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Period pains and ovulation cramps

Pain during menstruation, known as dysmenorrhea, used to be regarded as pyschological or ‘all in the mind’ because no physical or hormonal reason could be found. The pain is very real and is now acknowledged to be an imbalance of hormones. Endometriosis also causes pain at menstruation. There are two kinds, cramps which occur on the first day of menstruation which are similar to labour pains, so severe that the child/woman is doubled up. This type of pain generally starts 2 years or so after her first period when ovulation begins and is usually gone by the time a women is in her mid twenties, it always disappears after a full term. It has been found that the cells lining the uterus of women with this type of pain secrete a high level of prostaglandin F-2-alpha. The normal treatment is to give a prostaglandin inhibitor such as mefanamic acid. The other type starts at the first period and can continue until menopause. The pain is a continuous ache in the lower abdomen, starting 1 to 2 weeks before menstruation, increasing in severity until bleeding starts and then easing. Ovulation pain which occurs in the middle of the month is a mild cramping on one or other side of the abdomen. It is thought that it is caused by the contractions of the Fallopian tube as the egg makes its way down to the uterus. Sometimes there might be a slight vaginal discharge or bleeding.

PMS

Premenstrual Syndrome (PMS) is the most complained about symptom from premenopausal women in the Western world. It usually starts about 2 weeks before a period and gradually becomes worse until there is complete relief before or just after the menstrual bleeding starts. Symptoms can vary depending on a woman’s particular constitution, but they are usually some or all of the following:

• Mood swings
• Irritability
• Depression
• Anxiety
• Fatigue
• Tender breasts
• Bloating
• Water retention
• Weight gain
• Sugar cravings

These are the main symptoms which can vary in severity with the worse type being extremely debilitating and is called Premenstrual Dysphoric Disorder or PMDD.

There is a common link between the main PMS symptoms and the symptoms women can experience during the perimenopause, a time leading up to the menopause. It is due to the fact that oestrogen is usually more dominant than progesterone. With PMS, the progesterone can be low or normal during the 2 weeks before a period begins, but the oestrogen still remains quite high where it should have dropped and allowed progesterone to become the dominant hormone –read more: Progesterone Therapy. The other problem can be that synthetic oestrogens in the environment are hindering the normal ebb and flow of both hormones creating disharmony – read more: Environmental Poisons. This can lead to the syndrome commonly known as ‘oestrogen dominance’ which can cause all the symptoms listed above.

In the 10 years leading up to the menopause, it is usual for most women to run down on progesterone as their ovaries ‘splutter’ out of eggs. As most of the progesterone is produced only when a woman ovulates, the levels can become quite low some months; and then nearly all of the time in the last few years before menopause. This is another time when most women will become ‘oestrogen dominant’ creating very similar symptoms to PMS.

Progesterone is the hormone that negates the harmful effects of too much oestrogen, so when there are signs that it is low, supplementing can bring significant relief for most women.

Much more detailed information can be found in Dr John Lee’s book ‘What Your Doctor May Not Tell You About Premenopause’ – see the Home page.

Polycystic Ovary Syndrome (PCOS)

Polycystic means multiple cysts which, in PCOS, refers to many tiny follicles developing just below the surface of the ovary. This is not harmful in itself, but if the normal development of a mature egg in the follicle followed by ovulation is disrupted it can create other hormonal imbalances that can become extremely distressing for example, women with PCOS tend to suffer from one or more of the following symptoms: irregular or absent periods, infertility, increased facial or body hair, acne and oily skin, thinning and hair loss, weight problems.

The exact cause of PCOS is unknown, but it has been established that there is a disruption of the hormones produced in the ovaries coupled with the hormone insulin which is produced in the pancreas. It is not clear why this happens, but it tends to run in families, so can be passed on through the genes. Lifestyle factors and stress can also exacerbate the condition.

Insulin connection

The hormone insulin is found to be higher in most overweight women with PCOS and, to a lesser extent, some slim women. In PCOS the cells of the body do not use insulin efficiently, so the pancreas produces more in order to remove any excess sugar out of the blood. If the pancreas did not do this, blood sugar would become too high and diabetes would develop. This is known as insulin resistance which can be helped with a diet low in sugar in many cases.

Another function of insulin is to stimulate the ovarian cells to grow and produce sex hormones and although the body’s cells in a woman with PCOS are resistant to insulin, the ovaries are not. The higher insulin levels can over stimulate the ovaries to produce more testosterone which can cause some of the symptoms above such as facial hair (hirsutism).

Irregular periods and reduced fertility

The average menstrual cycle is about 28 days, but can vary a few days either side. Irregular or absent periods affect around 75% of women with PCOS. This can be a result of not ovulating each month which can also lead to problems with fertility.

As the eggs in the follicles mature, they release increasing levels of oestrogen (oestradiol) which stimulates the growth of the bloody lining of the uterus in preparation for a fertilised egg. This happens in the first two weeks of the cycle after which ovulation should happen which produces higher levels of progesterone from the empty follicle. This becomes the dominate hormone during the last two weeks of the cycle and its production stops oestrogen proliferating the bloody cells and further refines the uterus ready for implantation of an embryo.

Progesterone is essential for maintaining a pregnancy and also to balance the effects of too much oestrogen which is responsible for building up the uterine lining. If progesterone production is hindered in any way then a woman will suffer from symptoms such as infertility, heavy periods and irregular cycles and, in some cases, higher androgen levels one of which is testosterone.

This is dues to persistently high luteinising hormone (LH) and constant surges of follicle stimulating hormone (FSH) which are initiated by the hypothalamus and sent out to the ovaries by the pituitary in order to try and regulate the cycle and create ovulation. When ovulation does not happen as in PCOS, then more of the androgens are released instead.

Supplementing with a little natural progesterone around the time when ovulation is due can go a long way to break this vicious circle and create a hormonal balance which can start the process of normal regular cycles. This can help reduce the constant production of the LH and FSH which in turn can reduce the androgen hormone levels. This coupled with strategies to bring down insulin levels and weight may reverse most, if not all, of the symptoms of PCOS.

Poor hair, nails and skin

Progesterone is naturally at its highest levels during pregnancy where most women feel and look their best. Hair becomes more healthy looking and glossy, nails seem stronger and skin is clearer and glowing. One of progesterone’s main functions is to maintain a pregnancy until full term – hence its name progesterone – pro-gestation. Women normally produce around 20mg – 30mg of progesterone a day during the second half of the menstrual cycle. This rises to 300mg – 400mg by the third trimester in pregnancy. When progesterone levels have dropped after the birth, women notice that hair starts to fall out, nails become weaker and skin seems duller. However, when women start to supplement with natural progesterone, most will notice the same effects as in pregnancy to a certain degree. This is especially if they were suffering with oestrogen dominance which can interfere the normal function of the thyroid gland as symptoms of hypothyroidism can also cause poor hair quality, dry and weak nails and skin. Please see here for symptoms of an underactive thyroid – hypothyroidism.

Postnatal Depression (PND)

For most women, pregnancy is a time when they feel and look very well as they wait with pleasant anticipation for the arrival of the new baby. Hair looks more healthy and glossy, nails seem stronger and skin becomes clearer with the ’pregnancy glow’. It is no coincidence that it is also a time when the body produces the hormone progesterone at very high levels compared to those of normal menstrual cycles. It does this in order to maintain the pregnancy as this is one of its main functions in the female body. It rises from about 25mg a month in a normal menstrual cycle to 300 – 400mg by the third trimester. Hence its name ‘progesterone’ – ‘pro- gestation’.

During the first trimester the ovaries constantly pump out progesterone until about 10 – 12 weeks after which the placenta takes over and produces huge amounts every day to make sure the foetus remains in place. As progesterone levels rise to the highest levels, a sense of wellbeing and calmness prevails in most pregnant women. However, this seems to fade just after the birth when the placenta is expelled taking with it the huge production of progesterone. Many women will experience a feeling of lower mood about 3 days later which is known as ‘3 day blues’. This is understandable with the many changes in hormone levels and the emotional aspect of a new baby to look after. Normally, this doesn’t last very long as the hormones start to rebalance to the normal pre-pregnancy state and periods resume. However, some women will not fully recover and go on to develop persistent symptoms such as:

• Feeling sad most of the time
• Tearfulness
• Feeling of unable to cope
• Loss of confidence
• Irritability
• Anxiety
• Feelings of hopelessness
• No interest in things that use to give pleasure
• Feelings of inadequacy as a new mother

These are some of the signs of postnatal depression which can be mild, moderate or severe needing immediate medical intervention. However, for the moderate to mild PND, progesterone therapy has been shown to work well by replacing the progesterone lost after childbirth and giving the body time to gradually rebalance itself without the sudden drop and loss of progesterone. The levels can then be gradually reduced over weeks or months until the body is able to cope with its own without supplementation.

Although there can be many aspects of PND, progesterone supplementation should be one of the first treatments to consider due to its positive effect on the mood and nervous system in general. Research in 2002, published in the journal New Scientist, has shown that the higher levels of progesterone in pregnancy can act in a similar way to anti-depressants and raise serotonin levels. It can also raise a woman’s pain threshold in preparation for the birth and give a feeling of relaxed wellbeing during pregnancy. It is no wonder that some women feel so low when it is dropped suddenly and the body cannot compensate as efficiently as others who don’t seem to suffer in the same way.

Pregnancy problems

In approx. 10% of women problems can develope during pregnancy. In these women their placenta is under-devloped and giving progesterone throughout the pregnancy not only helps with the symptoms but the chances of getting pre-eclampsia are greatly reduced. The problems are: nausea and vomiting (sometimes called morning sickness which is badly named as some women are sick all day). When severe it is called hyperemesis meaning excessive vomiting. Nausea normally goes within 4 months, but in some women it continues throughout pregnancy. Pre-eclampsia which occurs in late pregnancy, affects 5% of pregnant women. It is characterised by a raised blood pressure, excessive weight gain, oedema (water retention) and protein in the urine. If untreated it will lead to eclampsia, characterised by a severe headache followed by convulsive seisures. Eclampsia accounts for 5% of maternal deaths and 40% of foetal deaths. It is one of the commonest causes of infant and maternal deaths throughout the world, and yet the cause is still unknown. It has been found that PMS sufferers have a greater chance of developing pre-eclampsia. Some of the other problems experienced by women are: headaches throughout pregnancy, depression, backache, lethargy, dizziness, fainting, irritability and bleeding. An added benefit of progesterone therapy has also emerged, in a study held it was found that the ‘progesterone babies’ were on average more intelligent than a control group. On no account must the progesterone be stopped suddenly as this will cause a miscarriage. It is essential to eat small, starchy meals every 3 hours to keep the blood sugar stable.

Prostate diseases

The symptoms of prostate disease are: enlargement, smaller urethras, inflammation, increased frequency of urination and cellular changes leading to cancer. In many cases these changes can be linked to a rise in oestrogen and di-hydrotestosterone and a drop in testosterone. The rise in oestrogen also causes fatty tissues to be deposited in mens breasts and to shave less often, whereas high levels of di-hydrotestosterone have been linked to prostate enlargement and cancer. Progesterone is as vital for mens health as it is for womens. Approx. 5 to 15mg is made on a continuous daily basis in the testes, which then converts it into testosterone and other hormones, including oestrogen. As progesterone protects men against excessive oestrogen, particularly the xeno-oestrogens and di-hydrotestosterone, some researchers believe that the drop in the level as a man ages and the rise in environmental oestrogen is causing the alarming increase in prostate problems.