WHAT IS MENSTRUATION?
Menstruation is the cyclic discharge of blood and lining from the uterus. Menstruation begins at puberty and typically occurs monthly until a woman reaches menopause (1).
There are two phases of the menstrual cycle; the follicular phase and the luteal phase. During the follicular phase, follicle stimulating hormone (FSH) and luteinizing hormone (LH), are released from the brain and transported in the blood to the ovaries. These hormones stimulate the growth of eggs in the ovaries until one matures and is released from the ovary, in a shell known as a follicle. Once the mature egg and follicle are released from the ovary, estrogen levels increase, and as a result, the FSH levels decrease. This is when ovulation begins, and the egg passes through the fallopian tube toward the uterus (2).
Following ovulation, the luteal phase begins. In this phase, what is left of the follicle becomes the corpus luteum and produces a hormone known as progesterone. This hormone is responsible for thickening the lining of the uterus and for preparing for implantation of a fertilized egg in the case of pregnancy. However, when fertilization does not occur, the corpus luteum loses functionality and the hormones begin to decline. The endometrium then produces a chemical known as prostaglandins, that causes a series of uterine muscle contractions. These contractions cause the shedding of the endometrium. This release of the membrane tissue and blood through the vagina typically takes three to five days and completes the menstrual cycle (1,2).
Menstruation is an important and vital part of a woman’s reproductive ability. However, there are also complications that can occur during menstruation, that make it a difficult part of a woman’s reproductive functioning. Premenstrual syndrome (PMS) and dysmenorrhea are two issues that can occur during menstruation.
PMS AND DYSMENORRHEA
Premenstrual Syndrome (PMS):
Premenstrual syndrome is the experience of behavioral and physical symptoms in the week leading up to menstruation in a woman. The causes of PMS are not particularly well known, but it has been attributed to the surge and fluctuation of hormones that women experience during the menstrual cycle (3). Symptoms of PMS range from psychological to physiological, and progressively worsen closer to when actual menstruation begins, with most severe symptoms usually seen 1 to 2 days before menstruation (4).
Dysmenorrhea is a common disorder related to menstruation and can be defined as painful menstruation.
Primary dysmenorrhea is the most common type of dysmenorrhea and onset begins shortly a girl’s first menstrual cycle. It consists of abdominal cramping pain that occurs just before menstruation begins and can last between 2 to 4 days during menstruation. Primary dysmenorrhea is typically caused by the prostaglandins, which is responsible for the muscle contractions used to shed the uterus lining (5,6).
Secondary dysmenorrhea is abdominal and pelvic pain that occurs throughout the menstrual cycle, that is caused by some type of pelvic pathology or underlying condition. The onset of secondary dysmenorrhea is typically seen as new menstrual symptoms in women aged 30 to 50 years old. The pain caused by secondary dysmenorrhea typically lasts longer than that of primary dysmenorrhea and can continue even after menstruation has ended (5,7)
RISK FACTORS FOR PMS AND DYSMENORRHEA
Premenstrual Syndrome (PMS):
- Genetics (8,9)
- Obesity (10,11)
- Stress and anxiety (12,13)
- Increased age
- Uterine infections
- Caffeine consumption
- Alcohol consumption
- Multiple births (5,14,15,16)
SYMPTOMS OF PMS AND DYSMENORRHEA
- Bloating and water retention
- Breast tenderness
- Abdominal and back pain
- Aches in joints and muscles
- Sleep and digestion problems
- Skin problems such as acne (3,17)
- Back and thigh pain
- Lower abdominal pain
- Vomiting (18,19)
- Intensely painful menstruation
- Painful sexual intercourse
- Bleeding after sexual intercourse
- Bleeding between menstrual cycles
- Abnormally heaving blood flow during menstruation (7,18)
For more information on PMS and dysmenorrhea and diagnosis: 1. Talk to your doctor 2. Visit the Mayo Clinic website on PMS 3. Visit the Office of Women’s Health website 4. Visit the American College of Obstetricians and Gynecologists website on dysmenorrhea
PMS AND DYSMENORRHEA FACTS AND STATISTICS
Estimates show that up to 80% of women in reproductive ages have physical challenges with menstruation (20). Between 20% to 40% of females experience more severe symptoms of PMS that affect their daily lives (3).
In 2013 worldwide reports, up to 90% of adolescent girls and 50% of women suffer from dysmenorrhea. Of that amount, 10% to 20% of girls and women indicate that their experience is severe and debilitating (21).
MEDICAL TREATMENT OF PMS AND DYSMENORRHEA
The first line pharmacological treatment for PMS is serotonin reuptake inhibitors (SSRIs), which are antidepressants and have been shown to alleviate both psychological and physiological symptoms (22,23). Serotonin reuptake inhibitors include:
- Fluoxetine: marketed as Luoxetine HCl, Rapiflux, Sarafem, Selfemra (24)
- Paroxetine: marketed as Brisdelle, Paxil, Paxil CR, Pexeva (25)
- Sertraline: marketed as Zoloft (26)
- Escitalopram: marketed as Lexapro (27)
- Citalopram: marketed as CeleXA (28)
- Side-effects of these SSRIs include edema, anxiety, restlessness, blurred vision, rapid heart rate, gastrointestinal problems, unusual mood and behaviors, decreased libido, drowsiness, skin rashes, seizures, and trouble breathing (24,25,26,27,28).
Another line of pharmacological treatment for PMS is hormonal contraceptives (17). These include:
- Progestin: marketed as, Next Choice, Option 2, Ovrette, Plan B, Prochieve, Prometrium (29)
- Low dose estrogen: marketed as Enjuvia, Alora, Divigel (30)
- Side-effects of these include changes in vaginal bleeding, blood clots, numbness in extremities and chest, headaches, dry mouth, excessive thirst, frequent urination, loss of appetite, and depression (29).
In treating dysmenorrhea, the first line of pharmacological treatments is nonsteroidal anti-inflammatory drugs (NSAIDs) (31). These include:
- Celecoxib: marketed as Celebrex, NuDroxiPAK, SmartRx, CapXib Kit (32)
- Ibuprofen: marketed as Midol, Advil, Motrin (33)
- Side-effects of these include liver problems, bleeding of stomach and intestines, risk of heart failure, edema in face and extremities, blood in urine and stool, headache, dizziness, blurred vision, fatigue, vomiting blood, and muscle pain.
NATURAL WAYS TO HELP SUPPORT HEALTHY MENSTRUATION
Practices to Help Support Healthy Menstruation:
- Reduce salty food intake
- Eat a diet high in fish, eggs, fruit and vegetables
- Have positive social relationships
- Social support
- Reduce social stress (34,35)
Natural Supplements That Help Support Healthy Menstruation:
- Chaste Berry (36,37,38,39,40,41,42,43,44,45,46)
- Dong Quai (47)
- Ginger (48,49,50,51,52,53,54)
- Vitamin B-6 (55,56,57,58,59,60)
- Boron (61)
- Fenugreek (62)
- Vitamin B-12 with fish oil (63,64,65,66)
- Crampbark (67)
- Calcium (58,68,69,70,71,72,73)
- Ginko (74,75)
- Magnesium (59,69,76,77,78)
- Saffron (79)
- Vitamin E (80,81)
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