Painful Periods and PCOS What You Need to Know
Quite often when you see a list of common PCOS symptoms, you will see irregular, light, and missed periods are on the list. However, heavy, painful periods are not often on the list. This may be leaving you wondering if your heavy bleeding and painful periods are from your PCOS or from something else enterally.
But, YES, your heavy, painful periods are often a symptom of PCOS and definitely NOT a fun symptom to have.
First Let’s Dive into What PCOS Is…
Polycystic ovary syndrome (PCOS) is a common hormonal condition that occurs when your ovaries create excess hormones. It affects approximately 6-13% of women of reproductive age. Unfortunately, it is a chronic condition that usually starts in adolescence and can not be cured. However, some symptoms can be managed and improved with lifestyle and diet changes.
PCOS Can Cause:
Hormonal imbalances
Irregular periods
Excess androgen levels – Male hormones like testosterone
Cysts on ovaries
With irregular periods can come a lack of ovulation which can make it difficult to become pregnant.
PCOS is the most common cause of ovulation and the leading cause of infertility. It can also be associated with various long-term health problems like:
High cholesterol
High blood pressure (hypertension)
Type 2 diabetes
Heart disease
Endometrial cancer – cancer of the inner lining of the uterus
Common Symptoms of PCOS Include:
Heavy, long, intermittent, unpredictable, or absent periods
Infertility
Hair thinning/loss
Acne, oily skin
Weight gain – especially around the belly
Hirsutism – excessive facial and body hair growth
Due to the symptoms that can come with PCOS, it can also cause negative body image, anxiety, depression, and social stigma.
So, What is Period Pain and What Causes it?
All that painful cramping, backpain, nausea, abdominal pains, and fatigue coming into and during your period is a condition called dysmenorrhea.
As common as dysmenorrhea is, it is not actually normal to be getting all these symptoms during your period and is a sign that there is something else going on in your body – a big on being PCOS.
There are two different types of dysmenorrhea:
Primary Dysmenorrhea and Secondary Dysmenorrhea. Let’s dive into the differences of these two forms of dysmenorrhea.
Primary Dysmenorrhea: Primary dysmenorrhea is the cramping and/or mild pain in the lower abdomen and/or lower back that accompany your period. It commonly starts when adolescent females attain ovulatory cycles – within 6-12 months of getting their period.
Menstrual cramps and pains are usually caused by a rise in a hormone-like substance called prostaglandins – natural chemicals that cause the uterus to contract and shed its lining. Prostaglandins can also cause create an inflammatory response, which is what causes the menstrual cramping and lower back pains.
Your prostaglandin levels are highest just before and at the beginning of your period. Which is why the cramping and pains are felt more at these times. As your prostaglandin levels decrease the cramping and pains subside.
**If you are having severe cramping and/or pain with primary dysmenorrhea, it’s possibly due to an imbalance in your prostaglandin’s levels.
Secondary Dysmenorrhea: Secondary dysmenorrhea is super painful menstrual cramping and pains that is caused by and underlying condition, or structural abnormality within or outside your uterus, such as endometriosis, adenomyosis, uterine fibroids, and PCOS.
Secondary Dysmenorrhea can cause severe pain that can interrupt your daily life. It’s often not isolated to just before and the first day or 2 of your period.
It can also cause other issues such as:
Dyspareunia – Painful intercourse
Menorrhagia – Heavy Bleeding
Intermenstrual Bleeding
Postcoital Bleeding
Nausea/vomiting
Diarrhea
Fatigue and weakness
Headaches and fainting
The Bottom Line of Dysmenorrhea is:
Due to the rise of your prostaglandins, some mild discomfort, cramping and pains just before and at the beginning of your period is very common and somewhat normal. However, severe period cramping and pains are NOT normal and are a sign that you may have an underlying health condition.
** If it lasts longer than a day or 2 into your period and is disrupting your daily life and activities, you should reach out to your health care professional to find out what is going on inside your body and to talk about the next steps to take to find out why it is happening and what the best treatment options for you will be.
How PCOS can Affect Your Periods
One of the most common signs of PCOS is infrequent or irregular periods.
On average a women’s cycle is 28 days – anywhere between 21-35 days (12-13 periods a year) is considered a normal menstrual cycle.
However, women with PCOS often have infrequent or irregular periods. These women have cycles that are more than 35 days long and often only have 9 periods a year.
Infrequent or irregular periods are often due to high levels of androgens which is linked to PCOS. Not only do high levels of androgens cause infrequent or irregular periods, they can also cause acne and excessive facial hair growth (hirsutism) – both of which are also common symptoms of PCOS.
Along with high levels of androgens, on ultrasounds of people with PCOS are polycystic ovaries, which are not actually cists on their ovaries, but are fluid-filled sacs (follicles) that contain a developing egg.
However, with PCOS comes some crazy hormone imbalances and due to this the follicle does not properly mature and release the egg at ovulation. Instead, they accumulate on the women’s ovaries leading to irregular or absent periods.
The Link Between your Heavy, Painful Periods and PCOS
While it is well known that irregular or absent periods are common for ladies with PCOS, what isn’t as well known is that so are super heavy periods that just don’t seem to stop. This heavy prolonged bleeding is called menorrhagia, and it usually comes with severe cramping and lasts for more than 7 days at a time.
There can be is a variety of different causes of menorrhagia, with the main cause being hormonal imbalances, such as:
PCOS
Irregular ovulation – without regularly ovulating the uterine lining becomes thicker than normal, causing heavier, more painful bleeding when it sheds
Hypothyroidism – if your thyroid doesn’t produce enough thyroid hormones, it can cause heavier bleeding
Endometriosis – a condition that tissue similar to the uterine lining grows outside the uterus, causing heavier, severely painful periods.
Other causes of menorrhagia can be uterine issues such as:
Adenomyosis
Uterine polyps
Uterine fibroids
Endometrial hyperplasia
Medical conditions like:
Liver or kidney disease
Bleeding disorders
Some cancers
** With all these different causes of menorrhagia, if you are experiencing heavy, painful, prolonged periods, (even with PCOS) it is best to see your health care provider to get to the bottom of what exactly is causing them to be so awful so that you can safely take the next steps to find relief.
That said, because of the underlining inflammation that comes with PCOS, it is typically a big reason that you are having these horrible painful periods.
When you have inflamed tissue the production of prostaglandins is increased. As we talked about above, prostaglandins also create an inflammatory response and is the cause of the cause of cramping and back pain during menstruation.
So, with the extra inflammation that comes with PCOS increasing the production of prostaglandins, mixed with the increase of prostaglandins just before and at the start of your period, the severe cramping and back pain in people with PCOS can be quite intense at this time of the month.
Managing the Heavy, Painful Periods that Come with PCOS
There are several different things that you can do to help manage you horrible, painful periods. Some of this is short-term management that focus on what you can do in the moment, and some are for long-term management like diet and lifestyle changes that focus on managing the underlining hormonal imbalances so that your future periods no longer have such a negative effect on your everyday life and activities.
Short-term Management Strategies:
Applying heat – Heating pads or heat blankets can help increase blood flow and loosen tight muscles
Ginger and/or turmeric tea – these are powerful anti-inflammatories that help reduce prostaglandins
NSAIDS – If needed NASIDS like ibuprofen can be used to temporarily help with inflammation and pain
Caster oil packs – Can temporarily help with inflammation, swelling, and pain
Gentle movements/exercising - If you are up for it, things like yoga, walking, swimming improves your circulation and releases endorphins, which in turn can help relieve you from cramping and pains, as well as boosting your mood.
Staying hydrated – making sure to drink enough water, as well as electrolyte drinks, to keep you hydrated and your minerals up will help with bloating, fatigue, and muscle cramps.
**Yes, all of these short-term management strategies can help you, sometimes greatly, get through your painful periods. However, it is best to focus more on the long-term management strategies to help stop the symptoms from getting so bad in the first place and find long-term relief from them.
The goal is for the short-term pain management strategies to only be used as a back up instead of something that you rely on every month.
Long-term management Strategies
Long-term management strategies are things like diet and lifestyle changes, fixing any deficiencies that you might have, and improving your gut and digestive health.
Diet Changes:
A healthy diet will play a key role in the long-term management of your symptoms and just your overall health all together!
Some diet changes that you want to include are:
Balancing your blood sugar levels – Combining a healthy balance of protein, fats, and complex carbs (YES carbs!) into all of your meals is key to maintaining healthy blood sugar and insulin levels.
Including Anti-inflammatory foods – With inflammation being one of the biggest drivers of period pain, especially with PCOS, including anti—inflammatory foods into your daily diet is one great way to help keep that inflammation down.
Some of these foods are:
Fatty fish – excellent sources of omega-3s that are loaded with anti-inflammatory properties
Avocado – Rich in monosaturated fats which support hormone balance
Berries – Packed with antioxidants that fight inflammation
Turmeric, ginger, and cinnamon – potent anti-inflammatory spices
Flax and chia seeds – High in fiber to support gut health (Key to reducing inflammation) as well as omega-3s
Lifestyle changes
For a lot of us there are many different things we can add in, or change in our lifestyle to improve and manage our menstrual pain and awful periods long-term.
These are things like:
Gentle movement – There is nothing wrong with lifting weights and doing small amounts of cardio and HIIT, I recommend it to almost all of my clients, however, they do cause temporary, extra stress on the body, which in turn can cause some temporary, extra inflammation… that said, coming into the beginning and during our period it is best to focus on gentle movements like walking, yoga and swimming. As said above, this is also good for short-term management, for the same reasons.
Stress relief – Stress can really do a number on the body and is one of the biggest hidden contributors to inflammation, which by now we know that that is a big cause to severe period pains. Finding a way to help relief extra stress in your life is key. This can be things like meditating, deep breathing, breathwork, getting morning sun, being out in nature, talking to friends and family, and getting extra support from those you trust when needed.
Cutting back on alcohol – As fun as it is to go out with the girls for some drinks to digress, have drinks to celebrate or during holiday dinners/parties, etc. Alcohol is a known inflammatory, among other things – it really can do quite a number on your body, especially if you overindulge. Now I’m not saying that you need to cut it out completely – that’s up to you and what you want. However, cutting back/not drinking at all, especially when you are coming close to that time of the month will help greatly reduce any extra inflammation, in turn it will help reduce the cramping and pain you experience during menstruation.
Healing your gut/ digestive system
One thing that a lot of people don’t realize is the guts’ role in period pain. You gut and digestive system is key to regulating the inflammation, hormones, and detoxification in your body.
An unhealthy gut can:
Increase estrogen dominance by recirculating excess hormones
Trigger chronic inflammation
Worsening cramps and bloating
Disrupt immune function
One easy change that you can make is adding more fiber – including foods such as rice, chia seeds, fruits, veggies, and legumes.
Fiber feeds beneficial gut bacteria, helping ease inflammation, support digestion and helps your hormones balance by aiding estrogen detoxification.
It also helps to improve food transit time through the gut, which is especially helpful if you experience endo-related digestive issues.
** To really know what is going on in your gut and digestive system and how to fix it, it is best to talk to your health care provider and/or Nutritionist, so that you are given the right tools that YOU need to feel great again.
Supplements
When it comes to supplements, there are many different supplements that could help you get back to your optimal health. There is also A LOT of misinformation out there on supplements and A LOT of viral supplements being sold on social media that apparently are the magic key to fixing your gut/digestive health, balancing out your hormones (specifically your cortisol – See my Cortisol blog here), fixing your mental health and “mom rage”, etc, etc, etc…
The big truth is… there is NO one supplement, drink mix, or powder that can do all that.
Another truth is, and this is a bigger truth than above – Supplements are NOT a one size fits all. When taking supplements for your gut and hormone health, or any other health issues, they NEED to be individualized to fit you, and your bodies needs.
When it comes to taking supplements to help with long-term management of your painful periods and your PCOS they will be supplements that help your hormones and probably your gut and digestive health and they will NEED to be individualized to fit what your body needs.
These supplements will largely depend on your diet, lifestyle, any deficiencies that you might have, the condition of your gut and digestive health and what your hormones are doing.
In order to know what that is and to get the right supplements for you, you will need to be working with your health care provider and/or Registered Nutritionist.
The Bottom Line Is…
There are many different ways to manage your period pain that include short-term management and long-term management.
The goal is top not have to depend on the short-term management strategies every month, but to work on optimizing the long-term management strategies and use the short-term strategies as back up, when needed.
Some of the short-term strategies overlap with the long-term strategies – things like gentle movements (yoga, walking, and swimming) are great to incorporate into your life long-term but will also help you with short-term pain management.
Getting Support
One of the best things that you can do for yourself is getting support from family, friends, and professionals that specialize in woman’s health, specifically hormone health.
Being a Registered Holistic Nutritionist that is specialized in woman’s hormone health, my program Hormone Health for Females of all Ages is the perfect place for you!
This program is individualized and tailored to fit YOUR specific needs and lifestyle to fit you and what you need in the best way possible.
To learn more about it and how we can work together, click the link above to check out the program, book a 30-minute FREE Discovery Call here, or message me directly on Instagram!