Are Your Painful Periods Endometriosis?
Many women suffer from pain related to their menstrual cycle. For some the pain is minimal and manageable but for others the pain can be unbearable and requires hot water bottles, panadol, nurofen and time in bed curled up in the fetal position. Pelvic pain can be experienced around menstruation and/or ovulation. It can also become chronic without correlation to either menstruation event.
The cause of the pain can be difficult to diagnose. Studies show that on average women may go to at least 5 different doctors before a diagnosis is made. One condition that can contribute to painful periods is Endometriosis.
What is Endometriosis?
Endometriosis is a mysterious condition that affects 1 in 10 women globally. It is an inflammatory condition that occurs when uterine endometrial cells migrate into the pelvic cavity where they form lesions. Most commonly the lesions are found on the pelvic organs, on the walls which surround the pelvic cavity and sometimes on the bowel. Classically, endometriosis can cause pelvic pain, abnormal menstrual cycles and infertility. As the endometrial cells spread into the pelvic cavity it can also be responsible for painful intercourse, rectal pressure and pain with bowel movements, especially before a period. However, many women with advanced symptoms of endometriosis have never had any symptoms at all.
Diagnosing Edometriosis
As mentioned above many women can see quite a few medical professionals before a diagnosis of endometriosis is given. This is because there are other conditions such as irritable bowel syndrome that mimic endometriosis. A history of pelvic pain, inter-menstrual spotting, more frequent and higher volumes of menstrual flow and back pain do point to the likelihood of endometriosis but a definitive diagnosis can only come via a laparoscopy.
So What Causes the Pain Associated with Endometriosis?
Whilst much research has been done into this condition the cause for the migration of cells outside of the uterus and why there is resulting pain is still not completely known. A 2020 review of the clinical and experimental evidence of the mechanisms contributing to pain associated with endometriosis has shed light on new theories such as hormonal imbalance, progesterone resistance, immune dysfunction and inflammation. This gives rise to possible treatment options other than what is currently available.
The most commonly accepted reason for the migration of endometrial cells into the pelvic cavity is Retrograde Menstruation, or menstruating backwards. This theory was developed in 1927. It is now known that 90% of women experience retrograde menstruation but only 10% of women are diagnosed with endometriosis. This suggests it is a much more complex condition.
During menstruation the body has a highly regulated system to clear menstrual debris from the uterus to make way for another cycle. This is carried out by the immune system which programs the endometrial cells to die. This death results in the release of numerous cellular bi-products. Some of these bi-products are called prostaglandins. One of these prostaglandins is F2-Alpha. And, interestingly, high levels of this prostaglandin are found in women who suffer from menstrual cramps. It’s also the prostraglandin given to abort a fetus.
When endometrial cells filter into the pelvis they form lesions and go through the same cycle as the cells inside the uterus. They bleed, they die. But as the body does not actually release the blood, like in menstruation, these lesions create a build up of cellular bi-products which causes inflammation in the pelvic cavity. Inflammation is linked to many chronic pain and autoimmune conditions.
Another of the cellular bi-products is reactive oxygen species (ROS). ROS contributes to higher levels of oxidative stress. High levels of oxidative stress are found within the uterine fluid of women with endometriosis. However, an 8 week trial of oral anti-oxidants showed significantly reduced chronic pain symptoms in women with endometriosis. Anti-oxidants are beneficial in reducing oxidative stress also known as free-radical damage.
To experience pain there needs to be a sensory nerve pathway to the spinal cord for processing by the brain. Endometrial cells do not have a nerve pathway. When they adhere to the pelvic cavity they go through a process that generates new blood vessels to support their growth and survival and develop a sensory pathway through nerve fibres. The process is regulated by estrogen and immune cells. Some of the immune cells exacerbate local inflammation and drive the growth of the endometrial tissue. The increased nerve supply in lesions is closely related to chronic pelvic pain. The higher the density of nerves the higher the level of pain experienced. An imbalance in pain receptors can occur leading to a higher pain response. This has also been found in other visceral pain conditions such as fibromyalgia, gastroesophagial reflux and IBS.
An Energetic Approach to Endometriosis
As an energy practitioner I’m not only interested in the science behind this condition but also the energetics. In her book Women’s Bodies, Women’s Wisdom Dr Christiane Northrup describes endometriosis as an illness of competition. It comes about “when a woman feels her innermost emotional needs are in direct conflict with what the world is demanding of her.” Women are expected to be a part of the traditionally yang male world of competition and business sacrificing their yin feminine nature or desires. Often without the emotional support they need in their home or personal life.
From my Shiatsu persepctive the body’s energy is getting stuck at a deep level because the spirit is unable to fully express itself. This leads to a form of Blood Stagnataion. That is the blood is not flowing freely through the pelvis so circulation is poor. Shiatsu massage can be beneficial in improving the circulation of blood and smoothing the energetic pathways that flow through the pelvis. For clients with endometriosis I recommend a fortnightly shiatsu every 2 weeks for 2 months to help reduce the pain and menstrual irregularities often associated with endometriosis.
Dr Northrup encourages women with endometriosis to ask themselves the following questions:
What are my emotional needs?
What would I like to see happen in my job or my life that would nourish me fully?
Am I caught up in competition of any sort in my life? Am I willing to make changes?
Am I getting enough rest?
Do I believe that I have the power to change the conditions of my life?
How Do I Get My Period to Stop Hurting?
Conditions such as endometriosis are estrogen sensitive so their symptoms are inceased by estrogen. They are also exacerbated by an excess of inflammatory chemicals in the body. Women with endometriosis are found to have higher levels of cellular inflammation.
It is possible to reduce excess estrogen production and reduce cellular inflammation through dietary changes and supplementation: From a dietary approach:
Eliminate all trans-fats from your diet and caffeine
Eliminate red meat, dairy foods and egg yolks for at least 2 weeks then reintroduce them to see if your symptoms change and or go away then recur.
Introduce more cruciferous vegetables such as kale, collard greens, broccoli, cabage and turnips into your diet.
Soya foods such as tofu, soy sauce and miso can help
A diet high in fibre such as whole grains, beans, brown rice, vegetables and fruit can decrease circulating estrogens
For nutritional input:
Take essential fatty acids daily. This is easiest by taking a good quality fish oil or using flaxseed oil, macadamia nut oil on salads or eating macadamia nuts.
Take a good multivitamin-mineral supplement that is rich in B vitamins, zinc, selenium, vitamin E, D and magnesium.
It is also import to increase your anti-oxidants. Anti-oxidants help to reduce oxidative stress and inflammation. Most people are aware of the wonderful array of fruits and vegetables that provide us with anti-oxidants but did you know you can also activate your body to produce more anti-oxidants?
Unfortunately we cannot consume enough fruits and vegetables to provide us with the amount of anti-oxidants we need to combat the amount of oxidative stess our bodies are under. If you remember, high levels of oxidative stress proteins have been found within the uterine fluid of women with endometriosis and inflammation is linked to many chronic pain conditions.
One of the most recent breakthroughs in the scientific world is how you can activate your cells to improve your health. It has been found that the nrf2 pathway in a cell is the principal protective response to oxidative stress. By activating this pathway you can help your body to produce more anti-oxidants. Nrf2 is found in endometrial cells. When endometrial cells are in an abnormal place, which is anywhere other than inside the uterus, the expression of nrf2 is deregulated and the lesions have increased growth.
The 8 week trial of oral anti-oxidants that showed significant reduction of pain in women with endometriosis is a good sign that taking a supplement which provides anti-oxidant support to reduce free-radical damage from oxidative stress may be beneficial for women with menstrual cramps, painful periods and endometriosis.
So your painful period could be the result of higher levels of prostaglandin-F2 Alpha in your uterus which is giving you stronger menstrual cramps or it could be the result of higher levels of inflammation in the pelvic cavity that has arisen from endometrial adhesions. It’s always best to consult your GP and go on the path of finding a definitive diagnosis, however, it is possible to alleviate your symptoms through regular massage, dietary changes and supplementation.