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Menstrual Cramps PMS PMDD

Prelude to the Birth Control Series: The Diva Cup

Posted by on Aug 23, 2012 in Blog, Menstrual Cramps PMS PMDD | 70 comments

Prelude to the Birth Control Series: The Diva Cup

Starting this upcoming week, Paleo for Women is going to be embarking on Birth Control Week!  Which will likely in fact last more than one week.  Or one month.  Did you know there are nearly two dozen different types of birth control?!

And we shall be talking about all of them!

September will be the month of Your Sex Life, Your Pleasure, Your Method.  I want to help you find the most empowering, most healthful, and most delightful birth control method for you.  This should be more than a bit of a blast.

Following this will be explorations of menopause and conception and pregnancy and breastfeeding,   Oh.  My.



Beforehand, I would like to “kick off” the birth control series by introducing and advocating to you the wonders of The Diva Cup, which is a an alternative to pads and tampons.  Each of these methods have their own pluses and minuses, but in my opinion, the Diva Cup’s pros sometimes appear lifesaving and far outweigh it’s cons.

The Diva Cup is a small, bendy 1 oz. cup that you insert into your vagina to capture blood flow.  It is uniquely designed to suction to the walls of your vagina, so 100 percent of the time it is inserted correctly it does not leak.  Most women do not shed more than 4 oz of blood per menstrual cycle, so the cup does not need to be emptied all that often– for some women just at morning and at night.

To insert the cup, simply fold it in half (like so), wiggle it up there, and rotate it once or twice in order for the suction to take hold.  If you tug on the bottom afterwards and it doesn’t move easily, then it’s suctioned.


To remove, really get your fingers up there, disrupt the suction around the sides, and pull out (keeping the cup vertical!).

Pull out the cup when you go to the bathroom, pour the blood out into a toilet or sink, and re-insert.  Over time, you can probably learn how heavy your flow is at different times of your period, and learn how to time your Diva-emptying for optimal cleanliness.

Getting started

For women starting out on the Diva Cup, it might be wise to also wear pads while you get used to how the cup works.  It takes a time for two, for example, before learning the difference between suction against the vaginal walls and just plain hanging out in there.

Moreover, I think most women on their first month of the Diva Cup go through an interesting and hopefully hilarious learning experience.   I had more than one episode in a college library being stuck in a bathroom stall for fifteen minutes while yanking vociferously on that damned suctioned cup that just won’t budge, for example.

Step number one with the Diva Cup is don’t. panic.

But trust me, it comes out, always.  We just all need to learn the shape of our vaginas and how to navigate them with the Diva Cup.


Diva Cup Cons

-It requires being intimate with your vagina and cervix, something that some women just aren’t ready for.

-It can be interesting navigating public bathrooms.

-You can totally get blood all over your hands from time to time.

-You can totally get blood all over the bathroom if you’re a bit of a doofus about it, ie, pulling the cup out sideways.  Plus it’s just hilarious– life goes that way sometimes.

-The suction can make it tough to pull out once in a while, but gets easier and easier with practice.  (Read: don’t give up!)

Diva Cup Pros

-It’s environmentally friendly (no waste!)

-And therefore is perfectly suited for camping

-It’s biologically safe (the company sells a special soap if you’re interested)

-It’s way cheaper in the long run (only 35 dollars up front… 3-6 months worth of other methods)

-It’s comfortable (and in my experience, completely undetectable once inserted)

-It’s hassle-free (once you get the hang of it)

-You don’t have to carry tampons or pads around with you

-You can sleep with it in

-You may spot a bit at the beginning as you learn the Diva Cup, but later will almost never leak

-So therefore it’s great for athletics

-There’s no string or bulkiness, so the Diva Cup makes bikinis and lingerie worry-free

-The Diva Cup sits high up against the cervix, so vaginal lubrication can still come through the vagina

-You can still have pleasurable and blood-free oral and manual sex!


In all cases, I recommend trying it.  No harm, right?

So clearly I have a bias for the Diva Cup.  I understand that not all women have the same experience, and I invite you to share your reasons and feelings about the Diva Cup below.

The reason personally that I love it so much is that it is empowering.  More freedom, less fear of spotting and/or needing to change things.   More benefits for the environment and your pocket.  More intimacy with your own body.  More pleasure.  More sex.  Huzzah!  More life.

Have experiences, positive, negative, hilarious, mortifying, with the Diva Cup?   Share in the comments!  Would be an honor to hear them.


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Impaired Immunity, Hormone Imbalance, and Inflammation: Endometriosis as the Standard American Diet Triple Threat

Posted by on Aug 3, 2012 in Blog, Hormones, Menstrual Cramps PMS PMDD | 21 comments

Impaired Immunity, Hormone Imbalance, and Inflammation: Endometriosis as the Standard American Diet Triple Threat

Endometriosis is a widely encountered but poorly understood condition (as is the case with most hormonal disorders, such as PCOS.)  It affects, by some estimates, up to 20 percent of women of reproductive age,  and by more modest estimates, around 5-10 percent.  In either case this population comprises millions of women.

Moreover, no one is really sure how the endometriosis situation varies between countries–I have struggled for a while to dig up any information–but in general everyone seems to agree that endometriosis happens to everyone, but to Western, and, in particular, American, women the most.  And the most painfully.

Endometriosis is usually diagnosed in women through inspection of their infertility or their menstrual pain.  The reason this is the case is that endometriosis is the condition in which endometrial tissue grows in places outside of the endometrium.  Common locations include the ovaries, the fallopian tubes, and the abdominal cavity and bowels.    The fact that endometrial tissue may be found in important reproductive areas is in part why many women find out they have endometriosis when they have trouble conceiving children.  With tissue blocking a fallopian tube, sperm and eggs have a hard time communicating, and fetuses, growing.

Why endometriosis is painful  

Endometrial tissue can cause women pain first because they are abnormal tissue growth that can hinder normal physiological function.  And secondly, they grow over time.  Yet the most important reason endometriosis causes pain is that ectopic (misplaced) endometria act in the same way as the true endometrium does, just spread out throughout the entire body, wherever they are located.  

Endometrial tissue responds to hormonal changes in the blood in the same exact manner no matter where it is located in the body.  For this reason, ectopic (misplaced) endometria become inflamed, pulse, grow, and bleed throughout the course of a woman’s menstrual cycle.  This magnifies the pain of menstruation and distributes it wherever a woman might have endometrial tissue.  If a woman ordinarily has premenstrual cramps, but then the cramps occur also on her ovaries and in her intestines, she may be in for an increasing difficult menstrual cycle throughout her life.

How endometriosis happens

Medical professionals are not sure how these endometrial implants manage to escape the fallopian tubes and to plant themselves around the abdominals like mini-tumors.   Three seemingly less likely candidates are 1) Mullerianosis, in which the potential for cells to become endometrial is laid down in tracts during embryonic development and organogenesis.   In this theory, an endometriosis patient is made in the first 8-10 weeks of life.   2) Coelomic metaplasia, which asserts that some tissue types transform into others, perhaps triggered by inflammation, and 3) vasculogenesis, in which tissue grows de novo (or from new) via abnormal vascular growth.  Wikipedia et. al have plenty to say about these theories.

The emerging front-runner amongst these candidates, however, retrograde menstruation.  Retrograde menstruation is the phenomenon in which a woman’s monthly flow does not exit the body entirely smoothly southward via the vagina, but instead can flow “backwards” out the fallopian tubes and escape into the abdominal cavity.   From here, the tissue attaches itself to the lining of the abdominal cavity.  It then becomes a more or less permanent fixture.

But do all women with retrograde menstruation experience endometriosis?

No.  In fact, retrograde menstruation is pretty common, occurring in many women who experience no endometrial abnormalities.

So what has to be coupled with retrograde menstruation in order for endometriosis to occur?

This is where the Standard American Diet “triple threat” comes into play.  Immune system malfunction, hormone imbalance, and inflammation all appear to play significant roles.

The extent to which each factor impacts endometriosis is not clear, and certainly not all doctors are on board with this theory. Many medical professions believe that genetics are a dominant factor (they are at least important), or that one of the aforementioned developmental issues is the most important.  What is emerging from the literature, however, is the strong influence the varying factors of impaired immune system function, inflammation, and hormone imbalance have on endometrial development and pain.  The general idea is that impaired immune system function enables the tissue to implant itself, and inflammation and hormone imbalance exacerbate tissue growth, infertility, and pain.

Immune system dysfunction

Much of the endometrial research being conducted today is focusing on the possibility that in endometriosis patients, the immune system may not be able to cope with the cyclic onslaught of retrograde menstrual fluid.   It is common for menstrual flow to escape into the abdominal cavity.  But some women’s immune systems are capable of properly dismantling those tissues, while others are not.

The one overarching job of the immune system is to distinguish between “us” (inside our bodies) and “them” (intruders), and to kick the intruders’ asses.  One facet of this job that is less well known, however, is that the immune system also in a healthy body identifies tissue in the wrong location as “foreign” and attacks it.  The immune system works just as well locally as it does spread throughout the whole body.

That is, of course, unless the immune system has been down-regulated.   If the immune system has been impaired in any fashion, whether by stress, by micronutrient and vitamin deficiencies, or by an inflammatory diet, (one way in which inflammation plays a role) then it may not be strong enough to prevent the implantation of this tissue.  Especially because women in the modern world ovulate far and away more often than women have throughout history… so far as we can tell, anyway.  Since we are both pregnant and starving (presumably) less than ancient women.

In any case, the constant onslaught of reproductive tissue is just too much for some women’s impaired immune function to handle.

Might endometriosis be an autoimmune condition?  

Endometriosis may in fact be an autoimmune condition.  The jury is still far away from deciding whether or not it is a matter of impaired or of auto immunity.   One of the primary markers of autoimmunity is the presence of autoimmune antibodies.  In endometriosis, autoimmune antibodies are always present.   However, autoantibodies may also occur  in other conditions, such as cancer, massive tissue damage, and sometimes in healthy individuals.  It is not yet clear whether autoantibody formation in endometriosis is simply a natural response to chronic local tissue destruction, or a pathologic response leading to more generalized autoimmune dysfunction.

That being said, endometriosis fulfills most of the classification criteria for autoimmune disease.  These include polyclonal B cell activation, immunological abnormalities in T and B cell functions, increased apoptosis, tissue damage, and multi-organ involvement.

Yet despite these similarities, endometriosis appears to be, so far as reaserchers can tell, a condition in which the immune system is weak, and therefore endometriosis occurs, not so much that it is up-regulated and wreaking havoc destroying the body’s own tissues (as in the case in autoimmune diseases).  What then, gives?  Perhaps, in many women, autoimmune disease leads to impaired immunity, which leads to endometriosis.  This would explain the correlation that exists between autoimmunity and endometriosis, but it would allow for other factors, such as inflammation or plain old decreased immune activity, to also play causative roles.

Regardless, endometriosis is strongly associated with autoimmune diseases

Autoiummune diseases correlate fairly well with endometriosis, or at least some of them do.  And they may in fact be causative factors, as I just mentioned.   Autoimmune diseases which may be significantly associated with endometriosis include SLE, Hashimoto’s hypothyroidism, rheumatoid arthritis, Sjögren syndrome and multiple sclerosis. The best evidence exists for an association with inflammatory bowel diseases.


There are two ways in which inflammation impacts endometriosis.  First, in the genesis of endometriosis.  Here, inflammation may cause endometriosis by impairing the immune response.   Secondly, however, inflammation is what (coupled with hormones, discussed below) has the capacity to make endometriosis painful.  Just as in some women have painful periods and others do not, so the same phenomenon translates to the endometrial tissue that is located elsewhere in the abdomen.  If a woman has an up-regulated inflammatory response to her menstrual cycle, then her endometriosis will be painful.  If she does not, then her endometriosis can go unnoticed for years–even for her whole life.  It just doesn’t hurt her.  Inflammation partly explains why there is no statistical correlation between the extent of a woman’s ectopic endometrium and her pain level.   Some women have wicked ectopic endometria, but no pain because their inflammation levels are low.

So what is it about inflammation that is painful?  It is the prostagladins and other inflammatory markers that are produced in endometrial tissue at the time of menstruation.  These inflammatory molecules act locally.  This means that they create painful signals both in the endometrial tissue as well as in the surrounding tissues.  Hence why a phenomenon in such a specific place– ie, the endometrium– can hurt an entire abdomen.

When a woman has endometriosis, this inflammatory signalling and induction might be happening in various locations throughout her entire lower abdomen.


Hormones play an intricately linked role in the genesis of and pain generation within endometriosis.  Estrogen plays many roles throughout a woman’s body and in her cycle, yet one of the most important ones is to stimulate the thickening of the endometrium.  This is an important, normal process that happens in all women.  If estrogen levels are high, however, the endometrium grows very thick, and much larger than normal.  This provides  a) more tissue out of which ectopic endometria can be made, and 2) more tissue from which prostaglandins and other inflammatory markers can be released.   The more endometrial tissue a woman has, the more places pain can come from.  This is in fact the direct cause of most of the “normal” pain women experience with menstrual cramps…and therefore with endometriosis, too.

Estrogen dominance is caused by being overweight, possibly by consuming too many xeno- and phytoestrogens (though that is a complicated issue), and by systemic inflammation.  It can also be caused by having clinically low progesterone levels, since progesterone acts as a bit of a counterbalance to estrogen in the body.   Estrogen and progesterone need to be properly balanced in order for reproduction to proceed smoothly and painlessly.

See Danny Roddy’s view on estrogen as an inflammatory molecule (in excess.)

Endometriosis is usually treated with…

Surgery, birth control pills that raise progesterone levels, birth control pills that lower estrogen levels, or specific estrogen antagonistic medications.  Each of these fixes has its own problems, least of which is the fact that dosing with these kinds of hormones can lead to greater hormonal dysfunction further down the road.  Moreover, it does not get at the underlying cause, which is in many cases very serious.

Endometriosis might not go away entirely, but it can subside, and the pain can be minimized. 

Usually women who have painful endometriosis experience a soothing of their symptoms once they undergo menopause.  This is because their estrogen levels drop, and naturally.

There are other ways to naturally decrease estrogen levels.  Losing weight and decreasing stress are the two biggest factors.  Removing phytoestrogens, which include soy, flax, and all nuts and seeds, as well as xenoestrogens, such as BPA found in plastics, have also been implicated in throwing estrogen levels out of balance.

Yet there are even better ways to work with endometriosis.  And all of them, holistically, are enabled with a paleo diet.

Endometriosis probably– at least according to the majority of medical research and speculation– would not affect women’s health if they did not have compromised immune systems.  In endometriosis, it is unclear whether the women suffer autoimmunity, or if they just have the problem because their immune systems are functioning at a sub-optimal level.  In either case, a paleo diet mitigates the problem.

If endometriosis is autoimmune (a theory I am not sold on), an anti-inflammatory, gut-friendly diet should ameliorate its genesis and symptoms.  This means eliminating potential gut irritants such as wheat, dairy, legumes, and possibly nightshades and eggs from the diet.  Eliminating omega 6 vegetable fats should also be helpful.  A GAPS diet is appropriate in extreme cases.

If endometriosis is from impaired immunity (a theory I am more comfortable with), correcting gut imflammation in this case also goes a long way.  Having a vitamin-rich diet including many meats, organ meats, vegetables, and fruits, low in sugar and processed carbs, with plenty of stress reduction and sleep, with moderate exercise, and with vitamin D from sun exposure, should help boost immune function over time.   It is important to know that I am not promising a cure-all.  These problems can be complex hurdles to get over, and may take several months if not years of troubleshooting and patience and healing in order to get right.

So endometriosis will not necessarily go away.  Tissues might shrink, but they may be too far implanted to ever disappear.   But endometriosis can be mitigated, and with a diet and lifestyle focusing on nourishment, and whole, natural foods and activities.  The importance of stress cannot be under-emphasized, either.   Stress plays a large role in inflammation and in immune system functioning.  So moving forward with holistic healing–with stress-reduction, with love, with healthful foods and with a nourishing lifestyle–goes a very long way in propelling us forward into healthful, natural, kickass womanhood.


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Paleo and Menstrual Cramps

Posted by on May 9, 2012 in Blog, Menstrual Cramps PMS PMDD | 32 comments

Paleo and Menstrual Cramps

Ever think that menstrual cramps are just a fact of life?  That every woman has them?  And even if they don’t, that you are just one of the unlucky ones?   I call BS!  Cramps are actually a symptom of an underlying problem.  They can be cured.  The only thing that is required for that is to look at the underlying causes.  Once those are taken care of, the cramps almost always go away, or at least are eased considerably.

An important side note before getting started is that the same problems that cause cramping are the ones that cause a heavy menstrual flow.  Managing to cure one almost definitely cures the other (presuming that what is being handled is primary dysmenorrhea, not a form of  secondary dysmenorrhea caused by an underlying physiological abnormality).  This would be helpful for a lot of women.  Heavy blood flow reduces iron levels and can make women weak, woozy, and anemic.   What’s worse, a heavy period is arguably the biggest pain in the ass on the planet.

There are three respects in which a natural, paleo approach can ease the pain of and even cure menstrual cramps.  They are curing micronutrient deficiencies, cooling inflammation, and restoring hormonal balance.

Micronutrient deficiencies, cramping, and a paleo diet

Micronutrient deficiencies are a problem for menstrual cramping because micronutrients are key components in the contraction and relaxation of muscle tissue.  Electrolytes in particular, which would be potassium, calcium, sodium, and magnesium, all have well known muscle-relaxing effects.  In fact, deficiencies in any of these nutrients is the primary cause of muscle cramping elsewhere in the body.   Magnesium especially.   With adequate intake of each of these nutrients, as well as the whole slew of micronutrients and vitamins that are enriched on a paleo diet, the intense pain of abdominal muscle cramping can be eased.

A paleo diet maximizes micronutrient intake by the simple fact of keeping a woman’s diet within the range of whole foods.   This helps first by eliminating sources of empty calories.  Empty calories include all desserts, breads, baked goods, sodas, and wheat products.  They contain almost nothing of nutritional value, except for perhaps some B vitamins and a bit of these micronutrients, but all of these nutrients can be obtained from animal and other plant products in much higher quantities.

Moreover, empty calories, particularly wheat-based calories, have downright negative effects on nutrient absorption.  Wheat foods contain proteins called lectins, which bind with micronutrients strongly enough that they prevent normal digestive chemicals from being able to absorb the micronutrients themselves.   For this reason, empty calorie foods such as bread can actually make an individual’s micronutrients pass right through her.  When a woman replaces these empty, or even micronutrient-stealing calories with vegetables and animal products, she naturally increases her intake of just about every vitamin and mineral.  Foods that are particularly rich in magnesium include nuts, cruciferous vegetables, and halibut.  Foods rich in calcium include sardines, dairy products, cruciferous vegetables, and meats.  Foods richest in potassium are bananas, avocadoes, tomatoes, cruciferous greens, and salmon.    Organic vegetables have higher proportions of nutrients than inorganic ones.

Vitamin E has been shown by itself to reduce the pain of menstrual cramping.   Good sources of vitamin E are cruciferous vegetables such as spinach, turnip greens, broccoli, and chard, almonds, peppers, asparagus, tomatoes, and carrots.  Vitamin E is also available in high amounts in meat products.  Most importantly for paleo dieters, vitamin E is four times as concentrated in grass fed meat than feed lot meat.

Inflammation, cramping, and a paleo diet

A paleo diet is inherently anti-inflammatory.  Inflammatory agents include gluten, other wheat proteins, sugar, particularly fructose, and omega-6 PUFAs which are found in almost all vegetable oils.   A paleo diet is absent of these.  As a matter of fact, calling a paleo diet an “anti-inflammatory” diet is spot on.  The whole point of adopting a paleo diet is to reduce the inflammation that comes from eating toxins.  Yet the benefit of a paleo diet is not just in toxin removal; it is also in the addition of helpful molecules.  Paleo diets active include anti-inflammatory foods such as grass-fed ruminants, seafood, and vitamin- and anti-oxidant- rich plant products.

Reducing inflammation reduces the body’s hyper-reactivity to uterine physiology.   With a calmed immune system, a woman’s body will not leap into inflammatory hyper-drive.

The most important molecule to focus on in a discussion of muscle contractions and menstruation is prostaglandin.  Prostaglandin is an inflammatory eicosanoid, and it’s responsible for the contraction of muscles around the uterus at the time of menstruation.

The precursor to prostaglandin is arachidonic acid, an omega-6 fatty acid.   Arachidonic acid has positive effects in the body, since the inflammatory process is necessary for homeostasis and maintaining optimal health, but when consumed in excess, it provides ample material for the body to mount inflammatory processes.  Arachidonic acid is found naturally in animal products, particularly meat and egg yolks.  This has caused many conventional nutritionists to demonize meat and egg yolks.  Yet AA is also derived from the consumption of linoleic acid, another fatty acid, and linoleic acid is found in great amounts in soy, corn, and vegetable oils.   A natural level of consumption of AA is optimal, and should be ingested in the natural, animal forms.   With this kind of diet, the ratio of omega 6 fats to omega 3 fats is ~ 3:1 or 2:1, which is considered by most researchers today to be the optimal ratio.   When vegetable oils are regularly consumed, the ratio of omega 6 to omega 3 fats can spike to average American levels, ~ 20:1.  That incites the painful, inflammatory response.  No questions about it.

Hormone balance, estrogen dominance, stress, and a paleo diet

The final and most important piece of the puzzle is hormone balance.  When hormones get out of balance, which is really easy for women today, many things can go wrong.  A woman’s reproductive system is not to be messed with.

What goes wrong with menstrual cramping is that the uterine lining becomes too thick.  With a larger lining, more tissue exists to produce prostaglandin.  Moreover, more tissue needs to be shed, so more and more material needs to be squeezed through a smaller space (women with narrow cervixes are more prone to menstrual cramping).   This also, as I hinted at above, means that the exorcised material will be heavier, and the period will last longer.

Estrogen is responsible for the thickening uterus.  Therefore, estrogen dominance is the primary problem that most women with menstrual cramps suffer from.  Estrogen causes their reproductive organs to go into productive hyper-drive, and their abdominal muscles suffer the results.  If estrogen can be brought back down, a woman’s menstrual problems often cease.

Estrogen dominance is caused primarily by two factors: it is caused 1) by the consumption of phytoestrogens, and 2) it is caused by stress.

Phytoestrogens are naturally occurring plant chemicals that resemble, but are not identitcal to, a woman’s natural estrogen.  What this means is that phytoestrogens enter a woman’s body through her diet and act as estrogen in her body.  In some ways this phenomenon enhances normal estrogen functioning, and in other ways it inhibits the activity and signalling of true estrogen, since it confuses the body’s normal accounting mechanisms.  With both phytoestrogens and true estrogens in the blood, the reproductive organs and hypothalamic receptors do not know how much estrogen to produce.  Sometimes the pituitary will detect the phytoestrogens in the blood and go ahead and decrease it’s production of estrogen, such that a relative balance between estrogen-like chemicals and the rest of a female’s hormones is maintained in the bloodstream, yet other times the pituitary does not detect the phytoestrogens, and it goes on pumping out as much estrogen as it had previously.  In this case, way too much estrogen is floating around in a woman’s bloodstream, and it’s causing all sort of reproductive havoc.  This results in menstrual cramping.  It is also a factor in PMS, PMDD, mood disorders, endometriosis, uterine fibroids, and breast cancer.

Foods that contain phytoestrogens are legumes, nuts, and seeds.  These should be avoided by all women.   The worst of all of them, however, is soy, and is should be avoided at all costs by all women.  Sometimes soy and other phytoestrogens are recommended to women during menopause to mitigate their symptoms, and this does sometimes help with hot flashes and the like.  However, almost always soy leads to decreased ovulation, irregular menstruation, and impaired fertility.   Phytoestrogens may resemble estrogen, but they are not estrogen, and that confusion has plagued the medical establishment and struggling women alike for decades.

A paleo diet eschews soy, legumes, and goes light on nuts and seeds.  For this reason, it is helpful in restoring hormonal imbalance.  A paleo diet also eliminates the toxins I mentioned above which contribute to systemic inflammation, which in turn can incite estrogen production, so in this way it helps restores balance.  And finally, a paleo diet emphasizes natural, grass-fed animal consumption against feed-lot consumption, which minimizes the amount of foreign hormones and foreign hormone disruptors that are often injected into or fed to feed-lot livestock.

A paleo diet also emphasizes organic vegetables, or at the very least washing and peeling vegetables.  Conventionally-grown vegetables are often coated in fertilizers and such that contain potent endocrine disruptors.  It is important, especially during a person’s developmental years, to be as removed from these toxins as possible.

A second cause of estrogen dominance is stress.  Physiological stress from consumption of modern toxins as well as emotional stress from modern living results in a decrease in progseterone production and an increase in estrogen production.  The term “estrogen dominance” was first coined by Dr. Lee, and what it means is that estrogen is higher than the other hormones in the body.  In his book, he talks mostly about how much faster progesterone production falls off in menopause than estrogen production does (by 120 times!).   Estrogen levels may rise in response to stress, but it’s also important to note that estrogen dominance can also mean that estrogen levels stay the same while progesterone and testosterone levels fall.   The only way to insure that progesterone secretion does not stop is to have the healthiest possible functioning HPA axis.  This means reducing stress, both of the emotional kind and the physiological kind.

This being the case, a paleo diet is the optimal course of action.  It markedly reduces all kinds of stress: it eliminates toxins, for example, but it also restores blood sugar balance by eliminating sugar from the diet, which improves mood, and it optimizes dopamine, serotonin, and GABA functioning, all of which are necessary for being in a good mood and having a healthy HPA axis, too.

A caveat: the female response to stress is complicated, and it does not always result in estrogen dominance.  It can, for example, result instead in adrenal fatigue, or in stress-induced hypothalamic amenorrhea.   In both of these cases, hormonal disruption does not lead to estrogen dominance.  Yet in women with menstrual cramps, it is almost certain that this is the case, since excess estrogen is what causes uterine excess.

As a final note on hormone balance, being overweight contributes to estrogen dominance.    Almost all human cells carry an enzyme called aromatase.  What aromatase does is convert testosterone into estrogen.   This means that if aromatase activity has increased in a woman, her estrogen levels will spike, but her progesterone levels will remain the same.   The reason this happens in overweight women is because aromatase is highly active in fat cells.  Worse than that, however, is the fact that aromatase activity begets more aromatase activity, such that being overweight can create a vicious cycle of fat gain and estrogen production.  Many overweight women exist in a state of constant aromatization and estrogen production.  One way to mitigate this problem is to stop consuming aromatase-exciting foods such as soy, and to instead eat foods such as cruciferous vegetables which activate enzymes in the liver responsible for clearing excess estrogen out of a woman’s body.   Another way to mitigate this problem is with natural, non-restrictive weight loss.  A paleo diet provides just such a template.


One final way to restore hormonal balance and alleviate menstrual pain is with exercise.  Exercise boosts serotonin levels, and serotonin helps with the pain response.  Moreover, moderate exercise improves mood and mental clarity, improves glucose sensitivity, and better prepares the body to handle other stressors that come its way.

All that said…

hormone balance takes time.   Sometimes results can be seen immediately, but sometimes the body needs months to heal and to readjust the sensitivity of its hormone receptors.  For this reason, all of these steps help with menstrual pain, but patience and stress-reduction are possibly the most crucial steps of all.

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Menstrual Cramps: An Introduction

Posted by on May 9, 2012 in Blog, Menstrual Cramps PMS PMDD | 6 comments

Menstrual Cramps: An Introduction

Tomorrow I will post an article on the relationship between a paleo diet and menstrual cramps, but it is important first to understand what menstrual cramping is in and of itself.   What are menstrual cramps, and where do they come from?  Why are they so painful, and why do so many women suffer them?

Who has menstrual cramps

Menstrual cramps of some degree affect more than an estimated fifty percent of women.  Among these, up to fifteen per cent describe their menstrual cramps as severe.  Over ninety percent of  adolescent girls today report having menstrual cramps.  Cramps are their worst in a woman’s younger years and almost always peter out into her thirties.   This is evidenced by the fact that painful menstruation is the leading cause of lost time from school and work among women in their teens and 20s.

The two kinds of cramping

In primary dysmenorrhea, there is no underlying gynecologic problem causing the pain.   It is marked by abdominal pain first and foremost, but abdominal discomfort, irregular digestion, nausea, back pain, and headaches often accompany it, too.  Cramping may begin a day or two before menstruation, and it endures for the first few days of bleeding.  Menstrual cramping is commonly conflated with PMS, but they are in fact two separate medical phenomena.

In each woman, primary menstrual cramping may begin as early as six months to a year following menarche (the beginning of menstruation).  However, menstrual cramps typically do not begin until ovulatory menstrual cycles  occur, and ovulation normally does not beginning happening for some time after menarche.  For this reason, an adolescent girl may not experience dysmenorrhea until months to years following the onset of menstruation.  Some women experience cramping at different periods of their lives.  Modern medicine does not sufficiently recognize this phenomena or investigate it’s causes, but periodic cramping is probably induced by dietary, stress, and lifestyle fluctuations.

In secondary dysmenorrhea, on the other hand, some underlying abnormal condition contributes to the menstrual pain. Secondary dysmenorrhea can result from endometriosis, uterine fibroids, adenomyosis, ovarian cysts, having a copper IUD, pelvic inflammatory disease, PMS, or sometimes even STIs.

What causes menstrual cramps?

The origin of menstrual cramping is in the physiological changes that take place each month in the menstrual cycle.  Each month, the inner lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy.   This occurs in the first two weeks of the cycle, and is called the follicular phase.  At the start of week three, the woman ovulates.  After ovulation, if the egg is not fertilized, no pregnancy will result and the current lining of the uterus becomes superfluous. The woman’s estrogen and progesterone hormone levels thus decline, and the lining of the uterus swells.  It is eventually shed in the form of menstrual flow, and it is replaced by a new lining in the next monthly cycle.


When the old uterine lining begins to break down, inflammatory mediators called prostaglandins are released. Prostaglandins regulate muscle contraction and cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies.   This occurs on the first day of menstruation.  After the death of this tissue, the uterine contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina.  This is why women who use diva cups  often discern physical tissue with their menstrual discharge.  It is in fact the dead tissue of the old endometrium.

Why are cramps so painful?

Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman’s cervical canal is narrow.

The difference between menstrual cramps that are more painful and those that are less painful is a direct correlation with a woman’s prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in the endometrium (uterine lining) when compared with women who do not experience cramps. Menstrual cramps are actually quite similar to those a pregnant woman experiences when she is given prostaglandin as a medication to induce labor.

In a normal-functioning woman, menstrual cramps occur at a given pressure and frequency.   The pressure is between 50 and 80 mmHg, they last around twenty seconds, and the frequency is ~1-4 contractions per ten minutes.  In women who experience painful cramping, this pressure can rise to 400 mmHg, and the contractions might last up to ninety seconds.

Prostaglandin activity in menstruation

Prostaglandins are eicosanoids, a class of molecules involved in the signalling of inflammation.   Specifically, prostaglandins are lipids involved in chemical signalling, but they are not endocrine hormones.  Endocrine hormones are produced from a discrete location and then sent out to the rest of the body.  Prostaglandins instead exhibit paracrine function, which means that they are produced locally and for local use all throughout the body.  In menstrual cramps,  therefore, prostaglandins are produced out of essential fatty acids in cells surrounding the uterine tissue.   Then they signal to surrounding muscle tissues to contract.  If prostaglandins are produced in excess, then the abdominal muscles receive a signal to contract that’s excessively strong, and the contractions will become strong enough for it to be painful.  Prostaglandins also affect intestinal tissue, which is why many women experience diarrhea, constipation, or changed bowel movements during the first days of menstruation.

Conventional  cramping treatment

Health professionals sometimes make holistic recommendations.  Unfortunately, they’re either obvious or ineffective, so they don’t do much for women who suffer cramping.  For example, women are told to lose weight and to quit smoking.   (Duh.)  They are also told to eat a “healthy diet” full of fruit, vegetables, and plenty of fiber, “which is particularly useful since it cleanses the body of excess estrogen (which can lead to heavier and more painful periods and cramps.”    Some doctors also recommend sleep and exercise, which are two recommendations I can actually get behind.

More typical reactions to cramping involve the medical cabinet.  For mild cramps women are advised to take aspirin or acetaminophen.  When acetaminophen is coupled with a diruetic, such as in diurex, midol, or pamprin, it is supposed to be more effective, possibly because it accelerates the removal of prostagalandins.  For more severe cramps, women are told to take NSAIDs.  NSAIDs lower the production of prostalglandin.  Ibuprofen, naproxen, and ketoprofen are all NSAIDs that do not require prescritpions.  NSAIDs that doctors proscribe with a prescription are mefenamic acid and meclofenamate.  The final recourse for particularly painful cramping is birth control.  Birth control pills, in preventing ovulation and the regular cycling of estrogen and progesterone levels, sometimes prevents menstruation wholesale.  When women still have a monthly period, the prostalglandin levels are typically normalized and the menstrual flow lightens.    It goes without saying that these options treat the symptom, but not the cause of menstrual cramps.  Without paying attention to what dietary and lifestyle factors are affecting inflammation, pain, prostalglandin and hormone imbalances, cramps will never go away.

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