Women have long suffered from painful periods. So much so, that it’s viewed as a normal symptom of a menstruating woman. It is estimated that over 50% of menstruating women have pain for 1-2 days each month. But when does the pain classify as endometriosis? And what exactly is endometriosis?1 We are breaking this down for you, in this edition of The Peaceful Pelvis.
Let’s be honest, Aunt Flow isn’t always the greatest. Though it is a necessary and important part of adult female health, there is a lot of misunderstanding of what is normal and what is treatable. For many women, as they begin to menstruate as young girls, they will begin to have painful periods. Shortly before starting a period, the cells that line the uterus (endometrial cells) will release a large amount of a natural chemical called prostaglandins. The prostaglandins are released as the endometrial cells break down, in turn causing the uterine muscle to contract (causing cramps) and shed the endometrial cells that have degraded. Pain that is truly from this cycle tends to decrease as she ages and often even further after the woman has children. That’s the quick and easy description. But there can be so many other factors that come into play with the painful periods.
Moving onto endometriosis. Endometriosis, simply put, is when those cells that are typically found in the lining of the uterus (called the endometrium) are found in areas outside of the uterus. In cases of endometriosis, this abnormal cell growth is commonly found in other organs and tissues within the pelvis. However, there have been cases of endometrial cells having been found as far as the lungs and the brain, though this is extremely rare.2 A woman with endometriosis does typically experience pain with menstruation but may have pain during other times of their cycle as well. As with any disease process, the severity of the symptoms and presence of the abnormal cell growth can vary.
Endometriosis can also cause the formation of scar tissue and adhesions to form within the abdominopelvic area, causing a distortion of anatomy and other functions to be effected.3 Obviously, when organs and general function of the body is restricted, this can have a cascade of effects. So how is endometriosis diagnosed? The “gold standard” of diagnosis is currently from laparoscopic surgery to be able to visibly see (and subsequently remove) the adhesions throughout the abdominopelvic area. Because surgery is the primary method of diagnosis for women, it is really left up to the woman and the doctor’s curiosity to seek this confirmation. Due to this, diagnosis often takes an average of 12 years.3
Regardless of if the pain is endometriosis or not, a woman’s provider will often prescribe birth control in an effort to help manage the pain. This works well for some women and less so for others.
Pelvic health therapy can help!
As described, there can often be restrictions in and around the uterus which can cause discomfort when the uterus contracts to shed the endometrial lining. With visceral manipulation, we work to decrease those restrictions around the uterus and all associated organs and allow for an improved natural rhythm of all of the organs. This can also help women post-surgically ensure that the mobility of the tissues that previously had adhesions, remain mobile and decrease the chances of adhesions reforming. A practitioner performing visceral manipulation should have advanced training in this area and ideally have a strong understanding of the pelvis as well. As with any type of pelvic pain, we want to identify the origin of the symptoms. Occasionally, the muscles and tissues within the pelvis and vagina may be tense due to the woman (unintentionally) tightening due to the pain. As with any sort of injury or pain, it is a natural response for a person to want to protect and limit movement to that area. Gently encouraging movement with exercises, sometimes as simple as proper breathing, can help to encourage small necessary movement.
Treatment during therapy may or may not involve internal (vaginal) work. This is really dependent on a number of factors. I find that performing a pelvic exam at least once allows me to more definitively determine if the muscles and tissues within the pelvis area associated with the woman’s symptoms. However, that being said, if the woman is in extreme pain, it isn’t always ideal to start there. Working abdominally to start with, will often get things heading in the right direction.
Frequency of treatment can vary too. If a woman is in a lot of pain, I will often start with once a week until we start to get momentum. As things improve, I shift to once every 2-3 weeks. Sometimes it can take 4+ weeks before we get the severity of the symptoms to be better managed. For less severe cases, I may recommend seeing the woman once every 2-3 weeks to begin and spacing it out even further as things improve.
Other Alternative Treatments
As mentioned above, the two most common forms of treatment suggested by providers for painful periods is birth control and surgery (in more severe cases to formally diagnose and remove adhesions). However, in addition to the physical therapy described above, there are some other treatments and lifestyle adjustments that can be helpful in managing the pain as well.
There have been a limited number of studies that have been completed on the effectiveness of acupuncture to manage the pain associated with endometriosis and painful periods. However, anecdotally, a large number of women are turning to this alternative treatment and seeing results. Finding a provider that is deeply knowledgeable in the nuances of endometriosis and menstrual cycles can be of great benefit. They may occasionally suggest certain Chinese herbs that can assist in symptom management as well.
We will have another upcoming post breaking down the details of dietary adjustments that may assist with endometriosis. There are many suggestions and opinions out there. At the end of the day, the answer is complex. What works for one person may not work for you. So it is important to keep track of what you eat and the severity of your symptoms so you can pinpoint any associated foods that cause a flare in your symptoms.
Working with a Nutritional Therapist or Registered Dietitian that is well versed in balancing hormones and endometriosis will get you further in your symptom management.
Meditation can be difficult for some people. However, there is more and more research to support this practice. After several weeks of consistent meditation, there have been changes observed in the brain’s activity in these painful areas.5 Patients often mention that they struggle with meditation, either becoming restless or distracted. Meditation is often referred to as a practice – as it takes time to improve in your ability to quiet the mind and focus. So start small: 5-10 minutes a day – a few times a week. I often find that people who are just starting a meditation practice do best with a guided meditation. I often suggest, Stop, Breathe & Think, as a great app for beginners. I particularly appreciate that the user is prompted to check in with their body and identify how they are feeling physically, mentally and emotionally. The app then generates a few suggested short meditations. As you get more familiar and in more of a routine, you may find you like other apps or meditating without guidance.
To sum it up…yes, a large number of women experience pain with their menstrual cycles. Is it always endometriosis?…NO. Do these women have to “just deal with it” each month?…NO. For some, the pain can be addressed in a matter of a few visits. If we can provide some relief from cramps, pelvic pain, back pain, heavy flows, etc., then I feel we’ve taken a step in the right direction. If you, your daughter, friend or co-worker experience any of these symptoms, give us a call and we can discuss what treatment may look like for you.