Petechial Period Pain: the Pandemic Problem of Endometriosis

For many women period pain can be a monthly misery. Dian Shepperson Mills Cert Ed BA Dip.ION MA looks at the possible causes behind the condition and provides dietary and nutritional advice on how to alleviate it

The ovaries, the main female reproductive organs, function on a 28-day cyclic pattern to secrete oestrogen and progesterone which matures the ovum (egg cell), ripening it ready for release at ovulation usually on day 14 of the cycle. The ovaries, of which there are two, respond to the release of hormones from the hypothalamus and pituitary gland in the brain. These hormonal messages also stimulate a build up of the uterus (womb) lining, also known as the endometrium, which is broken down and shed on menstruation. In a healthy woman, this cycle just continues normally and pain-free, from teen years to the early fifties. However, for many women the monthly period can be a miserable experience, with symptoms ranging from mild discomfort to severe debilitating pain.

Period pain is never normal, it is a sign that something is wrong and it is important that the cause be investigated. As many as half of menstruating women are affected by period pain, and of these, about 10% have severe pain, which greatly limits activities for one to three days each month. ⁽¹⁾ Three types of menstrual pain may occur: burning inflammatory pain, muscle cramps, and sharp tugging pains from adhesions.

Also known as dysmenorrhoea, period pain is classified as either primary or secondary.

Primary dysmenorrhoea is most likely to be caused by uterine cramps. The uterus is a muscle and like all muscles, it contracts and relaxes. Although most uterine contractions go unnoticed, strong ones can be painful. Uterine cramps are thought to be associated with the release of inflammatory prostaglandins, which are found in menstrual secretions and have a powerful effect on smooth muscle such as the uterus.

Secondary dysmenorrhoea is menstrual pain caused by another condition such as fibroids, endometriosis, and ovarian cysts.

Fibroids
Fibroids are non-cancerous tumours that develop from cells that are already part of the uterus. The condition is often hereditary and usually affects women in their 30’s and 40’s. Fibroids are two to five times more prevalent in black women than white women. The female hormone oestrogen appears to associated with the growth of fibroids. Pain may or may not be present and heavy blood flow (menorrhagia) may occur due to the surface area inside the womb being enlarged by the growths.

Endometriosis
Endometriosis is a common but serious menstrual condition that affects one in ten females in their reproductive years. It is a disease in which the endometrium (tissue which lines the womb and is normally shed during menstruation) flows backwards through the Fallopian tubes and drips into the abdominal cavity. These implants continue to respond to monthly hormonal commands, which break down and bleed. They have also been found to produce their own oestrogen that can trigger the implant to bleed at any time throughout the monthly cycle. Because this blood is trapped inside the peritoneal cavity it results in pain and inflammation of the surrounding areas. Strings of blood may form adhesions that stick organs together rather like a cat’s cradle. This may lead to painful intercourse in some women. It may also distort the uterus and ovaries making conception and pregnancy difficult.

Ovarian cysts
The presence of cysts (fluid filled sacs) in or on the ovaries may cause pain. There are several types of cysts, but in the case of endometriosis they known as endometriomas or “chocolate cysts”, which are filled with stale brown blood. These may range in size from 1 cm to 20 cm. Pain often occurs when a cyst twists on its stalk. If an ovarian cyst bursts, the pain from the warm fluid on intestinal tissue can be excruciating, causing the body to go into shock with cold sweats and shakes. In such cases, medical help should be sought immediately. High copper levels are linked to cyst formation.

Precocious and Early Puberty
Precocious puberty occurs when girls as young as five or six years old develop breasts and begin menstruating. In Western cultures teenage girls are maturing earlier each decade and early sexual development can bring dysmenorrhoea and associated conditions such as endometriosis into the realm of adolescents. In the nineteenth century puberty normally commenced around the age of 17 years of age and in the early twentieth century it was around 14. According to research at the Schools Health Education Unit many young girls in Western society now begin menstruation as young as 10 or 11. ⁽²⁾

Recent research reports that girls with the highest prenatal polychlorinated biphenyl (PCB) and dioxin exposure (substances generated by industrial processes), tended to hit the first stages of puberty earlier than others. ⁽³⁾ Fifteen per cent of white girls in one study showed external signs of puberty (breast buds and pubic hair growth), by the age of eight years. ⁽⁴⁾

Other reasons why girls may commence puberty early has been linked to the ingestion of growth hormones which are fed to beef and dairy cattle, and chemicals present in plastics, which are “chemical cousin’s” to oestrogen have been shown to affect the reproductive system in animal research. ⁽⁵⁾ These chemicals, known as nonylphenols, leach out of plastic products such as bottles, containers and cling film into food.

Out of a class of fifteen girls, aged twelve to thirteen years, three quarters reported period pain, which kept them awake at night. Many had severe abdominal cramps, and heavy blood flow to the point of flooding, with a sore and bloated stomach. Most felt exhausted by painful debilitating menstrual cramps that disrupted their school attendance. ⁽⁶⁾

Conventional Treatments: Drugs and Surgical Techniques
Many doctors and specialist consultants have had little nutritional training so often dismiss practical dietary changes. Strong painkillers which disrupt digestion or anti-spasmodics are often prescribed to combat period pain. The GP should check for fibroids, endometriosis, cysts and cancers, as all these conditions (as mentioned earlier) may cause pain and heavy bleeding.

Another orthodox approach in dealing with period pain is the use of the oral contraceptive pill (OCP), which is being prescribed to children as young as ten years of age. This is be used to suppress ovulation. Girls may have been on the OCP for ten to twelve years by the time they reach their early twenties. Side effects commonly reported from the OPC are bloating, weight gain, irritability, erratic bleeding and depression. For some it works well, but others do not tolerate the changes in body biochemistry – (the pill raises vitamin A and copper levels in the blood and reduces levels of B vitamins, zinc, and depletes healthy gut flora). New research from Italy indicates that long term OCP use may exacerbate endometriosis. ^(7,8,9)

More drastic treatments for period pain include burning away the womb lining or hysterectomy (womb removal). Many gynaecologists argue that hysterectomy should be considered only if cancer is present. New research from the USA states that the removal of the womb robs the body of its ability to produce prostacyclin, a hormone that protects against heart disease. The womb also produces sixty enzymes that function in the body. ⁽¹⁰⁾ Although it is unclear exactly what these enzymes do, it is believed that they play a role in disease prevention.

Long term follow-ups in women who have taken the OCP for ten years or more, or who have undergone hysterectomy, are not normally undertaken, so we know very little as to how these procedures affect health in later life. However, we do know that in young women (premenopausal) breast disease is on the increase, and in the menopausal years there appears to be more women suffering from heart attacks than previous literature suggests. ⁽¹¹⁾. This may be due to dietary changes when more saturated and hydrogenated fats are eaten.

TEN POINT DIETARY PLAN TO COMBATING PERIOD PAIN

When the diet is correctly balanced, the nutrients required by the reproductive system help it to work more efficiently. Nutritional supplements may be taken short term to correct deficiencies. However, a healthy eating programme is vital to improve the menstrual cycle and reduce period pain. Most studies report that exercise helps relieve period pain. ⁽¹²⁾ Take a brisk, 20-minute walk each day, as this will aid the excretion of excess oestrogen and increase endorphin levels that help to combat pain.

1. Eat three regular meals a day. This is vital in order to allow the liver to rest and renew itself.
2. Avoid the intake of refined sugar, processed foods, caffeine, aspartame, and alcohol. Refined foods and alcohol deplete the body of certain nutrients that are essential for hormone health.
3. Eat two pieces of fruit a day. Berries such as blackberries, blackcurrants, blueberries, cranberries and raspberries are particularly recommended as they are rich in proanthacyanadins – antioxidant compounds which have a strong anti-inflammatory and diuretic action.
4. Eat three to four servings of vegetables each day including green leafy vegetables to increase magnesium levels.
5. Replace meat and dairy products with oily fish and nuts and seeds. Good quality oils in the diet is a major key to correct hormone balance. The oils in fish such as sardines, mackerel and salmon, and seeds and nuts, are precursors to the series 1 and 3 prostaglandins (PGE1 and PGE3) – hormone-like substances with anti-inflammatory properties. Series 2 prostaglandins (PGE2), formed in the body from saturated fats in meat and dairy produce, trigger inflammation. Avoid hydrogenated fats wherever possible.
6. Eat complex forms of carbohydrates only such as oats, corn, rye, brown rice, buckwheat, tapioca, quinoa , barley and legumes. Wheat may trigger abdominal pain, bloating and constipation in some susceptible individuals so intake should be reduced or avoided. These are usually women with family members with atopic conditions such as asthma, eczema, hayfever, diabetes , coeliac or lactose intolerances. Genetic types from Celtic or Nordic countries or Ashkenazi Jews carry certain genes which may cause intolerance problems. Avoidance of all wheat products should then be undertaken. Dian’s research shows that 86 per cent of women with endometriosis find relief from abdominal pain when avoiding wheat.
7. Avoid sugar-laden carbonated and soft drinks, and replace with filtered or bottled water or diluted fruit juices.
8. Try to prepare the majority of your meals using fresh ingredients and keep convenience foods to a minimum. This will help to reduce the intake of hidden sugars, saturated fats and chemical additives.
9. Avoid cow’s milk products, and replace with goat’s or ewe’s milk products or plant-based alternatives such as soya, oat and rice milk.
10. For sufficient dietary protein, reduce the intake of red meat and bovine dairy foods. Eat more oily fish, eggs, nuts, seeds, berries, peas, beans and lentils.

Nutritional Therapy
In addition to the supplements below, a multi vitamin and mineral is recommended for general health and a gentle iron supplement (30mg a day) to address heavy menstrual flow.

Vitamin B
B vitamins such as B1, B6 and B12 have been shown to exhibit an anti-inflammatory and analgesic action. When taken in combination they “produce significant dose-dependent pain relief and inhibition of inflammation, comparable to the action of phenylbutazone, a standard treatment in orthodox medicine”, but without the side effects. ⁽¹³⁾ The best way to take B vitamins in the form of a vitamin B complex.

Good food sources: Brown rice, oats, nuts, beans and eggs.
Suggested dosage: 50-100 mg a day

Magnesium
The uterus, being muscle tissue, responds well to magnesium, which helps it to relax. Excess calcium, on the other hand, can cause muscles to become tense. As calcium and magnesium work together in the body, the correct balance of these minerals is crucial for normal uterus function. Magnesium supplements have been found to reduce the symptoms of period pain in both preliminary and double blind-studies. ^(14,15,16)

Good food sources: Green leafy vegetables, fruit, nuts and seeds.
Suggested dosage: 150 mg twice a day.

Omega-3 fats from fish oil and flax seeds
Diets low in Omega-3 fatty acids have been associated with menstrual pain. In one double-blind trial, supplementation with fish oil, a good source of Omega-3 fatty acids, led to a statistically significant 37% drop in menstrual symptoms. (17) In that report, adolescent girls with dysmenorrhoea took an unspecified amount of fish oil that provided 1,080 mg of EPA and 720 mg of DHA a day for two months to achieve this result.

Good food sources: Oily fish and flaxseeds. Eat deep sea fish twice a week as it is less likely to be polluted.
Suggested dosage: 1000 mg fish oils once a day or one tablespoon flax seed oil a day.

Evening Primrose Oil
Evening primrose oil (EPO), is rich in gamma linolenic acid (GLA), a fatty acid that the body converts to series 1 prostaglandins (PGE1). PGE1 has anti-inflammatory properties and may helps improve menstrual flow.

Suggested dosage: 1000 mg once a day.

Vitex agnus castus
The herb Vitex agnus castus has been reported to relieve the symptoms of dysmenorrhoea. Its benefits stem from its actions upon the pituitary gland - specifically on the production of a hormone called luteinizing hormone (LH). This indirectly reduces the oestrogen to progesterone ratio and helps regulate the menstrual cycle.

Suggested dosage: 40 mg of the dried herb twice a day.

For further information contact:

The Endometriosis and Fertility Clinic
London Road, Hailsham, East Sussex. BN27 3DD
Tele/fax: 01323 846888
Dian can be contacted:
dian@endometriosis.co.uk
http://www.endometriosis.co.uk
http://www.endodiet.com
http://www.makingbabies.com

Dian Shepperson Mills is a nutritional therapist practicing in Sussex, and at the Putney Clinic 0208789 3881, and the Hale Clinic 0845 009 4171 or +44 (0) 207 323 1693 in London. She is co-author with M.W. Vernon of Endometriosis and Fertility: a Key to Healing and Fertility through Nutrition (Thorsons, £14.99, ISBN: 0-00-713310-3) and specialises in women’s health . Dian is researching the link between dietary intolerances and immune system failures in endometriosis and fertility. She is a member of the British Association of Nutritional Therapists, the American Society for Reproductive Medicine and the European Society of Reproduction and Embryology. She has worked with women with endometriosis for 16 years and has first hand experience of this disease.

The Endometriosis SHE Trust UK
14 Moorlands Way, Lincoln LN6 7JW
Tele/fax: 0870774 3665
http://www.shetrust.org.uk

References

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13. Greenwood Jr. Optimum vitamin C intake as a factor in the preservation of disc integrity. Med Ann DC 1964;33:274.
14. Benassi L, Barletta FP, Baroncini L, et al. Effectiveness of magnesium pidolate in the prophylactic treatment of primary dysmenorrhoea. Clin Exp Obstet Gynecol 1992;19:176–9.
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