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Pelvic Pain: Are You Being Heard?

Women's health has long been a specialty focus in my practice, largely become I lean into caring for those who aren't heard, who feel ignored, those who need an advocate. Women have long suffered in healthcare, which our political climate today gives loud testimony.

I've written previously about painful menses (dysmenorrhea), menstrual migraines, polycystic ovarian syndrome (PCOS), endometriosis, chronic pain in the vulva (vulvodynia), uterine fibroids, abnormal uterine bleeding, hormonal acne, premenstrual syndrome, menstrual cycle problems, interstitial cystitis, hot flashes, low libido, and vaginal dryness. Pelvic pain though, or pelvic inflammatory disease, is sort of that catchall diagnosis for when we have yet to discover what the underlying cause is and again, this isn't a huge surprise; it takes a good 10 years or more to even diagnose endometriosis. Even when we do know, often its because we've ignored pathology so long it now has dire consequence, often infertility and chronic pain. Let's talk.

Painful menses and pelvic pain are very common reasons women seek gynecologic care. They may have pain with menstrual cramps, abnormal bleeding, significant irritability, insomnia, gastrointestinal upset, anxiety, or concern they "aren't normal."

Dysmenorrhea is the medical term for painful cramps with your menses, a nagging discomfort or even crippling discomfort in the pelvic or lower back region accompanying your flow. You might feel pelvic heaviness, fullness, and aching, worse when you are upright and active. It is somewhat relieved when resting, with a heating pad, and with NSAIDs. You might even experience headache, nausea, vomiting, or diarrhea.

These pain associated with dysmenorrhea typically starts with the first cycle you ovulate as an adolescent or teen, and generally repeats with each ovulatory cycle starting just prior to the flow, improving with time. Sometimes this comes later in life though, or returns later in life, into the second, third, or fourth decade. The discomfort may present before, during, or after your flow and it seems to worsen with time. We call the former, primary dysmenorrhea, and the latter, secondary dysmenorrhea.

Chronic Pelvic Pain

Similar to dysmenorrhea, chronic pelvic pain has many of the same symptoms, but it can be independent of the menstrual cycle, and may include more broad symptoms, such as anxiety and depression, constipation and diarrhea, fatigue, radiating pain down the leg, low back pain, reduced libido, irregular cycles, sleep disruption, vaginal spasms, substance abuse, pain with intercourse or penetration, difficult relationships, and loss of interest in social activities.

Chronic pelvic pain can have many origins which is why we see so much variety in its presentation. It lasts for months and can occur outside the cycle. While it can be a challenge to diagnose, as it presents as gynecologic, gastrointestinal, urologic, musculoskeletal, neurologic, psychogenic, endocrine, even nutritional, trauma, or infection, this is not a scenario that should be quickly dismissed. There are a number of pretty serious underlying causes that can be quite catastrophic when ignored. Pelvic infection is common, but appendicitis or even cancer can be to blame. Spinal cord damage and multiple sclerosis (MS) are other causes.

Most women never learn their why, or at least in conventional medicine. Admittedly, it happens to in functional and integrative medicine, the bane of every functional medicine provider, as we are the curious clinicians eager to dig in and better understand the roots or dis-ease. We don't want to just treat the leaves of any plant in distress (throw bandaids on the problem), but rather, we seek to investigate the soil and check the environment in which the plant is living.

When these challenging cases do present though, while digging in is vital, part of the work is also triage, giving some relief to the immediate distress. This can quite often be done with botanical medicine, along with a number of other integrative healing modalities. We must also be wise to addressing inflammation as we work to identify its cause, as well as immune dysregulation and the psycho-emotional aspect of chronic pelvic pain.

The challenge for women is often knowing when this is "part of being a woman" and when they should be seen by a medical provider. The reality is that "part of being a woman" does include changing emotions, changing sensations in our body because this is the beauty of being a woman. We cycle like the moon, we transition like the seasons, and so much of this has been pathologized because we are compared to men who are more stoic, more consistent and unchanging. I want women to feel empowered, to lean into those changing rhythms and find themselves in that, but there comes a point where we gaslight ourselves because we fear being bullied, being told we're weak, or because we don't want to be a bother.

My hope is that you, and your daughters, even your own mothers join me in our Healing Women's Circle, that we can meet up in our program for Embracing Our Crone Season or that our adolescent girls can celebrate their first moon, but if this pain and discomfort is affecting your life, your relationships, or your sexual experiences, it's time to dig into the issue. Don't wait because the earlier you honor your body's alarm signals, the body's fire alarm, the easier we can put out the fire with less consequence.

We should not be experiencing pain with our bowel movements, or feel bloated after we eat. We should be able to rest easy and feel refreshed after a night's sleep. We should not have reoccurring illness or infection, and our body's should not be odorous, even when we sweat and even around our flow. Our weight should regulate in a healthy parameter, and we should enjoy both work and play, without anxiety or addiction.

Functional & Integrative Wellness

When I was first working in functional medicine, the dive beneath the surface to address problems at the root was truly fascinating, but not unlike the midwifery model of care. Midwives aren't bandaid appliers; we see the whole woman and the entire childbearing experience, and seek a balance that honors the couple. We are educators and we work to empower our clients, which is very true to functional medicine. I appreciated the integration of nutrients and botanicals, as these were the healing modalities that resonated with me the most, but what was missing for me, was that dive into our day-to-day, our most authentic selves.

In my mind, I had been practicing functional medicine. Certainly I did more than push nutraceuticals, and I caution you to be mindful of these practitioners, but while I did the proper testing, diving to the root of the issue, and was implementing diets and botanicals, I wasn't asking about trauma, or toxic relationships, or if they were genuinely happy. I think for many of us, the reality of our situation, our environment, and how this impacts us eludes us. We create a narrative for ourselves that we can live with, and as I've learned the hard way, we can be our most toxic gaslighters.

Fatigue for example. What does this even mean? Am I allowed to claim this? I have so much to do, so much to accomplish, I have to move, so how do I know when it becomes fatigue or if I am just absolutely exhausted and overwhelmed from being the one who cares for everyone?

Even movement itself. I sat at a desk, writing in charts, creating practice guidelines and educational programs, and I was busy, very busy. I was exhausted and because I had always had an active lifestyle, my mental exhaustion, felt like physical exhaustion. I hadn't realized I had sat in front of my computer, for years on end, completely hyper-fixated. I was professionally successful so it was working for me, right?

My relationships, well, I had learned to be the fixer, the savior, the forgiver, the healer. I was the absolute best at creating excuses, understanding their perspective, being empathetic, to an absolute fault. I was rationalizing abuse and wouldn't even recognize it until I spoke it aloud, and then realized I had to cover the truth because it sounded "worse than it really was," but even that was just more gaslighting.

This isn't just my life. It is also many of yours. I was eating the right diet, and I had picked back up in the gym, and was taking all the supplements, but my health was declining and my waistline growing. The best functional medicine program won't get you far if you aren't taking an honest look at your life. Who are you? What are your needs? What are your rights and your non-negotiables? What are your traumas? Are you honoring yourself? Do you recognize yourself?

This deep dive into self goes beyond typical functional and integrative medicine, and is what I have coined as functional and integrative wellness. Getting into nature is truly healing, so is journaling and finding a creative outlet. It seems so mundane, so innocent and almost condescending to even suggest to someone who feels they are drowning, but learning to pause, and truly breath, to just notice your present life, even noticing your emotions and living in your body is absolutely transformative.

We have to notice before we can heal. We have to learn to listen and communicate with our bodies to recognize our path towards healing.

This is part of the work, part of our work together. How are you sleeping? What do you dream about? What are you eating and why? How are your relationships? What do you do for yourself? How do you cope with stress, and why? What are your triggers? What does your inner child need to hear? How do you feel loved and how can you best love yourself? What patterns do you repeat? Are you connecting with nature? The list goes on and on.

We have our own journeys, and this can be explored in our wellness programs, with lots of guidance and support, but this "wellness" approach is a vital aspect of healing and as important as the more clinical, functional and integrative, even botanical approach.

Botanicals for Chronic Pelvic Pain

Botanicals are the perfect Earth Medicine nudge our body sometimes needs to restore balance. When women suffer with dysmenorrhea or chronic pelvic pain, they may often need to address stress, or work towards attaining better rest, and quite often, calm their nervous system. Their gut may be a wreck and potentially even their immune and endocrine system. This can be addressed from a functional and integrative approach, with botanicals supporting each avenue specific to you.

Ashwagandha, milky oats, eleuthero, St. John's wort, and lemon balm can be crafted into a tincture and taken throughout the month for support. We've talked about great recipes for uterine tonics in our dysmenorrhea discussion and you might want to consider calcium just prior to and into the first few days of your moon, or even a ginger root compress or infusion in a nice, hot bath as you feel discomfort. Much of this information is available to our active clients in our Wellness program, or again, our Earth Medicine program offers a plethora of resources. If you're interested in scheduling an initial consultation, feel free to message me or book online. You can also call our office at 765-335-2171.

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