But first as a woman, and second as a functional medicine doctor, I definitely do not see this as an acceptable standard for care, mostly because I know that there are other options that are not only more effective, but also much safer than the pill. Let’s dive in…

A few things to keep in mind as you read this post:

There are many reasons for abnormally painful periods and this post covers just three of them. But more importantly, if you’re struggling with painful periods, or any other symptom, it’s extremely important that you discuss your concerns with a licensed healthcare provider. There are many factors that could be at play, and you deserve to be heard and cared for in the very best possible way.

3 Reasons for Painful Periods

As I noted above, there are many women’s health diagnoses that have period pain as a symptom—things like endometriosis, fibroids, PCOS, and more. For this discussion, we will focus on reasons for period pain in women who don’t have a formal diagnosis. However, even if you do have an existing diagnosis, addressing some of these issues may actually help improve your symptoms.

1) Hormone Imbalances

The menstrual cycle can be divided into two main parts: the follicular phase (pre-ovulation) and the luteal phase (post-ovulation). We typically think of estrogen as the “main” hormone of the follicular phase, and progesterone as the “main” hormone of the luteal phase, but really Both are present and working all the time, just at different levels.

Sometimes, the relative proportion of estrogen and progesterone (in relation to each other) fall out of balance, and this can cause symptoms like cramps and other forms of menstrual pain. For example:

During the luteal phase (after ovulation), the menstrual lining starts to build up in case the egg is fertilized. Estrogen’s job is to build up the lining, directing blood flow and tissue growth in the uterus, whereas progesterone’s job is to keep things from getting out-of-control, so to speak. If estrogen levels are disproportionately high in relation to progesterone levels (i.e. estrogen dominance), the uterine lining will become more robust, often leading to a heavy period with clots, which may be painful to pass. Additionally, high estrogen levels lead to higher levels of prostaglandins in the uterus, which causes higher levels of inflammation and pain (see point #3).

Estrogen dominance and progesterone deficiency are just two examples of hormone imbalances that can cause period pain. Other hormones like cortisol and thyroid hormones (especially hypothyroidism) affect the menstrual cycle and can cause symptoms such as pain.

2) Feminine Protection Products

I would give a TMI warning but really I don’t think periods should be a taboo subject anymore. Frankly, ever person alive is here because of the functioning of a woman’s reproductive system, and I think we all could stand to understand it a little bit more. So, yes…we’re going there.

Tampons are convenient, but not if they’re causing painful cramps—and yes, tampons can cause or worsen cramps if they aren’t inserted correctly. Take a look at the graphic above. The tampon pictured is right up against the cervix. When the uterus contracts to expel blood, it will bump up against the tampon causing pain, kind of how punching a wall hurts a lot more than punching into the air.

Instead, angle the applicator downward. By pointing the applicator downward (and relaxing during insertion), the tampon will be able to reach an area of the vagina called the posterior fornix, which is behind the opening of the cervix. Then, instead of bumping into the tampon, which is held firmly in place by the muscles of the vagina, it will slide past the tampon, which is much more comfortable.

However, some women have cramps no matter where the tampon is located. Alternatively, you can use pads or a menstrual cup. The Diva Cup takes a little getting used to (you’ve gotta be up close and personal with your lady parts) but rather than stopping at the cervix, it encircles it, eliminating any possibility of bumping and pain. The plus side of a menstrual cup is that it only needs to be changed every 12 hours, rather than 4-6.

Another reason women tend to tolerate pads or menstrual cups better is because most brands of feminine hygiene products contain preservatives and bleaching chemicals that can irritate the vagina, increasing the local levels of inflammation and causing pain. (More on inflammation in point #3). For this reason, I typically recommend keeping foreign objects out of the vagina and instead using external protection (pads), a menstrual cup (made from silicone), or organic tampons such as seventh generation, Rael, Tampax pure, or OB Organic.

3) Inflammation

When you have cramps What do you do?

If you handle it the way I did for many years, you pop an Advil, take a nap, and pray that you feel better in an hour. And, if you’re like me, it works.

That’s because napping and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen both reduce inflammation in the body, and it’s inflammation that’s responsible for period pain.

The inflammation caused by a period comes from chemicals called prostaglandins, which are naturally produced in the lining of the uterus to trigger contractions during menstruation and labor. In addition the triggering muscle contractions, these prostaglandins also create low-grade inflammation , which is perceived as pain in the pelvic area (i.e. cramps).

Whenever we have a localized area of inflammation, we have pain. This pain can vary in intensity, but in general, the higher the level of inflammation, the worse the pain is. That’s why bumping your shin on the corner of the bed hurts, but not as badly as breaking your leg would. The injury is much worse in the latter case. However, bumping your shin on the bed hurts more when you already have a bruise from doing the exact same thing the day before, or if you have a sore leg from running a marathon, or if your whole body is sore because you have the flu. That’s because in each of those cases, there is pre-existing inflammation in the body and the higher the level of inflammation, the worse the pain is.

The same is true with the localized inflammation in the uterus during menstruation. The naturally produced (and very necessary) prostaglandins in the uterine lining cause some inflammation, enough to produce mild cramping during the first couple days of a period. However, if there’s already a heightened degree of inflammation in the whole body, be it from chronic stress, poor nutrition, crash dieting, over-exercising, illness, or otherwise, the total amount of inflammation in and around the pelvis is higher. The higher the level of inflammation, the worse the pain is.

No matter the reason for the period cramps, whether due to a hormone imbalance, endometriosis, fibroids, or anything else, reducing the total amount of inflammation in the body will decrease the level of pain.

How to Naturally Reduce Inflammation

1. Acupuncture: this is probably my #1 recommendation for co-management of care with women’s health concerns in practice. Traditional Chinese Medicine is incredibly powerful in terms of its ability to help balance hormones, reduce stress, and decrease the inflammatory response.
2. Nutrition: Not eating enough, or enough of the right nutrients, can create imbalances that lead to heightened inflammation. Some of the most common nutritional deficiencies that predispose women to painful periods include omega-3 fatty acids, magnesium, and vitamin D. Talk to your doctor about having your levels checked.
3. Musculoskeletal Problems: Tight muscles are painful muscles, and if you’re dealing with chronically tight and painful muscles, that probably means you’re also dealing with high levels of inflammation in your whole body. I’m always amazed by how much better I feel when I rub epsom salt lotion into sore shoulders, massage out the knots in my neck with my acucurve self-massager, or stretching out on my foam roller.
4. Sleep: Poor sleep causes all kinds of problems, not just in terms of periods. Not getting enough sleep is interpreted by the body as a chronic form of stress, and pretty much all other health efforts will be blunted if you’re not sleeping enough. Adults need 8-10 hours per night.

In general, it’s not normal to feel awful during your period. While I’m a firm believer that menstruation is a natural process (and therefore it’s normal to feel different at different times of the month), but if your period is getting in the way of your ability function, that’s not okay. You deserve to find out what’s going on so you can feel your best and live a fulfilling life.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post 3 Reasons for Painful Periods (and Natural Treatment) appeared first on Dr. Alexandra MacKillop.

Progesterone is a tiny molecule that plays a big role in the hormonal picture. When levels start to go awry, our health and well-being suffers. Understanding how our hormones affect wellness is not only an important tool for self-care, but this knowledge also gives us the power to advocate for ourselves so we can access the care we deserve. Whether your goal is to regulate your cycle, conceive and carry a healthy pregnancy, reduce the long-term risks associated with hormonal imbalances, or just gain some good, old-fashioned information about how your body was designed, read on!

Hormones throughout Your Cycle

Throughout the female cycle, two hormones tend to be held responsible for triggering key events such as ovulation and the start of a period:

• In the first half of the cycle, estrogen rises and falls, correlating with a hormonal signal from the brain that triggers the release of an egg.
• Following ovulation, the corpus luteum produces progesterone, which is responsible for thickening the uterine lining in anticipating of pregnancy.
• After about seven days, progesterone levels peak and begin to steadily decline; once they drop low enough, the lining starts to shed, signaling the start of a period and another cycle.

When progesterone levels drop too low, or aren’t produced in a functional ratio in comparison to other sex hormones like testosterone and estrogen, our health suffers. Chronically low progesterone can increase risk of osteoporosis, poor blood sugar control and diabetes, breast cancer, depression, anxiety, and other neurocognitive disorders. Low progesterone also leads to symptoms such as:

• Migraines
• Absent or irregular periods
• Bleeding or spotting between periods
• Low libido
• Recurrent miscarriages
• Painful periods
• Insomnia
• Luteal phase defect
• Infertility
• and more…

What Causes Progesterone Deficiency?

The production of progesterone from the ovaries is regulated by the hypothalamic-pituitary-gonadal axis, a delicate web of signals between the brain and reproductive organs. Progesterone deficiency can result from interruptions along the entire axis, whether from a signaling problem at the brain level, or from dysfunction of the ovaries themselves. One of the most common reasons for low progesterone is chronic stress. Elevated stress hormones create a negative feedback loop that interrupts the signaling between the brain and ovaries, decreasing progesterone production. In many cases, especially with women who are over-exercising or under-eating, stress acts on the HPG axis to prevent ovulation altogether. Without ovulation, the corpus luteum doesn’t form, and the main mechanism for producing progesterone during the luteal phase is completely taken out of the picture.

Here are a few other reasons for low progesterone:

• Adrenal dysfunction
• Perimenopause
• Vitamin deficiencies
• PCOS
• Low body fat
• High prolactin (such as in breastfeeding women)
• Calorie or carb-restricted diet
• Too much exercise (especially high-intensity or weight training)
• Use of contraceptives containing synthetic progestins
• Oophorectomy (surgical removal of ovaries)
• Hypothyroidism
• Inflammation
• Estrogen Dominance (creating a relative progesterone deficiency)

What to Do About Progesterone Deficiency

As with any hormonal imbalance, effective treatment starts with identifying the root cause. This is why it’s so important to work with a naturally-minded healthcare provider to review diagnostic tests and lifestyle/history to get to the bottom of the progesterone deficiency. If undereating is the driving force behind low progesterone, for example, no amount of vitamins or supplements will effectively solve the problem. The nutrition (and the relationship with food) needs to be addressed, first!

Note: I explain the details of what is and isn’t normal and how to explore natural treatment options in my book, Go with Your Flow. Click here to learn more.

Once an appropriate diagnosis is made and healing efforts are underway, there are a number of steps that can be taken to help the body natural restore progesterone production, balance out the production of estrogen, and get the hormone levels back to a functional status quo.

Lifestyle

Diet and Exercise: Overdoing it in the gym and under eating are the main forces behind low progesterone. These create a state of allostatic overload, lowering progesterone output or altogether inhibiting ovulation—a condition called hypothalamic amenorrhea. When I’m working with a patient whose history and labs point to progesterone deficiency, the first place I start is with cutting back on exercise, and upping her intake of carbohydrates and fats. Hormones are produced from fat and cholesterol, so adding in foods like eggs, butter, and oily fish are essential. Carbs are also extremely important for women, and we can’t menstruate without them. Low-carb and calorie-restricted diets also affect production of all kinds of other hormones, including thyroid, immune, metabolism, and more.  

Stress: In my clinical experience, the most common cause of hormonal imbalances among women are related to stress. Whether that source of stress is emotional, relational, physical, nutritional, or otherwise, stress management is key. Progesterone and cortisol are both produced from the same hormonal precursor, called pregnenolone. When stress levels are high, the body allocates its resources towards producing cortisol, which means there aren’t many leftovers for producing progesterone. (This is called pregnenolone steal.) The end result is a low progesterone level. Stress also inhibits the HPG axis at the brain level, preventing the LH surge that triggers ovulation. Without ovulation, it’s impossible for progesterone levels to remain high enough for health and fertility.

Sleep: Sleep and stress go hand in hand. When we aren’t sleeping enough, cortisol production goes into overdrive, creating all the problems described above. Lack of sleep also distorts the circadian rhythm, changing the natural patterns of sleep hormones and neurotransmitters that regulate cyclical patterns in the body—everything from the sleep/wake cycle to the menstrual cycle. Lack of sleep also tends come along with over-use of stimulants such as caffeine and nicotine, which create their own subset of hormonal fallout.

Progesterone has a reciprocal relationship with sleep deprivation. Since one of the roles of progesterone is to create a feeling of calm and relaxation, low progesterone can feed forward into insomnia symptoms, furthering the degree of sleep disruption and deprivation. Targeting issues like insomnia at their root cause is essential for true health and healing.

For more information about lifestyle methods for balancing hormones, checkout this post: 5 Ways to Balance Your Hormones, Naturally

Supplements

Progesterone Cream: Progesterone cream is a supplemental form of progesterone that is applied as a lotion to the skin and absorbed into the blood stream. Just like a pill, progesterone cream supplements the existing amount of progesterone produced by the body, but does not address the root cause behind the progesterone deficiency. However, progesterone cream can be a helpful temporary step for women who are suffering from extremely painful periods, or who are experiencing fertility struggles due to low progesterone.

Vitamin D: Vitamin D really is more appropriately classified as a hormone than a vitamin. Like other hormones, it is derived from cholesterol and circulates throughout the body, communicating with almost every organ system. Vitamin D also plays a regulatory role in the production of sex hormones. Because of our largely indoor lives and the risk of skin cancer from UV exposure, most Americans are deficient in vitamin D. In my clinic, I test every patient’s vitamin D levels so that I can safely prescribe supplements to restore functional vitamin D levels and hormonal balance.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4507331/Vitamin B6: In women suffering from a luteal phase defect (a luteal phase that lasts 11 days or fewer, which is a consequence of low progesterone), supplementation with vitamin B6 has been proven to extend the length of the luteal phase. This helps correct for associated fertility struggles, in which the fertilized egg doesn’t have sufficient time to implant in the endometrial lining before menstruation begins—an event triggered when progesterone levels dip.

DHEA: Like cortisol, testosterone is produced from the same precursor as progesterone: pregnenolone. When cortisol levels or testosterone levels are high, progesterone production tends to suffer. DHEA is an intermediate between pregnenolone and testosterone, so supplementing with DHEA in women who are suffering from low progesterone because of elevated testosterone can reduce the consumption of pregnenolone for testosterone production. That leaves more available for progesterone production. DHEA can also cross-react with the pathway for progesterone production, elevating levels even in women whose deficiency is not the result of hyperandrogenism.

Vitex: Naturally occurring iridoids and flavonoids present in Vitex mimic the role of the corpus luteum, acting on the ovaries to stimulate the production of progesterone. In this study, Vitex was dosed at levels of 20 mg tablets daily.

Closing thoughts…

As if the symptoms of progesterone deficiency aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Natural Treatment for Progesterone Deficiency appeared first on Dr. Alexandra MacKillop.