According to Medline Plus and the Merriam Webster® medical dictionary, dysmenorrhea simply means “painful menstruation”. Other sources report that menstrual pain must be significant enough to interfere with normal activities of daily living to be labeled dysmenorrhea. The information in this article applies to painful menstruation regardless of the severity, in addition to cramping or spasms whether it’s perceived as painful or simply uncomfortable. Additionally, the American College of Obstetricians and Gynecologists (ACOG) mention the following symptoms associated with dysmenorrhea: cramps or pain in the lower abdomen or back, pulling feeling in the inner thighs, diarrhea, nausea, vomiting, headache, and dizziness. But again, this article will simply focus on pain and cramping (or spasms). One more thing worth mentioning is that I will be discussing primary dysmenorrhea (caused by the reasons mentioned in the next paragraph) as opposed to secondary dysmenorrhea (commonly caused by endometriosis and/or uterine fibroids).

The ACOG reports that increased levels of prostaglandins which are naturally present cause uterine pain. Prostaglandins are natural biochemicals found in nearly all the cells of the body. And one their functions is to regulate the contraction of smooth muscles (of which the uterus is made of). The ACOG also says that before a female’s period begins, these levels increase; at the onset they are “high”; and during menstruation these chemicals begin to decrease.

The standard medical treatment for dysmenorrhea (as reported by the OCAG) “may include medications and techniques” to relieve pain. The medications include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to block the body’s production of inflammatory prostaglandins. Also OCAG says: “Hormonal contraception, such as birth control pills, patches and vaginal rings, also reduce menstrual pain. In some cases, the hormonal intrauterine device (IUD) may be recommended”. The “techniques” refer to different surgical methods that are mentioned on their website.

The OCAG also mentions “Other Treatments” which include: vitamin B1 and magnesium supplements, massage, acupuncture or acupressure, and stress management. They do however, say that these approaches will not prevent the condition. I’m not sure if that statement is entirely correct as I found this quote on prevention.com: “Like calcium, magnesium plays a role in controlling muscle tone and could be important in preventing menstrual cramps”. Two scientific references are cited after that statement, but I cannot find the full text of one of the articles, or understand French for the other.

Now I’ll discuss how I can help a patient with dysmenorrhea achieve greater health through chiropractic and applied kinesiology care. According to Walter Schmitt, DC, DIBAK, DABCN (one of my mentors) there are 5 possible causes of dysmenorrhea. These are : 1) spinal and pelvic subluxations, 2) ileocecal valve, 3) visceroptosis, 4) calcium metabolism, and/or 5) hormonal imbalance. Let’s look at each individually. The explanations I cite may or may not be exactly the same as Dr. Schmitt’s.

1) Spinal and pelvic subluxations- Personally, I prefer to use the term joint restriction/dysfunction (lack of full joint range of motion) instead of subluxation (“bone out of place”), but that’s not worth differentiating here; and the two terms are used interchangeably despite an actual difference. Spinal and pelvic joint dysfunction can have an impact on organ function because of the related nerve supply to those organs. The uterus receives its nerve innervation from spinal levels T10-12 (T=thoracic/”mid-back”), L1 (L=lumbar/”low back”), and S2-S4 (S=sacrum). It is thought that there is a positive correlation between the function of the vertebral joints that reside at the same levels as the nerves that control an organ (the uterus in this case). Here is published research on that idea; though I wouldn’t be surprised if you can find research stating no correlation – that seems to be the nature of research. Additionally, if there is “torque” or misalignment in the pelvis, the structure of the organ that resides in it may also be compromised. And remember, structure determines function, not the other way around. This connection has been noted numerous times in my patients. Again, extensive research on this topic has been difficult for me to find; fortunately those patients who have been helped by this approach did not require me to provide them with research before they consented to the treatment. Obviously the treatment in this case consists of manual adjustments to the spine and pelvis (or elsewhere) to restore optimal joint range of motion. Here is one study on chiropractic adjustments specifically related to dysmenorrhea.

2) Ileocecal valve– This is probably one of the most unknown (or least-if ever talked about) parts of the body. It is a sphincter muscle in the cecum (“pouch” between the small and large intestines) that mainly prevents the waste products in the large intestine from refluxing back into the small intestine (specifically the ileum). This is the same idea as the esophageal sphincter becoming “lax” and allowing the contents of the stomach to reflux back in to the esophagus. This structure really deserves its own article because if it is malfunctioning it can cause (direct and indirect) systemic effects throughout the body. Essentially, it can be stuck “open” or “closed”. The “open” variety is much more common; which allows for the (“toxic”) contents of feces in the large intestine to flow backwards. The large intestine should “store” feces in order for eventual elimination, while the small intestines is meant for absorption. So essentially this problem results in a build-up of toxins in the small intestines that may get absorbed into the body and specifically the lower abdomen and back. Because the general “solution to pollution is dilution”, the body may concentrate fluids in that region (where the uterus resides as well) and the result may be swelling and inflammation in the region and its organs. The usual suspects causing the ileoocecal valve to remain “open” is diet (esp. harsh, fibrous, irritating foods), food allergies/sensitivities, parasites, and “emotions” – this is my experience and was brought to my attention from Dr. Scott Walker. I can’t tell you how many times this is the “cause” (well the cause is really the 4 examples just mentioned – of which they may also have another cause) of severe, acute low back pain. The onset is usually sudden, with no trauma. It’s often the person who picks up a piece paper off the floor, or is brushing their teeth and then suddenly experiences terrible low back pain. Click here for more information on the ileocecal valve.

3) Visceroptosis– This refers to when an organ prolapses or “drops” from its normal resting position. Again, structure determines function. In regard to the uterus, I often find this to be the cause of malfunctioning (inhibited or truly weak) abdominal and/or pelvic floor muscles; as those are the muscles responsible for keeping the uterus in its normal position. It can also result from “weak” or lax ligaments that support it.

4) Calcium metabolism- This can be a result of numerous reasons and will also be the topic of a separate article. There are many causes of muscle cramps and spasms, and calcium metabolism (not necessarily deficiency) is high on the list in my experience. I say “metabolism” because a patient can have adequate stores of calcium in the body, however it may not be “directed” to the appropriate area of the body and result in symptoms (in this case the soft tissue or smooth muscle of the uterus). The relationship between calcium and muscle cramps or spasms is widely known and here is one reference. This certainly can be a result of calcium deficiency (usually from poor food or supplement choices). More commonly though, the calcium needs to be directed into the soft tissues appropriately. I find the most common factors affecting calcium metabolism to be a magnesium deficiency, pH (acid/alkaline) imbalance, and/or essential fatty acid imbalance.

5) Hormonal imbalance- This is a topic that definitely requires multiple articles of discussion. Regardless, the most common condition resulting in functional female hormonal imbalances that I see is “estrogen dominance”. This can be the result of an excess of estrogen, a decrease in progesterone, or an imbalance in the proper ratios between estrogen and progesterone. I didn’t search for research citations on this as hormone imbalance is a well-known cause. The fact that birth control pills are a common medical treatment speaks of this. Treatment generally needs to be directed to diet and lifestyle, supplementation (vitamin, mineral, essential fatty acid and herbal esp.) to restore hormonal balance, and reduced exposure to xenoestrogens in my experience with patients.

I would actually add a sixth possible cause to be essential fatty acid imbalance. That is, (usually) the ratio between omega-3 and omega-6 fatty acid levels in the body. This can result in excess inflammation being poorly controlled and is almost always the result of dietary choices. Essential fatty acid supplements (fish oils or plant-based omega-6 oils) are my usual recommendation, until dietary changes can sustain normal balance. As mentioned above, this problem can exacerbate or result in calcium metabolism problems and/or hormonal imbalances.

Dysmenorrhea tends to be a rather simple condition to overcome, though perhaps not “easy” on an individual level.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Additional sources: http://healthydevil.studentaffairs.duke.edu/health_info/Dysmenorrhea%20-%20severe%20menstrual%20cramps.html http://www.metabolics.com/