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Hello everyone! This is Dr. Jennah Miller, naturopathic doctor, and today I’m going to be talking about what’s causing my period pain. So obviously, if we were to talk about all of the potential underlying causes, treatments, or ways to prevent period pain that could turn into a multiple hour lecture – so I’m just going to touch on the most important components of what might be causing your period pain.
To make sure we’re on the same page we need to first have a discussion about what a normal period should look like. Dysmenorrhea is the medical term for period pain, so going forward I’ll be using that term interchangeably. A normal period should be mostly liquid and it should contain no large clots over the course of your menstrual flow. A clot smaller than the size of a dime is considered normal, however.
In general, your blood flow should be bright red in color, however, at both the beginning and end of your menstrual flow – sometimes the blood can become darker due to oxidation or just the fact that it is older uterine lining. In general, the volume of blood flow should be between 25-80 mL over the course of your whole menses. 80 mL is actually quite generous – clinically, at a blood flow of greater than 60 mL over the course of your menses, we begin to see things like iron deficiency
anemia or just generalized fatigue. So if you’re feeling tired or have heavy menses, that might be a concern to take further look into. The most important thing to make sure we touch on, is that a normal period should have no pain. Any pain that’s
occurring with the onset of your menses or at any time during your menstrual cycle, is something that we should be concerned about. An important differentiation to make at this point is deciding what is common and what is normal and the difference between those. It’s very common for individual’s
to have PMS, to have period pain, or to have really heavy menses, but that shouldn’t be accepted as normal. We’ve come to determine that because everyone has these
concerns, they’re normal and something we just have to deal with as menstruators, but in fact they are not normal at all – and something we should make sure we look into and to try to both prevent and treat.

We’re going to differentiate between the two types of period pain or dysmenorrhea. The first one is known as primary dysmenorrhea and it’s generally characterized as
having no underlying pelvic pathology- so there’s no underlying condition that’s causing the menstrual pain. It’s mild pain and it tends to begin with onset of menstrual flow and lasts anywhere from 1-3 days going into menses. Incidence tends to decrease with age, so if you remember having really painful periods when you were a teenager and they’ve gotten better over time, this tends to indicate that
perhaps you have primary dysmenorrhea. In general, it’s cramping and colicky in nature, and it’s quite amenable to naturopathic treatments – you can often completely get rid of this type of pain. Next we’re looking at secondary dysmenorrhea, and this one is really important to make sure you get worked up for, to determine that there’s no underlying cause to your dysmenorrhea. Secondary dysmenorrhea is caused by an underlying pelvic pathology, and causes severe menstrual pain that is not limited to just the menstrual
period. So it can be pain that extends past the end of your menses or begins before the onset of your heaviest flow. Onset is typically around age 20, and it tends to get worse over time. So your period pain tends to get more severe, and can in fact last longer, the more periods we have. It tends to be dull and aching in nature, and it is severe enough to interfere with daily living.

So no you may have some clues to determine if what you’re experiencing is primary versus secondary dysmenorrhea, but what’s really going on beneath those terms? Period pain is typically caused by a few different things, but these are generally the most common, and the things we address in naturopathic medicine. First and foremost being muscle spasm – the uterine lining is in fact a muscle, and when it
begins to break down to prepare for menses, it releases a component known as prostaglandins. Prostaglandin release stimulates muscle contraction to aid in the shedding of the uterine lining, but when we produce too many prostaglandins, this leads to an increase in pain. Via naturopathic medicine, we usually address nutrient deficiencies and sometimes provide herbal support to decrease prostaglandin production, which can in fact totally reverse this sort of primary dysmenorrhea.
Next we want to look at hormones. The most common hormonal imbalance when it comes to dysmenorrhea is high estrogen in the presence of low progesterone, and this condition is typically termed as estrogen dominance. It can cause a lot of things, but generally we see PMS and pain symptoms, and we generally want to balance hormones as a result. Typically this is caused by long term exposure to
xenoestrogens, which are present in things like plastics, something our makeup products, as well as our cleaning products.
Next we want to make sure we address any signs or symptoms of histamine intolerance. There’s usually a build up of too much histamine in individual’s who have histamine intolerance, and this leads to an increase in both estrogen- which can lead to estrogen dominance – and inflammation. If you are experiencing period pain accompanied by things like anxiety, headaches, or brain fog, then looking into histamine intolerance might be the right step for you.
Finally, if we’re looking at secondary dysmenorrhea, we can see that there are underlying pelvic conditions that usually cause the pain. Some of the most common pelvic conditions are endometriosis, adenomyosis, fibroids, ovarian cysts, pelvic
inflammatory disease, the use of an IUD, and less commonly but more severely, things like cancer.
So you might be things, “now what?” – you sort of have an idea of what might be causing your period pain, but how can you move forward and get rid of it? The good news it that primary dysmenorrhea can completely disappear and be completely
reversed, especially with naturopathic treatment. In secondary dysmenorrhea, usually the main goal is to identify the underlying cause and treat that, but the pain itself can be drastically reduced once you’ve figured out what’s going on.
From a naturopathic perspective we’re going to do a few different things. We want to look at stress management to help balance hormones. Decrease any endocrine disrupting compound exposure, to help deal with estrogen dominance. Address any histamine intolerance that might be present via diet changes for the most part, as well as some key supplement additions. And then to address any nutrient
deficiencies that might play a role in increased prostaglandin release. In general for primary dysmenorrhea, we want to focus on decreasing prostaglandins and muscle
spasm, which is quite easy to do with interventions like acupuncture, because it increases blood flow, decreases stress, and helps to balance hormones – as well as things like acute herbal support in the form of tinctures and teas.
For the most part, we want to identify and treat any underlying cause that might be playing a role in secondary dysmenorrhea as well.
If you’re experiencing period pain and you have any questions for me, please feel free to reach out.
(hello@jennahmiller.com).

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