Endometriosis is a multifaceted gynaecological condition that affects many people with uteruses from as early as the first menstrual cycle, and possibly well into menopause. It is believed to be associated with a complex interplay of genetic, hormonal, and immune system factors that drive inflammation. A lesser known player that influences endometriosis is our microbes, in particular the bugs of our vaginal and digestive microbiome.

The vaginal microbiome is a complex ecosystem of bacteria, fungi, and other microorganisms that plays a crucial role in maintaining the health and function of the female reproductive system. In recent years, there has been growing evidence to suggest that changes in the microbiome of the vaginal and peritoneal fluid (the fluid which are reproductive organs exist within) may be associated with endometriosis.

Typically people without endometriosis are not shown to have many microbes within the peritoneal fluid, whereas those with endometriosis have been found to have dysbiosis of this area.

Photo by Alexander Krivitskiy on Unsplash

The vaginal microbiome can be imbalanced at many stages of life, however a long term imbalance such as in chronic candida can contribute towards inflammation and perpetual irritation of the nerves, aggravating the pain associated with endometriosis.

Dysbiosis within the digestive system can also aggravate endometriosis due to the increased production of lipo-polysaccharides (LPS) from dysbiotic bacteria, which contributes towards growth of endometrial lesions, increased inflammation and pain. Our gut bacteria play a large role in the balance of our immune system, and imbalances within our gut bacteria can disrupt this, worsening the inflammation of endometriosis which is driven by altered immune function.

If only correcting our microbiome was the sole answer, but it is part of the jigsaw puzzle.

You may be interested in these articles:

Endometriosis – Natural Management Options

Updates on Endometriosis

Thrush

10 Ways to Ease Period Pain

Endometriosis – an overview

The complexity of endometriosis makes it an overwhelming condition to tackle by yourself. Please don’t hesitate to get in touch if you would like to work together to improve this condition.

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Almost every woman has experienced menstrual cramps at some stage of their life, and if you have then you know they are definitely not an enjoyable experience.  They can range from a slight ‘twinge’ or feeling of mild discomfort that you can put up with, to such a degree of pain that despite pain killers and medications you are still curled up in the foetal position, maybe passing out from the pain and also experiencing all sorts of stomach complaints to go along with it.  Some conditions some as uterine fibroids, endometriosis and adenomyosis can cause severe period pain and erratic bleeding, however it is common to get period pain without it being caused by other conditions.  The technical term for period pain is dysmenorrhoea.

Quite often women are told that period pain is “normal”.  Well that’s not quite true – it’s certainly common, but normal implies that it’s okay to be in that much pain, and it isn’t.

I used to experience period pain along the lines of the above description – not the nice, go about your day one (I wish) but the ‘I think my insides are about to explode’ sort of period pain.  Over the course of my naturopathic studies I experimented on myself with different treatments and tricks to reduce this pain, until with more experience and knowledge I have been able to reduce the pain each month to a ‘niggle’.  My personal experience in this makes period problems and women’s health issues one of my favourite things to treat.

Below are a few simple techniques that you can try both throughout the month and during your period to make things a bit more comfortable for you.

1.  Acupressure Points

Acupressure uses the same meridians and points as acupuncture, however instead of using needles you are using your fingers and thumb to apply pressure.  You can do this at any time, and is a fantastic way to self treat.  It is always a good idea to consult an acupuncturist initially, as they can teach you what points may be more specific for yourself.  Below are some examples of common points that are used to reduce period pain.

Spleen 4

Acupressure Point – Spleen 4 / Grandfather Grandson Point / Gongsun

Also known as the Grandfather-Grandson point, this is located on the inner foot and helps to harmonise the abdominal area as well as reduce stress.  To find the point,  run your finger along the inside of the first metatarsal bone about an inch, until you find a slight depression.  Sit on the ground with the soles of your feet touching each other, so that you can hold the points of both feet at the same time.  Hold for 2 minutes.

Spleen 6

Acupressure Point – Spleen 6 / Sanyinjiao / Three Yin Intersection

To locate this point place one hand with your little finger in line with the base of your ankle bone, on the inside of your leg. Just above your index finger, along the edge of the bone, you’ll find a point that is quite tender to touch, particularly if you’re suffering from painful periods (you may also feel a very slight indent here).  Hold this point until you feel a reduction in your period pain.  It can take five to ten minutes for some women.  Repeat as necessary throughout the day for best results.

Liver 3

Acupressure Point – Liver 3 / Taichong / Great Rushing

This point helps to move stagnation of the body and blood, making it a good point for a wide variety of conditions – especially period pain.  It can often be a tender point to press, and most women with period pain will have stagnation along their liver meridian.  You can locate this point on the line between the first and second toe, about 3 finger widths from the edge.  You will know that you’re on the point when you find a slight indentation here, and it will be somewhat sensitive.  It is easiest to use you index finger for this point.  Start by massaging the point lightly, then hold it more firmly for another few minutes, breathing deeply all the while.  This is a very detoxifying point.

According to Adrian Low, Acupuncturist at Health Dimensions another helpful technique for reducing any form of lower abdominal pain is to massage the line running along the middle of the inner forearm (from wrist to elbow) in small circles with your thumb. It works best when performed on the side opposite to which your abdominal pain is on (e.g. if the cramping is on your left, massage your right arm).

2.  Exercise

One of the last things you’d probably want to do during your period is exercise, but exercise can help to improve blood flow and to produce endorphins which reduce pain.  A moderate paced walk during your period can be of benefit, as can yoga (see below).

The best way that exercise helps period pain, however, is when it is done consistently during the rest of the month.  This aids circulation, endorphin production and exercise is also able to reduce stress hormones.  Oestrogen dominance is a common cause of period pain, and keeping a healthy body fat percentage can help to minimise the effects of this – exercise of course is of benefit for this.

3.  Heat

If the muscles in your pelvic area are tight, it can worsen period pain.  Applying heat helps these muscles to relax, softening the uterus and the muscles and ligaments attaching to this area, which reduces pain (yay!)  Some research has also found that the application of heat also helps to reduce the pain chemicals sent to the brain.  Heat application is one of the simplest ways to reduce period pain, and if you’ve got a heat pack or hot water bottle at home it can be set up in no time at all.

You can use a wheat bag, a hot water bottle, or you can even find stick on heat patches which are great if you need to use it while out and about.

4.  Essential oils

There are several essential oils which can help to reduce period pain by relaxing the muscles and balancing hormones.

A 2012 study on Korean high school girls found that massaging the abdomen daily with a blend of clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil was more effective pain relief than acetominophen (paracetomol).

A 2012 Japan study showed that massaging the abdomen with cream containing a blend of essential oils blended with lavender, clary sage, and marjoram in a 2:1:1 ratio (this was diluted in an unscented cream at 3% concentration) throughout the cycle was able to reduce period pain within one month.

Certain essential oils such as Clary Sage and Sweet Marjoram can be applied directly to the abdomen during a period, with a hot facewash applied ontop of that to enhance it’s absorption.  Clary Sage is calming, relaxing and soothing to the female reproductive system, and Sweet Marjoram has pain relieving properties.

It is always advisable to consult a practitioner trained in the use of essential oils, who can prepare you an individualised formula.

5.  Physical Therapy and Stretches

Often by relieving tightness in the ligaments and muscles of the pelvis, thighs and lower back you can reduce the severity of period pain.

According to Osteopath Steven Takchi,  “The hip flexors anatomically lie close to the female reproductive system.  Due to sitting all day, the hip flexor is activated and this can contribute to tissue tightness, potentially putting more pressure on those organs.  A tight psoas and pelvic floor can also contribute to period pain tightening the fascia in that area, and a rigid and tight pelvis can contribute to period pain because of altered biomechanics which can cause restriction to the pelvic splenic nerve (this nerve comes from the sacrum to supply that whole area).  These areas are often tight due to sitting all day.”

Consulting a physical therapist such as an osteopath to address structural imbalances or muscle tightness can help to reduce period pain.  In the mean time, you can stretch your hip flexors at home.  You can find several videos online to do this, such as this video.

6.  Yoga

Yoga is another great way to reduce menstrual cramps.  Not only will it provide many of the same benefits as your standard stretches, but it will also help with relaxation, and to promote healthy energy flow along your meridians.

Below are some poses that may be particularly helpful during your period.  Rather than describe these poses, I have compiled some links to articles by yoga instructors, which illustrate them more clearly with pictures.

Pasasana: Noose Pose

This helps to stretch out the hips, which can often get sore during periods.  While the Noose Pose has your feet positioned close together, you can widen your feet in a variety called a Half Bound Squat, if needed.

http://www.active.com/yoga/articles/4-yoga-poses-to-ease-menstrual-cramps?page=2&stop_mobi=yes

Ustrasana: Camel Pose

This will provide a relieving stretch along the front of the body.  Practised regularly, this can help to promote good posture and strengthen the back.

http://www.fitsugar.com/photo-gallery/30192496/Camel/

Supta Baddha Konasana: Supine Butterfly pose

You may instinctively been doing this pose already.  It is a relaxing pose which helps to open the hips and rests the lower back.

http://www.myyogaonline.com/poses/restorative/reclining-bound-angle-pose-supta-baddha-konasana

Virasana: Child’s Pose

This pose helps to lengthen the spine, and relaxes the abdomen and nervous system.  Great for when things are all getting ‘a bit too much.’

 https://freedomgenesis.com/childs-pose/

http://www.myyogaonline.com/poses/restorative/child-pose-balasana

Note:  It is generally recommended to avoid poses called ‘inversions’ during your period, which are essentially any pose akin to a handstand.  The theory behind this is that is can promote retrograde flow, which is the movement of endometrial blood and cells into the pelvic cavity.  This is thought by some to contribute towards endometriosis.  This notion is debateable, and some health practitioners believe that a healthy immune system can ‘mop up’ this endometrial tissue when it travels beyond it’s home, therefore making the culprit an imbalanced immune system, rather than a yoga position.

 7.  Spices

Some of the herbs I commonly prescribe for period pain are readily available as culinary herbs – in particular ginger and turmeric.  These herbs both have pain relieving properties, so when taken regularly throughout the month they can help to reduce inflammation, making your period less painful.  Ginger is also great at reducing nausea, so extra can be taken during your period for added benefit.

Ginger is lovely in stirfries, marinades, sauces etc.  However when you’re wanting to take it during your period you will need a larger dose than you would normally have in meals.  To reduce pain and nausea, grate some ginger into a cup of boiling water (you could add some lemon and/or honey for taste) and sip on this, a couple of cups a day.

Turmeric is a spice that has been used in abundance in Indian foods and Ayurvedic medicine.  Nowaday it has a huge amount of evidence supporting it’s anti-inflammatory effects.  The spice is best utilised by the body when prepared in the traditional methods (that is, cooked with oils) so including turmeric into your cooking throughout the month can help to reduce inflammatory chemicals building up, therefore reducing pain.  High strength preparations are available in tablet form, and these may be helpful to take during your period as an alternative to common pain killers (thankfully Turmeric is safe on the digestive system).

8. Calcium rich foods

There is some research on the use of calcium to reduce period pain, it is likely that it is helpful because among other things, we know that it is important for muscle tone and along with magnesium, supports healthy contraction and relaxation of muscles.  Throughout the month aim to eat a wide variety of foods rich in calcium which include beans, seaweeds, nuts and seeds e.g. almonds and sesame seeds, dark green leafy vegetables (such as spinach and kale), as well as dairy (if you are intolerant to dairy, avoid it as this can worsen period pain as it can increase inflammation).

9.  Epsom salt baths

Epsom salt is the common name for Magnesium sulphate.  As you may know, Magnesium is an important mineral for your health, and it is most commonly known for it’s muscle and nerve relaxing properties.  Women who experience complaints such as period pain and PMS are often low in magnesium (most people are!) so addressing this deficiency can be of benefit throughout the month with food and supplementation, and for acute period pain have an Epsom salt bath to absorb the magnesium through your skin.  Simply add 2 cups of Epsom salts to a warm bath and soak in it for at least 15 minutes.  Try adding some essential oils for an added benefit.    Your cramps will reduce, and you should feel relaxed from the lovely bath.   Ahhh.

10.  Good fats

By increasing your consumption of ‘good’ fats, you can help to reduce inflammation, thereby reducing period pain.  Eating wild-caught fish and opting for grass-fed over grain-fed meats regularly throughout the month is a great way to help to boost your omega-3 levels.  It’s also a good idea to avoid the types of fats which increase inflammation, such as processed vegetable oils, deep-fried products and margarine, and avoid meats from grain-fed animals.  It is possible to supplement with a omega-3 supplement such as fish oil, however it is important to ensure you are getting a good quality product – see your practitioner for more info on this.    To read more about fats, click here.

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Ladies, this one is for you.

Certain types of pads and tampons contain chemicals that may worsen period pain, cause allergic reactions and irritation, lead to pelvic inflammatory conditions and even fertility problems.  They have a huge impact on our environment, as some of their ingredients never break down.  In this article I will look at what these synthetic products are doing to our body, and discuss some of the alternatives that are available to us.

Tampons – Is this the most important item to choose organic?

Chances are, if you’re interested in your health and wellbeing you have decided to ‘go organic’ – you shop for organic fruits and vegetables, you limit your use of house hold chemicals, you might also use organic body products.  But for women, an often overlooked source of chemicals is through our sanitary items – pads and tampons.

Most conventional pads and tampons use a variety or blend of rayon (wood pulp), viscose (synthetic product) and cotton.  Some tampons are also coated in polypropylene (a crude oil derived plastic) to make them ‘slippery’ as well as to bind and contain the synthetic fibres together (pure cotton tampons are much stronger so will not disintegrate).   Cotton is actually quite a ‘dirty’ crop – it is the most heavily sprayed crop in the world (26% of the world’s pesticides are used on cotton!) so cotton products contain a whole host of pesticides.  These cotton products are then bleached with chlorine, which as a result leaves a by-product called dioxin.  Most sanitary products also have added chemicals to absorb odour or create fragrance, however these are also derived from crude oil products.

This may in fact be one of the most important items with which to choose organic, as our ‘lady bits’ are actually extremely capable of absorbing chemicals.  This is not good news for the health conscious, and to make matters worse these chemicals can actually increase period pain!

The pesticides from cotton, the polypropylene that coats and exists within the tampon and the dioxin from bleach combine to create a hectic combination of chemicals that increase inflammation in our ‘lady parts’ and can also lead to other health problems such as endometriosis and infertility.  These chemicals are also commonly responsible for causing irritation and allergic reactions down there, so going organic can result in a much pleasanter time of the month.

Consider this rough equation:

• A woman with a regular cycle will have 11-13 periods a year.  Assuming she has a standard menarche from 13, and enters menopause at 51, that’s 456 periods.
• Take out about 42 periods for an average of 3 children (9 months pregnancy, approx 5 months of no periods during breastfeeding) to reach 414 periods.
• The average women has a period for 3-7 days (so let’s say 5), and can use anywhere from 3-6 tampons or pads a day (so let’s say 5).  That’s 25 pads and/or tampons a period.
• 25 pads/tampons a period x 414 periods = 10,350 pads/liners in a lifetime (oh and don’t forget the thousands of liners we’re probably going to use as well!)

That’s a lot of pads and tampons, and cumulatively, a lot of exposure to chemicals that you don’t want down there!

Photo by Karl Wiggers on Unsplash

GOING ORGANIC

Nowadays, many people are making efforts to reduce their exposure to chemicals – for good reason.  Good quality research papers have shown that many pesticides in our food can disrupt hormones, nervous system health and our immune system, and in addition can lead to several cancers and conditions such as chronic fatigue syndrome.

Going on from this, we can extrapolate from the knowledge that eating chemicals is bad for us, so therefore applying chemicals to our skin is bad as well.  (Cue an abundance of body creams and lotions with ‘organic’ labels, and another booming industry fraught with misinformation that misleads consumers (organic body products are not regulated in the same way that organic foods are, and many products labelled as organic may still contain harmful chemicals) – regardless of whether it is labelled as organic we should still diligently check ingredients of products we choose, and buy from reputable companies/suppliers).  Using (actual) organic body care products is another good move; in fact it may be even more important than using organic food as our digestive system, when working properly has a lot of acids and enzymes (e.g. in our saliva and stomach) that help to break down and eliminate chemicals.  Our skin is an amazing organ, and it has a great capacity to absorb anything that we apply to it, particularly when it is rubbed on in an oily based i.e. a cream.  This comes in very handy when we want to apply therapeutic creams, however not so good when the creams contain nasties.

The mucous epithelial membranes that exist within regions such as the rectum, nose, lungs and vagina have an even greater absorptive ability than the skin, which is why pessaries and suppositories have such a fast and effective action.  In addition to this the blood supply from the vagina goes directly into the pelvic plexus (the same veins the ovaries normally empty into), so when certain hormones and chemicals are applied to the vaginal mucous membranes they are directed towards the uterus before they are assimilated into the rest of the blood stream(1).

Pads and tampons are a major source of chemicals, due to the excessive spraying of cotton crops.  Tampons that contain other fibres, such as rayon, can leave trace amounts of fibre and chemicals on the vaginal wall after removal – this is an issue for not only chemical exposure, but greater risk for toxic shock syndrome.  According to Dr. Philip Tierno, a Clinical Professor of Microbiology and Pathology at NYU Medical Centre, 100 percent cotton tampons “consistently test under detectable levels for TSS toxins.”(2)  This is because non-cotton products have a structure that is more likely to shed fibres.  In the attempt to bind these fibres together tampons are coated in a type of plastic coating called polypropylene.

Check out this video to see the different tampon types hold their fibres together.  These polypropylene chemicals do not break down or decompose.  Remembering how many tampons are used in a life time this could accumulate, potentially contributing to health concerns, but it the immediate sense it can also cause irritation of the sensitive vaginal area.  Vulvovaginitis is a problem that many women experience and if it is worsened by sanitary items, it can make that time of the month a very uncomfortable time.

I have experienced in both myself and my patients a significant reduction in period pain with the use of organic sanitary items.  While there is limited research on this matter, I theorise the pain reduction to be due to a few reasons:

• By avoiding the polypropylene there is less of a topical irritation, creating less inflammatory chemicals in the area.
• Insertion and removal of tampons cause micro-tears in the vaginal wall, in which tampon residue can remain.  Synthetic tampons have a greater likelihood of leaving residue and the nature of their fibres can be more irritating.
• The removal of chemicals which can mimic oestrogen can both reduce prostraglandin production as well as reduce the exacerbation of conditions such as endometriosis, pelvic inflammatory syndrome and fibroids.

WHAT ARE OUR OPTIONS?

Organic pads and tampons

There are several brands that use organic products, and organic cotton tampons.  While they are usually a little pricier than conventional brands, I personally consider it to be worth it.

Organ(y)c, TOM Organic and Natracare are good options.  TOM Organic is an Australia based company, and also offers ‘subscription’ service, a novel idea considering this is something we use on a regular monthly basis (ooh and they’re pretty!).  Other less widely available brands include Seventh Generation.

Reusable pads.

Reusable pads usually consist of organic cotton and come in a variety of shapes and colours.  They are clipped onto the bottom of the panties and when used, need to be soaked overnight then washed as per normal.  This is considered to be more environmentally friendly than disposable pads and tampons, and many women consider this to be more comfortable as well – they feel like normal underwear and are silent (no plastic crinkling sound).  While the need to wash these pads may turn some women off, the environmental benefits are good and these are a viable option for those who do not wish to use an insertable product.

Wemoon is an Australian based company that offers a variety of reusable pads.  Lunapads also offer products online in a variety of fun colours, and also stock liners.

Menstrual cups.

Menstrual cups are bell shaped silicon or latex cups that are inserted into the vagina to collect menstrual flow.  This is a concept that has been around for a long time, however it is not commonly used or known about these days, perhaps due to a perceived ‘ick factor’?

According to the Diva Cup website, once you have tried menstrual cups you realise that most concerns are unwarranted – i.e. a typical flow is only 30mL per day, therefore removing the cup really isn’t going to be like a scene from a horror movie, and menstrual blood only smells once exposed to oxygen, so using the cup isn’t going to create more of an odour (in theory it will be less so!).  They can take a few cycles to get the hang of, to ensure they are positioned correctly.

Menstrual cups do have an impressive list of benefits – they are good for the environment, they can be kept in for 12 hours, reduce period pain (see above) and save money in the long term (while they cost about $60 to buy outright, they can save you up to $150 a year compared to buying disposables).

A good brand is the Diva Cup, which is approved by TGA in Australia.  Other brands include JuJu, Lunette, The Keeper (made from rubber) and The Moon Cup (made from silicon).

EDIT 3/10/17: I wanted to share my personal experience with a menstrual cup. Not long after writing this article I invested in a Diva Cup, and I can share with you that it has made my time of the month much easier, as having to change the cup only once in the morning and night means I can essentially forget about my period while I am out and about. I also have not had to buy any tampons, and only bought about 2 packets of pads (excluding maternity pads for post-partum) in the 4 years since getting the cup. I used to experience a lot of period pain, and when starting to use this I did notice there was some discomfort on the days I was worse, so I chose to use a pad on those days, however as time has gone on I now don’t have any period pain (I think due to improving my chemical exposure, using herbs, exercise, yoga and having a baby) so I can use the cup for my whole period. I used to have to wear a liner with it during the night and on day one of my period, but not at the moment. I found that it took a few cycles to get practiced enough to insert it confidently, having to learn the right angle to put it in and how to hold it so I could twist it into position, but now I can do it easily. I have on occasion had to change it whilst away from home but it is easy enough to do, I just tidy it up with some toilet paper and give it a good clean when I get home. I did read some reviews that the cup stains, but I haven’t found that to be the case, and this is 3+ years later. I also have been fine to exercise with it in, as long as it is inserted correctly to begin with. So essentially, I would definitely recommend getting a menstrual cup!

Absorbent Underwear

Companies such as Modibodi and THINX offer underwear that has absorbent section where a pad would be. They can be worn as a back up for menstrual cups or tampons, or on their own for those with a moderate-light flow. You can choose the type of absorbency that’s right for you – the range goes from 2.5ml absorbency (1/2 tampon) to 10-20mL (2 tampons).

They are reusable, so great for the environment, and save money for you over time. For athletes who don’t like wearing pads, tampons and cups during exercise, this is a great option.

Other options (that I haven’t research too extensively…)

• Reusable tampons (hard to find, most I’ve seen appear to be knitted, could that could be your next craft project?)
• Sea sponges (think re-usable tampons from the sea)
• Free bleeding (you were just going to wash those clothes anyway, I guess?)

Have you tried some of the less conventional options?  Or have you noticed a change from using organic pads and tampons?  Let me know your thoughts.

Works Cited

1. Touitou, Elka and Brian, W Barry. Enhancement in drug delivery. Boca Raton, Taylor & Francis Group : CRC Press, 2007.

2. Women Beware: Most Feminine Hygiene Products Contain Toxic Ingredients. Mercola.com. [Online] 22 May 2013. [Cited: 6 November 2013.] http://articles.mercola.com/sites/articles/archive/2013/05/22/feminine-hygiene-products.aspx.

The post Choosing the right products for that time of the month. appeared first on Alison Mitchell Naturopath.