In addition to the hormones estrogen and progesterone, hormonelike chemicals called prostaglandins also affect menstrual cramps. These chemicals are found in many tissues in the body, including the uterus, gastrointestinal tract, and blood vessels. There are many different types of prostaglandins, all of which affect muscle tension. However, not all prostaglandins affect muscles in the same way. Some, such as the series two prostaglandins (specifically the E2 and F2 Alpha), trigger powerful smooth muscle contractions. Because of this physiological effect, an overabundance of series two prostaglandins is strongly linked to menstrual cramps and pain. These prostaglandins have also been linked to high blood pressure because they act to narrow the diameter of blood vessels. They can also trigger irritable bowel syndrome since they cause cramping of the intestinal muscles. Not all prostaglandins, however, cause muscle contraction. Others, such as the series-one and series three, actually promote muscle relaxation and can help relieve menstrual cramps.
Prostaglandins are derived from fatty acids in the diet. The series two prostaglandins that trigger muscle contractions are derived from animal fat meat, dairy products, and eggs. The beneficial muscle relaxant series one and series three prostaglandins are derived from vegetable and fish sources of fatty acids. These fatty acids, called linoleic acid and linolenic acid, are found predominately in raw seeds and nuts, such as flax seed or pumpkin seed, and in certain fish, such as trout, mackerel, and salmon. Thus, how we eat can actually determine which hormonal pathway we travel, leading to either muscle tension or muscle relaxation. This is a very good example of how our food selection can determine our state of health. Like progesterone, excessive prostaglandin production is seen only during ovulatory menstrual cycles. Prostaglandin production increases during the second half of the cycle, peaking toward the end of the cycle with the onset of menstruation.
Primary Congestive Dysmenorrhea
The pain that characterizes primary congestive dysmenorrhea is different from that of spasmodic cramping. Congestive symptoms produce a dull aching in the low back and pelvic region, often accompanied by bloating, weight gain, breast tenderness, head-aches, and irritability. Unlike spasmodic cramping, these symptoms don't improve with age and, in some women, can worsen with age. Some of the worst symptoms are seen in women in their thirties and forties.
Women with congestive symptoms tend to retain excessive amounts of fluid and salt. Bloat accumulates in the pelvic region as well as breasts; it can cause an uncomfortable, dull aching sensation that makes these parts of the body tender to the touch. Excessive amounts of estrogen can worsen these symptoms, since estrogen increases fluid and salt retention in the body.
An excess secretion of the pituitary hormone ACTH can also worsen congestive symptoms. ACTH stimulates the production of adrenal hormones, which are then sent to the kidneys and cause the kidneys to retain fluid. As a result, women urinate less frequently in the time leading up to menstruation. Once the menstrual period starts, this excess fluid is released. Nutritional factors also influence bloating. High salt foods should be avoided, since they increase fluid retention.
Food allergies can also contribute to congestive symptoms. Women who are sensitive to both wheat and dairy products (two of the most allergenic foods) can have a premature increase in their congestive symptoms. I have observed this in many of my patients. Other high stress foods include alcohol, which is toxic to the liver. The liver is responsible for the breakdown of estrogen so that it can be excreted from the body. Excessive alcohol intake can increase the levels of estrogen in the body, increasing pelvic congestion. Sugar causes constriction of blood vessels, which can worsen cramps; both sugar and alcohol should be avoided in a cramp relief program. When I put women on a salt-free, dairy-free, and wheat-free diet, the tendency to accumulate bloat decreases, as does the dull, aching abdominal discomfort and low back pain. Other risk factors can also contribute to both spasmodic and congestive menstrual cramps. These include the following variables: