrease over time and after pregnancy. Primary dysmenorrhoea is pain that is not associated with underlying pathology, whilst secondary dysmenorrhoea refers to pelvic pain related to underlying pathology and exacerbated by menstruation, such as endometriosis, uterine fibroids, bladder inflammation, irritable bowel syndrome or chronic pelvic inflammatory disease.

Secondary dysmenorrhoea may be associated with infertility, heavy menstrual flow or irregular bleeding, dyspareunia (painful sexual intercourse), vaginal discharge, lower abdominal or pelvic pain at other times of the cycle. Excessive oestrogen exposure throughout the menstrual cycle is thought to be primary driver of dysmenorrhoea, as oestrogen stimulates excessive production of prostaglandins, including PGF2- alpha, which constricts endometrial vessels and contracts smooth muscle causing cramping and pain. Inflammation is also implicated as 10-30% of women who do not respond to anti-prostaglandin therapy are found to have elevated levels of inflammatory cytokines (leukotrienes). 

 

Factors associated with dysmenorrhoea include:
Primary dysmenorrhoea:

  • Inflammation – contractions due to increased prostaglandin secretion
  • Anxiety and stress

Secondary dysmenorrhoea. As above, but associated with underlying pathologies, such as:

  • Uterine ischemia (lack of blood flow)
  • Endometriosis
  • Narrow opening of cervix or other anatomic abnormalities
  • Endometrial polyp
  • Fibroids
  • Uterine/pelvic infections
  • Chronic/acute pelvic inflammatory disease (PID)
  • Intrauterine device (IUD)
  • Abdominal surgery
  • Sexually transmitted diseases


Common signs and symptoms of dysmenorrhoea include:

  • Moderate to severe cramping and abdominal/pelvic pain beginning with the onset of period and lasting 8 - 72hours
  • Dull or dragging pain radiating to lower back, groin, legs
  • Headache and/or migraine
  • Nausea and/or vomiting
  • Diarrhoea
  • May have IBS symptoms pre-menstrually with constipation and/or diarrhoea
  • Tender breasts, swollen abdomen

     

Treatment for Dysmenorrhoea

Effective treatment involves correcting oestrogen dominance, reducing prostaglandin secretion and addressing underlying disorders. Detoxification of excess oestrogens occurs in the liver and the gut. Hence, dysbiosis (gut flora imbalance) and poor liver function can contribute to excess eostrogen. 

Herbal Medicines, Diet, Specific Nutrients and LIfestyle factors play an important role:

  • Herbal Medicines: Dong Quai, Peonia, Cramp Bark, Corydalis, Kava, False Unicorn, Fennel, Barberry, St John's Wort and others
  • Nutrients: Zinc, Selenium, Iodine, Activated B Vitamins, Magnesium, Calcium D-Glucarate, Idole-3-Carbinol and others
  • Probiotics (if dysbiosis present): Lactobacillus rhamnosus GG (LGG), L. plantarum (299v) and others
  • Diet: Anti-inflammatory diet, Identify food intolerances, low alcohol and caffeine, minimise processed foods
  • Lifestyle: Activities that help relieve stress e.g. bush walking, yoga, tai chi, meditation, relaxing baths. Regular exercise is also important