Painful Menses, PCOS, Endometriosis

Painful Menses

Menstruating woman often have painful cramps and pain before, during or several days after menses begins.
It is usually due to excess estrogen, deficient progesterone, and possibly excess testosterone. It is often accompanied by heavy bleeding leading to anemia.
Testing can identify the levels or each hormone. Once we understand the hormone imbalances, we can begin to balance the hormone levels.
It is important to understand why your levels are imbalanced.

Common causes of hormone imbalances

Hormone Disruptors (chemicals that dysregulate hormones)
Xeno hormones – substances that act like hormones – they are often found in food
Hormones like birth control pills or IUD
Medication used for acne, depression, anxiety, infections
Excess consumption of highly processed foods
Excess consumption of inflammatory foods
Excess chronic stress
Correcting the causes takes time and awareness. Changes are often needed to reduce imbalances and pain. Remedies, medication, herbs can reduce pain while you are correcting the imbalances.

How do we reduce stress?

This is a lifetime question to continue asking ourselves. It requires committing to a moderate life, and making choices that minimize stress. Managing stress is an art, a skill, and a requirement for good health.

PCOS – Poly Cystic Ovary Syndrome

Key Features of PCOS:

Irregular Periods: Infrequent, prolonged, or missed menstrual cycles due to lack of ovulation.
Higher levels of male hormones (like testosterone) can cause symptoms
Acne Excess facial or body hair (hirsutism) Thinning scalp hair
Polycystic Ovaries: Enlarged ovaries with many small fluid-filled sacs (follicles or “cysts”) seen on ultrasound.
Note: Despite the name, not everyone with PCOS has ovarian cysts, and not all ovarian cysts indicate PCOS.

Other Possible Symptoms:

Weight gain or difficulty losing weight Fatigue Mood changes Difficulty getting pregnant (infertility) Darkening of the skin (especially around neck creases or under breasts) Skin tags

Causes

Insulin resistance: This can lead to increased androgen production. Insulin resistance is caused by excess carbohydrates, lack of protein, and consuming inflammatory foods. This is a complex subject that requires awareness and professional support. Insulin resistance is also known as pre-diabetes or high blood sugar.
Genetics: Often PCOS runs in families.
Low-grade inflammation: May stimulate ovaries to produce androgens. We eat a lot of inflammatory food, so we are adding to this condition.

Diagnosis:

Based on at least two of the following three criteria (Rotterdam Criteria):
Irregular or absent ovulation
High androgen levels
Polycystic ovaries on ultrasound

Treatment Options – Mainstream Medicine

There is no cure, but symptoms can be managed based on goals (e.g., reducing acne, restoring periods, improving fertility):
Lifestyle changes (diet, exercise, weight management)
Birth control pills (to regulate hormones and cycles)
Metformin (to improve insulin sensitivity)
Anti-androgen medications (for hair and acne issues)
Fertility treatments if trying to conceive (like clomiphene, letrozole, or IVF)

Treatment Options – Functional Medicine

Functional Medicine does consider lifestyle changes to be the main initial aspect to focus on.
1 Diet -excess carbohydrate consumption, lack of protein, eating inflammatory foods, skipping breakfast, excess stimulants like coffee and energy drinks.
2 Medication is not a first line choice unless the symptoms are severe. Some medications for PCOS are very poorly tolerated.
3 Stress management is also a major focus, since stress leads to many practices that cause this condition to begin with.
4Homeopathy, and nutritional supplements are options that tend to have less adverse side effects than medication. Medication can be an option.
5Metformin can be helpful with minimal side effects

Endometriosis

Endometriosis is a chronic medical condition where tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus, causing pain, inflammation, and sometimes fertility problems.
This is a serious condition that has developed over time. It is usually due to excess hormones for many months or years. Some young woman develop hormone imbalance at puberty.
Normally, during a menstrual cycle, the endometrial lining builds up inside the uterus and is shed during a period if there’s no pregnancy. Endometriosis is a condition that has excess lining developing, usually from excess hormones.

Endometriosis physiology:

This tissue grows in places it shouldn’t be (like on the ovaries, fallopian tubes, bladder, bowel, or pelvic lining).
Unlike normal menstrual tissue, the tissue can’t exit the body, so it becomes trapped.
This leads to inflammation, scar tissue, and adhesions (organs sticking together).

Common Symptoms:

Pelvic pain, especially during periods (can be severe)
Pain during sex
Pain with bowel movements or urination (especially during menstruation)
Heavy or irregular periods
Infertility
Fatigue, bloating, or nausea
Symptoms can vary widely. Some people with mild disease have severe pain, while others with advanced disease may have no symptoms at all. Endometriosis is often not diagnosed in the early stages because the symptoms are vague and are similar to many less serious conditions.

Causes:

Retrograde menstruation (blood flows backward into the pelvis)
Immune system issues
Genetic factors
Hormonal imbalances – (especially excess estrogen, deficient progesterone or excess testosterone)
Diet of excess carbs and low protein
Inflammation from food and beverages

Diagnosis:

Medical history
Pelvic exam
Imaging (like ultrasound or MRI)
Laparoscopy (a minor surgery where doctors look inside the pelvis)—this is the only definitive way to confirm endometriosis.

Treatment Options:

Depends on symptoms, severity, and goals (e.g. managing pain vs. getting pregnant):
Pain relief: NSAIDs (e.g., ibuprofen)
Hormonal therapy: Birth control pills, IUDs, GnRH agonists, progestins
Bio-identical hormones
Surgery: Laparoscopic removal of endometriosis lesions
Fertility treatments: If trying to conceive (IUI, IVF, etc.)
Lifestyle support: Diet, exercise, pelvic floor therapy, counseling for chronic pain

Bottom Line:

Endometriosis is not just bad period pain. It is a complex disease that affects quality of life and can be physically and emotionally exhausting. Early diagnosis and tailored treatment can make a big difference.
A thorough examination by a Gynecologist is highly recommended, including ultra sound or an MRI.
My contribution to this condition is usually adjunctive and not primary. I can reduce the severity by providing lifestyle support, hormone balancing, and treating co-morbidity like hypothyroidism, anemia, and hypoglycemia.
Improved nutrition, stress management and hormone balance can provide very significant improvements.