The Why: Physiology of Menstrual Symptoms
To understand why menstrual symptoms can cause the discomfort they often do, it is first important to understand what is happening during menses (and parts of the cycle leading up to it). During your follicular phase (days 1-14 of your cycle), a part of your brain called the hypothalamus and your pituitary gland work together to stimulate the ovaries to produce estrogen. This estrogen thickens the lining of your uterus, called the endometrium, to prepare for any potential pregnancy. After you ovulate (for the average 28 day cycle this is around day 14), the luteal phase begins and lasts through the rest of the cycle. It begins with the formation of a structure called the corpus luteum that secretes progesterone and further preps the endometrium for potential pregnancy. If pregnancy doesn’t occur, both hormones (progesterone and estrogen) drop. This sudden drop in hormones triggers the shedding of the endometrium; this is what we know as menstruation.
Menstruation can be uncomfortable for a large majority of people, and can even result in excruciating pain for some. There are a lot of factors that cause dysmenorrhea (menstrual pain), so let’s dive into some of them.
The main contributor to dysmenorrhea is the release of a substance produced by the endometrium called prostaglandins. Their job is to cause the uterine muscles to contract in order to push out the shedding uterine lining. Higher levels of prostaglandins often correlates to higher levels of pain with cramping. (NIH) Now, you might think, “My other muscles don’t hurt like this when they contract. Why does this result in so much pain?”. When the uterus contracts, which is necessary to expel the endometrial lining, the contraction can also cause reduced blood flow to the area due to compression of blood vessels. Your body can detect this lack of blood flow and release inflammatory mediators; this can cause cramping in the abdomen, back, or upper thighs. Conditions that increase inflammation levels, such as endometriosis, uterine fibroids, or adenomyosis, can intensify this pain. The prostaglandins can also enter the bloodstream. When this happens, symptoms such as nausea, vomiting, diarrhea, headaches, and just that overall sensation of not feeling well can occur.
Along with physical symptoms like pain – which very much contributes to low mood – mood changes like anxiety, depression, and anger can occur before and/or during menses primarily due to hormonal fluctuations and their interaction with neurotransmitters (our brain’s chemical messengers). (JH, LLU)
- The fall in progesterone before menses can cause dysregulation of GABA receptors, which are involved in our stress response, as well as lead to increased cortisol (the “stress hormone”). This can lead to high anxiety and lower capacity to handle stress. When the fall happens rapidly, it can cause significant mood instability.
- The fall in estrogen before menses also leads to reduced serotonin activity, which can lead to anger, depression, cravings, irritability, and overall emotional dysregulation.
Hormones can also directly impact parts of the brain responsible for processing emotions. Estrogen has a role in supporting a number of these areas:
- Modulates the fear/anxiety response in the amygdala
- Supports cognitive and emotional control
- Hippocampus: supports memory and cognitive function
So when estrogen falls pre-menses, there can be dysfunction in these areas, leading to anxiety, “brain fog”, and emotional fluctuations. (SR)
The Problem: Gaps in Women’s Healthcare
In our society, menstrual symptoms are often brushed off as just something that happens and isn’t that serious. For those with significant PMS symptoms, 1-2 weeks of every month can be full of debilitating pain and/or mental & emotional symptoms and it is expected that they function fully as normal, physically and emotionally showing up the same as any other time.
Even within medical settings, women so often have their pain and experience diminished by being told PMS symptoms are normal, or being told to just take Ibuprofen, rather than also investigating further to see what else may be going on and how to manage it. While menstrual symptoms are common, that doesn’t make them all normal, which is the way our current healthcare model seems to treat them. Just because a lot of people experience the same negative symptoms, doesn’t mean it is normal or you should have to just suffer through it. Another contributing factor to the lack of care for reproductive symptoms in women’s health is simply that there is a huge gap in research when it comes to women’s health.
The Solution: Root-Cause Care and Supportive Care
While some conditions such as PMDD, PCOS, and endometriosis have been increasingly recognized and treated in more recent history, for a lot of menstrual symptoms (and even for those who have these disorders but have not gotten a diagnosis), there is not standard-offered care. Menstrual symptoms that are significantly impacting someone’s day to day life should be evaluated further to determine any underlying pathology. While this root-cause approach is best to actually treat symptoms and any conditions that may be making them worse, supportive care can also be beneficial. There are a variety of modalities – pharmaceuticals, botanicals, bodywork, nutrition, and other lifestyle factors – that can help support menstrual symptoms.
Meet Dr. Hernandez
Dr. Tia Hernandez offers a visit specifically for support during your menses. The visit varies slightly based on the patient’s individual symptoms, but is a bodywork visit focused on the areas of the body that can be tight and painful during menses – the lower back/sacrum, neck and shoulders, and the ovarian & uterine ligaments. This visit is meant to be a time for you to relax, feel better, and get the type of care that should be available during this time of the month. To schedule: Schedule a 60 minute pelvic care visit with Dr. Hernandez with the reason for visit as “Menses Care”.
