Dysmennorhoea and Prostaglandins

Painful Periods (Dysmenorrhoea)

It is estimated that between 50 and 70 percent of women endure some degree of period pain and cramping. Of those, approximately 10 per cent experience contractions so extreme that they are one-and-a-half times more powerful than labour pains.

How Painful is Painful?

Every month many women suffer from pain around the time of their periods. For some women the pain can be so debilitating that they are forced to take time off work or can only get through their periods by dosing themselves with painkillers. Pain is normally considered to be a message from your body, telling you that something is wrong and that an investigation is in order. However, painful periods are viewed somewhat differently by the medical profession and many women who complain of period pains are advised to take a painkiller and to get on with it.

Every one of us has a different pain threshold, and it is impossible to imagine what another person might be experiencing. Only you know whether or not your period pains are unacceptably high for you, and if the pain is affecting the quality of your life, it’s time to do something about it.

What Symptoms Could You Experience?

Obviously pain is the overriding symptom in dysmenorrhoea, but many women will experience other symptoms, including:

• A constant, low, dull backache (congestive dysmenorrhoea) and/or

Finding Out If There is a Reason For the Pain

Because pain is usually a warning signal from your body, it is important that the pain is investigated. But period pains, can however, be unusual in that there may actually be nothing medically wrong.

There are two categories of painful periods

You will need a full investigation in order to assess which of these two types of dysmenorrhoea you are suffering.

This section will concentrate on primary dysmenorrhoea – in other words, painful periods that do not have a diagnosable medical cause. If you are suffering from secondary dysmenorrhoea you will need to address the cause of the pain, such as endometriosis or fibroids.

What Can Cause You to have Painful Periods?

Throughout the month your womb contracts and relaxes on a regular basis. You will probably be entirely unaware that these contractions are taking place. However, around the time of your period, they become stronger. In order to squeeze out the blood from the lining built up during your menstrual cycle, your womb has to contract. This should, theoretically, be a painless or only mildly painful occurrence, but for some women, the contractions are stronger than they need to be, causing enormous pain.

Cramping can also occur and this tends to be connected with heavy periods. The greater the build-up of womb lining, the more violent the contractions needed to get rid of the engorged blood.

There is also supposed to be a resting phase between contractions, but when contractions are so strong, the womb does not relax properly in between. In this case, the blood flow and, consequently, the oxygen supply to the womb, is restricted, which can cause pain. This is the same principle as applies in the case of a tension headache – tense neck muscles constrict the oxygen supply to your brain and you experience pain as a result.

Prostaglandins

Another cause of painful periods can be the excess production and release of hormone-like substances called prostaglandins. Many of the prostaglandins are actually ‘healthy’, and have a beneficial effect on the body (see page 154). However, two types of ‘bad’ prostaglandins, known as PGF2 Alpha and PGE2, can be increased in some women. PGF2 Alpha is a vasoconstrictor, which means that it works to reduce the blood flow to the womb muscle, and PGE2 is a highly inflammatory substance that can trigger muscle contractions and increase the sensitivity of your nerve endings to pain.

Research has shown that women with primary dysmenorrhoea have significantly higher levels of of both prostaglandins PGF2 Alpha and PGE2.

Prostaglandins are present in every cell in your body. They tend to be low in the first half of the cycle and then rise sharply towards your period, and can cause a variety of other symptoms including headaches, nausea and fatigue.

The natural treatment section on page 155 explains how you can help your body to produce fewer of these ‘bad’ prostaglandins to alleviate your symptoms.

Dietary Changes

In chapter 1 we establish the concept that what you eat is the foundation of your health. Taking that one step further, diet is also extremely important – even critical – to the treatment of painful periods. Why? Because the substances (prostaglandins) that are normally at the root of the pain are increased or decreased according to what you eat.

As you have seen, there are both ‘good’ and ‘bad’ prostaglandins. PGE2 is classed as a ‘bad’ prostaglandin because it increase the womb contractions and increases the pain. PGE1 is classed as a ‘good’ prostaglandin because, among other things, it also does the following:

PGE3 can also be classed as a ‘good’ prostaglandin because it helps to reduce inflammation and abnormal blood clotting.

It’s fairly obvious that you need more of these ‘good’ prostaglandins if you are suffering from period pains, but your body has to produce them in order for them to be there to have an effect.

How are prostaglandins produced?

Essential fatty acids (EFAs) in your diet provide the raw materials for the production of prostaglandins. So the starting point is the amount and quality of essential fatty acids (oils) that you eat.

The essential fatty acids are discussed in detail in Chapter 1 and below you will see how your body makes the choice between producing ‘good’ or ‘bad’ prostaglandins.

What you need to do as a starting point is to adjust your diet so that you are increasing those foods that begin the process of producing beneficial prostaglandins (PGE1 and PGE3) and reduce the foods that cause your body produce too many of the negative ones (PGE2), which increase contractions and inflammation. As well as providing your body with the right foods to kick start the beneficial prostaglandin process, you also need to make sure that there is nothing in your diet or your lifestyle that will prevent your body from converting the right foods into healthy prostaglandins.

The best way to get to grips with this system is to imagine that there are two trains (Omega 3 and Omega 6) running along a number of tracks. The Omega 3 train needs to reach the PGE3 station and the Omega 6 train needs to reach the PGE1 station. If there are any obstacles on the Omega 6 track, the train will be redirected towards the PGE2 station.

Foods that encourage the production of ‘bad’ prostaglandins

As you can see from the chart above, it is very important that you avoid all of those foods that are high in arachidonic acid (AA). Your body produces PGE2 from AA, of which the main sources are dairy products. This means eliminating or at least reducing dairy in any form, including milk, cheese, cottage cheese yoghurt,butter and even dairy ice-cream. AA is also present in red meat and although the saturated fat content of red meat is higher than in white meats, AA is higher in chicken and turkey than in red meat.

You may then be concerned about your calcium intake without dairy produce in the diet, but there are many other good sources of calcium, including leafy green vegetables and even sesame seeds (see page 176). If you want to be extra sure, take a multivitamin and mineral supplement that contains good levels of calcium as well as other nutrients for your bones.

Factors that can block the conversion of essential fats.

In order to start the ball rolling, your body has got to convert the Omega 6 series, linoleic acid (LA) into GLA (gamma-linoleic acid). It has been discovered that many women have an inherent (naturally occurring) problem in their bodies, which means that there is some difficulty converting the essential fatty acids to GLA.

If you are one of these women, and you are also a big dairy food eater, you will undoubtedly end up with very little PGE1 (good) and too much PGE2 (bad). Obviously when the balance is tipped in that direction, you’ll be much more likely to suffer some nasty symptoms, and one of those can be period pains.

There are a number of other factors that can hamper the conversion of linoleic acid to GLA and these include stress, a diet that is high in sugar, and deficiencies of vitamin B6, magnesium and zinc. An enzyme called delta-6-desaturase helps your body make this conversion (see chart, page 157) and this enzyme needs B6, magnesium and zinc in order to do its job.

If you are suffering from painful periods, it is important that you take nutritional supplements for between three and six months, to ensure that the nutrients required for the conversion are present in adequate levels.

Supplements

Vitamin B6

Vitamin B6 is needed to help produce ‘good’ prostaglandins, so it is worth taking a good B-complex supplement. This vitamin has been shown significantly to reduce the intensity and duration of period pains.

Vitamin B1

This vitamin is very effective in helping with period pain. In one study, it was given to 556 women (aged 12 to 21 years), who had moderate to severe dysmenorrhoea. Some of the women were given the B1 first for 90 days and then changed to a placebo. Others were given the placebo first for the 90 days and the B1 next. A full 80 per cent of the women were completely cured after starting the treatment. This effect remained for at least two months after the B1 was stopped.

Vitamin B12

Because both vitamins B1 and B6 are helpful with treating period pains, the best approach is to take a vitamin B complex. This will also give you vitamin B12, and it has been found that a combination of fish oil and B12 is actually more effective than just fish oil on its own for relieving dysmenorrhoea. The scientists could not explain why the B12 made the treatment more effective.

Vitamin E

Up to 70 per cent of women have found the supplementation of vitamin E to be useful in treating painful periods. The reasons for this effect are unclear, but it may be that vitamin E’s antioxidant properties help with the pain, or control the levels of prostaglandins.

Vitamin C and bioflavonoids

Bioflavonoids are helpful with period pain because they help to relax smooth muscle and reduce inflammation. Bilberry is one of the best bioflavonoids for this, but other bioflavanoids can be helpful. Include berries of any kind (including blackberries, blackcurrants, raspberries and even grapes in your diet).

Magnesium

Magnesium acts as a muscle relaxant and it has been shown to have a beneficial effect on painful periods and lower back pain, so it is worth taking as a supplement. Magnesium also has the ability to lower the ‘bad’ prostaglandins that may be causing the womb to over contract.

Finally, along with the vitamin B6, magnesium is required by your body to help convert the essential fats into beneficial prostaglandins. Try always to take them together.

Zinc

This mineral is important for eliminating period pains because it is needed for the proper conversion of LA to GLA.

Essential fatty acids (EFAs)

Taking EFAs in supplement form is extremely important in the treatment of painful periods. Research has shown that women with low intakes of Omega 3 fatty acids (the ones that come from fish, linseed and walnuts), have more painful periods than women who have a good intake. The study that found this link also discovered that the extent of the pain was connected to the ratio or balance of the Omega 3 and Omega 6 fats. The women with the worst period pains ate a much lower ratio of Omega 3 fats in relation to Omega 6 fats – a one to four ratio.

I would suggest adding either fish (EPA) or linseed oil capsules in order to keep the ‘bad’ prostaglandins (PGE2) under control.

Bromelian

This is an enzyme contained in pineapples and it has been found to be extremely useful for treating painful periods. It has anti-inflammatory properties and helps as a natural blood thinner. Bromelain also acts as a smooth muscle relaxant and is thought to decrease PGE2 and increase PGE1 (the ‘good’ prostaglandins).

Above information on Dysmenorrhoea and Prostaglandins was taken from

‘The Natural Health Handbook For Women’ by Dr Marilyn Glenville PhD. Published by ‘Piatkus’ Publishers Limited, London 2001. ISBN 0 7499 2191 9

For sources of Fish Oil such as Mega-Epa, and Linseed Oil recommended by Dr Marilyn Glenville see www.naturalhealthpractice.com , and www.biocare.co.uk.