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Painful Menses in Our Youth: Dysmenorrhea

Updated: Jun 29

My oldest daughter, now 30 years-old, started her menses when she was crazy young. She was prepared though, not real bothered by it, nor needing much guidance from me. Maybe that's just part of growing up in a home often filled with breastfeeding mommas talking about all things women's health and raising babies; we never shied away from those discussions.

Not long after her first moon though, we had a pretty significant family tragedy so I wasn't on my game as her mother. I didn't notice when her periods had became more painful, that is until one afternoon, I was trying to nap away my grief when I was woken by her moaning, lying on the kitchen floor, and her younger brother frantically doing everything he could for her and not knowing how else to help.

He says, "Mom, I gave her cheese. I gave her crackers. I gave her left-over breakfast but nothing is working." My daughter, lying in the fetal position on the kitchen floor, moans out, "I don't know what is wrong with me. I started my period this morning and then I just started starving to death. I keep eating and eating and nothing is helping." My daughter had just had her first menses that followed ovulation.

I remembered experiencing this myself as a young lady. In fact, one time I was sitting in biology class and I was feeling absolutely horrific. My teacher even noticed and asked me if I was okay, in front of the entire class, and I could barely speak. I felt faint and the room was fading away. His daughter happened to be a student in my same class, so he asked her to walk me to the nurse's station and I barely made it. As soon as I stepped through her doorway, I fell onto her couch. Then my lunch hit the floor and my mother had to come pick me up.

My periods were tough, as were my daughter's, essentially up until we each had our first child. It was hard to manage that first or second day. She wore a TENS machine when she was younger, which was super helpful, but there were times we both called into work or school. My daughter often had a headache, nausea and diarrhea. I think mine was much more about intense cramping and feeling very light-headed. Neither of us had any other health problems, and we were both pretty active in our younger days. The heating pad and the occasional Ibuprofen gave us temporary relief. She was often stealing the arnica oil from my birth bags because she found it so incredibly helpful.

As a clinician, now I wish I had known more as a young mother, and even a young gal myself. I wish the two of us hadn't suffered so significantly with our moons. It seemed with every child I had, my discomfort got noticeably better, so that after my last, I never really had menstrual cramps again. Certainly it is important to rule out underlying pathology, such as endometriosis and not nearly enough are practitioners actually investigating the presence of this condition (so please connect with me or your own primary care provider to rule out significant problems if you are experiencing similar symptoms), but to some degree there is quite noticeable sensations accompanying our cycles. It's this murky line though, when these discomforts impact our ability to effectively participate in our normal daily routine, that makes it hard to discern if this is normal.

If you are experiencing great discomfort, are your menses normal? Do they come regularly each month, at about the 28th to 32nd day, or are they longer or shorter? Do you skip a menses entirely every now and then? Through our entire lives, we want a regular cycle. Imagine the moon in the sky coming late or early, or not showing up at all. We'd have to question what was happening, what has gone awry, right? Healthy women, in their childbearing years, cycle each month.

Is your flow consistent? Do you bleed for two or three days, typically, or much longer? Do you require super tampons or pads? Do you bleed through your clothes or see clots? How often are you changing your pads and tampons? Does your flow start with brown blood, or red, does it end red or do you have a few scanty days of dark brown bleeding?

What improves your discomfort? Heating pad? Yoga? Ibuprofen? Arnica oil? Massage? Is your pain dull, sharp, spasmodic, and where do you notice it specifically? When we as clinicians, are evaluating painful menses, there is much to discern and maybe many aren't asking enough questions? Maybe they don't feel the typical 6 minute consultation allows the time, but these questions help us discern between pathology and normal discomforts.

It is true that so many of us, girls and women, are taught to live in a man's world, which is consistent and unchanging, so that we find ourselves inconvenienced by our body's changing needs. The culture expects for example that women can become pregnant, birth, recover, and nurse that child while also not missing a day or work or in anyway inconveniencing anyone else in doing so, including the father of the child. There is no margin of grace for being a woman and experiencing female events, cycles, or seasons; we are expected to show up consistently as man. Therefore, when our bodies experience the intensity of bleeding each month, we haven't the ability to step out of the demands of daily life and turn into ourselves, pouring into love and support in our being. We don't have a red tent to escape to where we will be cared for and provided for, allowed to separate ourselves and walk away from the demands of life.

Sometimes, if all has demonstrated to be well, our role as women's health providers is to simply remind or support women in creating an environment that supports their needs. Maybe they need to step into their unique needs as a woman and give voice to those needs, unapologetically. This does create some challenges that will need to be navigated because again, very few employers or schools allow for this grace, but that should be part of our culture. Women are the change. We shut down or pause sometimes for snow days and high heat. On occasion, I skip yoga or change my vinyasa flow to more of restorative practice so I can give myself space to move through this next phase, this cycle. But again, there is some discernment here between needing to embrace one's authenticity and take up space, and gaslighting oneself into tolerating discomfort that is truly pathologic but going unaddressed.

I wish as a younger mother I had demonstrated to my children that moms have cycles, and there are days in which she will step out of her role a bit to care for herself, and even, taught my boys to care for women and support them in these ways. I wish I hadn't found my cycle so inconvenient and let it change my mood because I was aggravated that I couldn't keep up and power through, that I had to endure in spite of all I was feeling. I wish I didn't fear my classmates stealing my purse in middle school and finding my pads and instead, had to hold back my pride and lean into feeling empowered because the boys recognized I was a damn woman that could bleed for days and survive it!

How Might Nutrition & Lifestyle Impact Your Cycle?

This really is important because some diets are inflammatory and can exacerbate these more uncomfortable cycles. When working with clients who have any inflammatory or autoimmune concerns, my goal is to help them identify what might be contributing to their inflammation. This can anything, including stress, insufficient sleep, even too much noise or lack of sufficient movement. Diet though is often fairly easy to identify, particularly when using the MRT testing. We can identify what foods are not inflammatory and limit the diet to just these foods for the first few days, let the gut heal, and then start to reintroduce foods one at a time. Most food sensitivity testing identifies foods, but doesn't offer you a list of foods to eat to that will assure you are really allowing the gut to rest. Sometimes once that inflammatory cascade is initiated, the body can react and find threat in most everything. We become overly sensitive, so as we calm this down and eliminate the true threat, the body can relax.

Your daily routine may not be as nourishing as you might need. Maybe you are contributing to a team sport, a project at work, or even in a relationship that really isn't serving you, but you feel obligated. You've invested all this effort already so it's time to walk away. Maybe you have a hard time balancing the demands of school, practice, social, and home? Is it time to give yourself a break?

As we start to work through this discussion, the clinician can address or bring awareness to areas of your life that maybe you haven't really given proper attention. Maybe it's time to stop and recognize your needs, even your rights. As we start to create change, in hopes of improving outcomes, one of my more common first steps is the MRT diet, which many have found great success. Maybe simply reducing red meat consumption proves helpful. Many kids are eating lots of processed foods, pizzas and burgers, and reducing this can be helpful. This was paramount for my own health. Assuring you have an adequate intake of iron in your diet is also important, although reducing dairy consumption can be helpful for some as well. Fresh fruits and vegetables are healing and typically low inflammatory. We can figure out how to manage attaining a healthy diet while also navigating a busy schedule.

Nordic Naturals or Carlson fish supplements can help add oils, or high quality omegas into the diet. I often share that most of us aren't getting sufficient healthy fats and oils from our diets, which is like running farm equipment for years and never oiling it. This will create heat and inflammation right? These oil supplements are like pouring fresh oil over an old worn out engine. Try 1.5 to 3 grams daily. Magnesium can also help relax the body, 400-600mg daily.

Movement is vital for moving fluids, toxins, and lymph through the body as well as challenging our muscle mass and our flexibility. It's even vital for our brains. Many kids are quite active, but too many aren't. Find an activity that resonates. It doesn't have to be a team sport. Maybe you prefer to ride your bike, hike, garden, or do yoga.

Find time to relax. Turn off the drive to be productive all the time. Your cycle can force this upon you, and sometimes, we need to trust and lean into that. Soak in the tub, add some epsom salt. Put on some nourishing soul music. Acupuncture and massage can be helpful, and TENS machines are truly wonderful for cramps associated with dysmenorrhea as well.

Utilizing Botanical Medicine

Assuming all pathology has been ruled out, a dong quai and peony formula may offer relief, although not to be taken during your actual flow. You might also add licorice, motherwort to support your emotional health, and even ginger for your gut. This recipe is in our Eden's Little program available to all of my active clients, and there is a recipe for a cramp recipe that can be taken during one's flow.

Moxibustion once daily for 20 minutes starting five days before the predicted onset of menses can also be helpful, but discontinue when menses begins. Deep abdominal massage with warmed ginger infused sesame oil can also offer relief. This can be done a few days prior to the onset of your flow throughout your menses as desired.

Conventional Approaches

The approach with conventional medicine is often about prostaglandin inhibition because again, this is the cause of most of the discomfort - seven times higher in these women, remember?! Our NSAIDs do this well, and if they are started two days prior to the flow initiates, this can really be life changing, as the prostaglandins are highest those first two days of the flow. The concurrent symptoms caused by prostaglandins, such as nausea and vomiting, diarrhea and insomnia, even headache can also be relieved from this approach, but NSAIDs such as Motrin and Ibuprofen do have risks. Even a few days a month can be risky for some, even those without any apparent risk, so doing this as a routine each month is not advised. We can utilize herbal preparations to support the body along with the Motrin as necessary, as we dig into the underlying cause of the imbalance.

When this isn't helpful, which is true for about 20% of women, then oral contraceptives or prostaglandin synthetase inhibitors are likely the next approach. They work on the same principle, reducing prostaglandin production. Hormones are quite disruptive to the gut though, so this isn't a fabulous fix either, nor does it address the underlying problem. Women who smoke, have high blood pressure, or blood clotting problems can't really utilize this option either.

What if I am Still Incredibly Uncomfortable?

Your cycle should be noticed. Your body is moving through phases within each moon cycle and we want to pay attention, we need to pause and give space for this, but if you feel this isn't right, there is more going on here, then connect with your trusted women's health practitioner. I am happy to work with clients, functionally or if in the Lexington area, I can extend primary care services. It may take a few cycles to decrease inflammation through methods discussed here, but trust your intuition if you believe there is more that needs investigated.

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