Dysmenorrhea
or Painful PeriodsIntroduction: Menstrual periods
can be painful without an obvious cause. This is labeled "primary dysmenorrhea"or
"functional dysmenorrhea". In other cases a cause can be found and this
is called "secondary dysmenorrhea" or "acquired dysmenorrhea".
Some of the causes for acquired dysmenorrhea are: a narrow cervical canal or a
polyp blocking the cervical canal. Endometriosis and adenomyosis
are also frequent causes, which is a condition where the lining of the uterus
grows into the wall of the uterus (adenomyosis)
or endometriosis
grows through the tube onto the ovaries. Sometimes the endometriosis
even grows onto the surrounding bowel in the pelvis and can cause an acute emergency,
particularly when there is associated bleeding into the abdominal cavity. With
menstruation this tissue tends to bleed and causes often painful periods. With
primary dysmenorrhea despite a thorough work-up by the specialist no cause can
be found. It is thought that prostaglandins are likely to blame, which originate
from the edometrial lining of the uterus and lead to uterine contractions. Symptoms:
With dysmenorrhea there is pain in the lower abdomen, which is crampy,
sometimes even colicky. The latter acute presentation is often associated with
the passage of membranes and blood clots (called"membranous dysmenorrhea").
There are often generalized symptoms such as nausea, sometimes vomiting and headaches.
The abdominal pain may also radiate into the lower back or into both legs. The
woman with dysmenorrhea may also urinate more often and complain of constipation
or diarrhea. Treatment: The physician needs to examine
the patient and if everything checks out O.K., reassure the patient that everything
is normal. Treatment for Dysmenorrhea: The doctor
likely will recommend that a woman with dysmenorrhea take a prostaglandin synthetase
inhibitor 1 or 2 days before the menstrual period begins and to continue this
until 1 or 2 days after it finished. Popular prostaglandin inhibitors are:
ibuprofen (brand names: Motrin, Advil, Ibu, Rufen), naproxen (brand name: Anaprox,
Synflex), mefenamic acid (brand names: Ponstan, Ponstel). Essentially these medications
help to reduce the prostaglandin, which is released around the time of the menstruation
thus relieving the cramps and pain in the uterus. However, it only works optimally
when the woman takes it early enough as otherwise the prostaglandins already released
into the system will continue to produce symptoms. If this medication does
not work, the doctor likely will suggest an oral contraceptive, not for the purposes
of avoiding pregnancy, but because it has been shown in the past that women with
dysmenorrhea got surprising relief with the birth control pill. The standard low-dose
estrogen-progesterone contraceptive pills will suppress ovarian function and this
way help to normalize the periods and avoid the prostaglandin induced pain cycle.
Your doctor will advise you which BCP to take, but some of the more common ones
are listed here: Cyclen, Tri-Cyclen, Lo/Ovral, Desogen, Ortho7/7/7, Ovcon, Tri-Norinyl,
Genora, Min-Ovral, Nordette and many others. If this does not help, it
is advisable to ask for a referral to a gynecologist in order to have more testing
done. Often the specialist may recommend a surgical removal of the endometriosis
lesions through an endoscopic procedure or else the prolonged taking of the birth
control pill or Provera (a progestin, which is different from bio-identical progesterone,
Ref.11). However, these artificial hormones do not fit the hormone receptors in
the body causing potentially serious side-effects and functioning as unopposed
estrogen stimuli that make endometriosis worse. The surgical procedure may help
for a few periods, but then they re-grow and the patient may be worse off later.
The solution to this dilemma is described in the next paragraph (the use of bio-identical
progesterone cream). Hormonal Dysbalance and Endometriosis: Dr.
John Lee (Ref.10 and11) has written extensively about the connection of endometriosis
to both estrogen dominance and lack of progesterone. Xenoestrogens, which are
estrogenic substances in the environment (diethylstilbestrol, polychlorinated
biphenyl or PCB, Bisphenol A etc.), but also petrochemical xenohormones such as
pesticides can block estrogen receptors leading to a lack of ovulation and subsequent
lack of progesterone. The body produces more androgens (male hormone products)
that get transformed into estrogen in fatty tissues such as the breasts. These
excess estrogens over stimulate the lining of the uterus, which in turn is responsible
for the development of endometriosis.
For a woman with endometriosis bioidentical
progesterone cream is given with daily doses of 40mg to 50mg per day from day
10 to 26 of the cycle. With this treatment protocol it can take up to 6 months
for symptoms of endometriosis to subside. Some women continue to have some residual
symptoms. This treatment protocol must be continued until menopause to prevent
recurrences and complications. It must be stressed here that only the natural,
bioidentical progesterone (available through a compounding pharmacy) will be effective,
not one of the synthetic progestins. |
