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Every healthcare provider is likely to work with clients trying to manage dysmenorrhea. Dysmenorrhea is uterine pain, or menstrual cramps, in the lowest part of the pelvis a few days before, during or after a menstrual period. Pain may occur with menses or precede menses by 1 to 3 days and peak 24 hours after onset of menses and subside after 2 to 3 days. It is usually sharp but may be cramping, throbbing, or a dull, constant ache; it may radiate to the legs. Headache, nausea, constipation or diarrhea, lower back pain, and urinary frequency are common; vomiting occurs occasionally. Symptoms of premenstrual syndrome may occur during part or all of menses. Sometimes endometrial clots or casts are expelled.
Identifying Types of Dysmenorrhea
Understanding the distinction between the types of dysmenorrhea can assist a bodyworker’s treatment plan. While a massage therapist is not equipped to make this distinction, determining a client’s medical history can reveal the reasons behind their pain or can encourage a client to seek a physician’s care. There are two main types of dysmenorrhea.
Primary dysmenorrhea, the more common type of dysmenorrhea, may affect more than 50% of all women, usually starting during adolescence. In 5 to 15% of women with primary dysmenorrhea, the pain associated with uterine contractions and ischemia during menses is severe enough to interfere with daily activities and result in absence from work or school. The pain occurs only during menstrual cycles in which an egg is released, and likely results from excessive prostaglandins made by cells in the inner lining of the uterus to make it contract and be shed during menstruation.
Prostaglandin levels are higher in women with primary dysmenorrhea. Prostaglandins are hormone-like substances that serve three primary functions: they cause the uterus to contract (as occurs during labor), reduce blood supply to the uterus, and increase the sensitivity of nerve endings in the uterus to pain. Lack of exercise and anxiety about menstrual periods may also contribute to the pain.
Secondary dysmenorrhea is defined as menstrual pain due to pelvic pathology involving the uterus, Fallopian tubes or ovaries. Secondary dysmenorrhea usually begins during adulthood unless it is caused by early congenital malformations. Symptoms may indicate the presence of physical pelvic abnormalities. The most common causes are endometriosis (tissue from the lining of the uterus implants outside the uterus), fibroids, adenomyosis (endometrial tissue that grows into the wall of the uterus causing it to enlarge and swell during periods), pelvic inflammatory disease, and the use of an intrauterine device (IUD) that releases copper or a progestin.
In a few women, the pain results from passage of menstrual blood through a narrow cervix (cervical stenosis). A narrow cervix may be genetic, or result from polyp removal or cervical treatment (for dysplasia or cancer of the cervix). Abdominal pain due to other disorders, such as inflammation of the fallopian tubes or abnormal bands of fibrous tissue between structures in the abdomen, may be worse during a menstrual period. If an increase in pain or a sudden change in the menstrual cycle occurs, a woman should consult a physician.
The Menstrual Experience
The experience of menstrual cramps can be different for all women. Some simply feel a passing discomfort with menstruation, while others could be doubled over in pain by it. Typically, the pain comes in cramp-like spasms, originating in either the lower abdomen or the lower back caused by contractions in the uterus. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus, creating pain due to lack of oxygen.
The pain can remain centered in the body, radiate up the spine or down the legs; it may be accompanied by dizziness, nausea, vomiting or diarrhea in some women. These associated symptoms indicate clarification of etiology by a physician.
Mild primary dysmenorrhea typically causes women to experience pain a few hours before their periods start, and then eases once their menstrual flow begins. Occasionally, the pain continues into the second and even third day of their periods.
Prostaglandin Production: Curse and Blessing
Prostaglandins, the hormone responsible for causing so many women pain, have a critical role in preserving the perpetuation of our species. Each month the lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. If a pregnancy occurs, the fertilized egg attaches itself to the lining to be nourished as it develops into a baby. If the egg is not fertilized, the lining is not needed. Prostaglandins are then released in the uterus, triggering the muscles to contract and squeeze the lining out, resulting in menstruation. During childbirth, prostaglandins are released to contract the uterine muscles for pushing out the baby.
Altering the prostaglandin levels represents a chemically-induced way of relieving menstrual cramps. However, bodyworkers have other tools to provide dysmenorrhea relief:
- Hydrotherapy – The use of heat has a long history of relieving menstrual cramps. Warmth increases circulation, thus reducing muscular tension. A warm bath or hot pack on the abdomen or lower back can bring enormous relief. An all-natural fiber hot pack using moist heat is a top choice by bodyworkers to reduce menstrual pain.
- Acupressure – According to Alexis Phillips, a medical massage instructor and supervisor of the Peter Ling Clinic of the Swedish Institute in New York City, “the foot contains acupressure points that are believed to be connected along internal energy pathways to the pelvic area.” Phillips advises to feel for sensitive spots during menstruation in the depressions above either side of the heel and along the Achilles tendon. Traditionally, massage over the Kidney, Liver and Spleen meridians will balance hormone production. Acupressure on the foot and calf, specifically on tender spots found on the three mentioned hormone-related meridians, has the effect of reducing muscular tension and increasing uterine blood circulation.
- Abdominal Massage – In addition to many Asian bodywork styles, abdominal massage is also part of many Swedish massage routines. Abdominal massage is a direct technique to increase uterine circulation, thus reducing localized muscular tension. A 2005 Korean study involved administration of abdominal meridian massage for 5 minutes per day during 6 days from the fifth day before menstruation to the first day of menstruation. Their results demonstrated that abdominal massage was a very effective treatment for dysmenorrhea.
- Aromatherapy – Many women experience menstrual cramp relief with the use of aromatherapy. Certain essential oils are known to have relaxing effects on the mind and on cramping muscles. Mood swings can be addressed by incorporating essential oils into regular massage, warm relaxing baths or diffusing a relaxing blend. Essential oils to consider include clary sage, lavender and ylang ylang. For pain and/or cramping a warm relaxing bath, a warm compress applied to the lower back and abdomen or clockwise massage of the abdomen can be helpful. Essential oils to consider include clary sage, geranium and marjoram. For too much bleeding try a warm compress on the lower abdomen. Essential oils to consider include cypress, frankincense and geranium. For too little bleeding, a warm compress on the lower abdomen or a warm bath can be helpful. Essential oils to consider include basil, clary sage and juniper berry.
In conclusion, massage therapists have a myriad of options available to them to deliver pain relief to over half of their female clientele with PMS. Whether using heat therapy, acupressure, abdominal massage, aromatherapy or any variation, bodyworkers can reduce uterine spasms without hormone therapy or surgery.
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