The patient: Jessica, a 35-year-old graduate student and part-time waitress.
Why she came to see me: Jessica walked into my office with a grimace I’m all too familiar with. For the past several months, she’d been struck with menstrual cramps so severe they were wreaking havoc on her life. While her primary care physician had urged her to restart the oral contraceptives she’d ceased taking two years earlier—or undergo a laparoscopic surgical procedure to investigate whether she had endometriosis (a condition that’s often accompanied by pelvic pain and cramping)—Jessica wanted to find a natural and effective solution.
How I evaluated her: I began my work with Jessica by having a long, in-depth discussion about her symptoms, future health goals, and lifestyle.
Jessica, in her own words, didn’t live the healthiest of lifestyles, but claimed she tried—selecting a salad over pasta a couple of nights per week and taking a multivitamin every morning. But between her rigorous academic schedule as a graduate student in clinical psychology and her job as a server at a popular restaurant, her well-being was often pushed to the back of her mind. Until, that is, the onset of her period, when her stomach would contract to the point that she had trouble standing erect and, as she said, “couldn’t function.” In recent months, these menstrual cramps had gotten so debilitating she’d missed three seminars at school and had to find other servers to cover her shifts. When the cramps occurred, she could do little more than curl up in a ball and wait for them to pass while her husband brought her sparkling water and tried to soothe her with Netflix.
The more we talked, the more I realized that menstrual cramps weren’t the only symptom accosting her. While her period had been a “non-issue” for most of her life, these days it was unfailingly accompanied by acne, tender breasts, bloating, insomnia, backaches, and an upsurge in her anxiety. The mounting intensity of her menstrual cramps only exacerbated her nervousness. “I’m anxious enough as is,” she said, “and every time my stomach starts to spasm, I’m convinced something is really, really wrong with me.”
As she stated at the beginning of our appointment, she wanted to avoid going on birth control as she and her husband intended to start a family in the future. “We’re not actively trying, necessarily,” she said. “But we would also be delighted if it happened.”
Her diagnosis of menstrual cramps—technically known as dysmenorrhea—was clear; what wasn’t certain was why now. To get to the bottom of this, I ordered a 24-hour urine test on the 21st day of her cycle to asses her hormone levels. I also conducted a pelvic exam and ordered an ultrasound to rule out the possibility of ovarian cysts, uterine polyps, or endometriosis (although the more definitive test would be a laparoscopic surgical procedure).
What my evaluation revealed: To our immense relief, Jessica’s pelvic exam and ultrasound came back normal, as did her hormone test. That said, I believed that her decision to go off birth control pills may have been impacting the severity of her menstrual cramps.
Think of it like this: Shortly before a period starts, the endometrial cells that line the uterus produce large amounts of prostaglandins—compounds that trigger the uterus to contract, thus resulting in pain—and higher levels of these compounds can take menstrual cramps from mild to acute. Oral contraceptives, meanwhile—which lower the amount of prostaglandins by inhibiting the growth of the endometrial cell layer—can reduce menstrual pain. By going off the pill, Jessica was, in essence, turning back on this natural response she once had. Further, the stress she was under—and the lifestyle she was leading—were exacerbating inflammation throughout her body, intensifying her period pain, and weakening her ability to cope.
How I addressed her problem: First, we addressed the urgency of the problem—providing Jessica with immediate relief for her menstrual cramps. Her first course of action—when available—was to bathe her stomach in heat as soon as the cramps struck. A bath with Epsom salts or a soothing essential oil, such as chamomile and lavender, would be her best bet, I said. However, if she was in a pinch, applying a warm washcloth to her abdomen (or taking a hot shower with the water spraying at her) would also do the trick. (Heat helps relax uterine muscles, which results in diminished cramping.) I also urged her to sip ginger tea, which can reduce inflammation and decrease spasms in the uterus, and to take crampbark—an herb that operates as an excellent uterine relaxant and antispasmodic (300 mg three times per day).
We then addressed her lifestyle. Jessica’s diet largely consisted of food she could grab on the go—a Cliff bar for breakfast, a fast-food cheeseburger for lunch, French fries as a snack at work, Chinese takeout with her husband on the nights she was home, and candy and trail-mix when she was studying. While I understood the urge to eat and jam as fast as possible, her imbalanced, Standard American Diet was playing a role in the severity of her premenstrual symptoms. The foods she was eating were heavy in animal fats but low in fiber, which is crucial to staving off period pain, in that fiber enhances overall estrogen metabolism. (Fiber also encourages improved digestion, which can diminish bloating and that icky sense of fullness.) Further, conventional, non-organic animal products—the very ones she was eating—may contain xenoestrogens. These compounds can mimic estrogen in the body, disturb hormone balance, and lead to increased cramps. At the same time, the candy she was depending on to power through study sessions was also contributing to her cramps. Why? Sugar frequently leads to inflammation and bloating, and both can contribute to (and exaggerate) menstrual cramps. Instead, I asked her to incorporate calcium-rich foods into her diet, such as leafy greens (research shows that this bone-boosting mineral can help alleviate menstrual cramps), eat “healthy” fats such as fish and avocados to decrease inflammation, and to fill her plate with foods that are high in antioxidants (such as leafy greens, berries, cherries, and pecans). If she was hit with a craving, I encouraged her to go for dark chocolate, as its high magnesium content can reduce menstrual cramps (as well as other PMS symptoms). To this I suggested she start eating flaxseeds; not only are they high in Omega-3s, lignans, and that ever-important, aforementioned fiber, but they’ve also been shown to prevent the release of certain prostaglandins. Lastly, I encouraged her to reduce her sodium intake. Salt—and salty foods—can lead to dehydration, and when you’re dehydrated, your uterus cramps even more.
Next, we looked at Jessica’s exercise habits. As she bluntly put it, they didn’t exist. The hours she spent on her feet waiting tables often felt like exercise enough, and she was often too tired between school and work to hit the gym. As I explained to her, this would have to change in order for her to regain her health. It’s one thing to wait tables and deal with its attendant stress; it’s yet another to get your blood pumping with a brisk walk or an immersive dance class. Aerobic exercise (such as biking and swimming) can help ease menstrual cramps in that it helps release beta-endorphins—your own, natural painkillers.
While Jessica took a daily multivitamin, I wanted her to increase her zinc intake, particularly in the days leading up to her period. Studies show that taking 30 mg of this vital mineral four days before menstruation can reduce menstrual pain. I also encouraged her to take 400 i.u. of Vitamin E, 1,000 mg of calcium, and 500 mg of magnesium daily.
Finally, we looked at the amount of stress in Jessica’s life. Between school, work, and her husband, she was constantly, relentlessly busy—and more and more research shows the direct link between stress and inflammation. To this end, I urged her to schedule in more time for herself, every single day. How she spent that time was up to her, but it was imperative for her to prioritize it.
The patient’s progress: Eight weeks later, Jessica returned to my office with a smile, her grimace gone. Following my instructions, she said, had been a game-changer. At first, some of the suggestions—such as taking a bath or going swimming—seemed self-indulgent and preposterous to her, given her busy schedule. But after turning to them when menstrual cramps struck, she realized how calming they were on her body and brain, and started incorporating them into her daily life. Her menstrual cramps had diminished radically—the spasms lasted only for a minute or two—her acne had disappeared, her anxiety felt more manageable, and her life, overall, felt “back on track.” What’s more, riding her bike to school and work allowed her to clear her mind for what rested ahead. She wasn’t pregnant—yet—but with her health in check, she was more than ready.
Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.