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Painful Periods

Most women suffer monthly from pain with their menstrual cycle. Pain for some can be severe enough to keep them from working or completing their daily tasks. It is possible to have more pain-free cycles and this can be accomplished without medications. Our job as physicians is to determine what the underlying cause is first.

One of the most common causes of painful menses is an increased production of prostaglandins. Prostaglandins are chemicals produced in the uterus that are responsible for making the uterine muscle contract each month in order for the uterus to shed its lining during the menstrual cycle. Individuals who experience pain often overproduce them.

Treatment revolves around the ability to reduce prostaglandin production and this can most simply be done with fish oils. Reducing prostaglandin release can decrease the pain if that is the primary reason for the menstrual cramps. For this therapy to be most effective, it is best taken the day prior to the beginning of menses or the moment it begins. My motto in regard to pain is that it is better to prevent the pain than to chase it. The quality of fish oil is important because you want to make sure that it has been tested for heavy metals. Dosing the fish oil as EPA 400 mg/DHA 300 mg every 3 hours until the day when you typically no longer have pain is what I recommend trying first. Fish oils should also be taken twice a day on a regular basis as well.

Too much estrogen can also encourage a greater production of prostaglandins so diet and the potential for hormone-balancing herbs may also be necessary. Eating 1 cup of cruciferous vegetables, like cauliflower, broccoli, and cabbage daily as well as adding in extra fiber like 1-2 tbsp of chia seeds, flax seeds or psyllium are helpful in encouraging better hormone balance by supporting the detox pathways through the liver and digestive tract. Other supportive therapies may include B vitamins, magnesium, piscidia, hormone-balancing herbal formulas, and acupuncture. Other causes of menstrual pain include endometriosis, uterine fibroids, ovarian cysts, and adenomyosis. The underlying cause must be established first by taking a thorough history and specific testing if necessary.