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Severe menstrual cramps relief: Menstrual cycle and exercise | TRIA Blog

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Menstrual cycle and exercise | TRIA Blog

There are training days where everything clicks. You’re destroying sets and slaying goals – at the end, walking out of the gym with a spring in your step. Then there are those other days. You’re out of sync and barely reaching the ends of your reps. After you’re all done, you feel like you were hit by a bus – repeatedly.

Why do you rock certain days and struggle through others? Maybe it’s how much you prepare, maybe it’s how things went at work, maybe it’s something else entirely. But what if there was another explanation? Even better, what if you could flip the situation and take advantage of it?

And what if it had everything to do with your menstrual cycle?

Fortunately, sports medicine physicians and dietitians have been uncovering a close connection between an athlete’s menstrual cycle and how her body responds to training. By understanding how the different phases of your cycle affect your hormone levels, you can time your diet and training accordingly and tap into the greatest physical and mental benefits of exercise.

So what happens during these phases? How do you know what part of the cycle you’re in? How do you hack it? And why didn’t we discover this sooner? To start, let’s go back to health class.


How your menstrual cycle can impact exercise and athletic training

There are two main phases of the menstrual cycle: the follicular phase and the luteal phase.

What is the follicular phase? The follicular phase happens during the first half of your cycle. What is the luteal phase? The luteal phase is the second half of your cycle. These two halves feature distinctly different hormone levels, with lower levels during the follicular phase and higher levels during the luteal phase.

Researchers and physicians are discovering that these hormone levels have a big impact on muscle development and how an athlete’s body uses energy.

The follicular phase and athletic performance

With a lower level of hormones during the first phase of your menstrual cycle, your body is primed to maximize hard training efforts. This means your body is better able to access stored carbohydrates, making this an ideal time for high-intensity training. It’s also easier to build and maintain muscle, which means this is also a great time to emphasize muscle-building exercises.

The follicular phase starts with day one of your cycle. You’ve recently lost some blood, so your body has a greater need for iron. Also, due to the shedding of the uterine lining during this time, there are a few days of increased inflammation. But during this lower hormone phase, hydration is easier, and you have a more even, cooler body temperature.

The luteal phase and athletic performance

During the back half of your menstrual cycle, your body is preparing for your next period or pregnancy, if you happened to conceive during this cycle. This means your hormones are running at a higher level, due to an increase in estrogen and progesterone. More hormones means a decrease in anabolic, or muscle-building, capacity. This means that it’s time to take it easier, focusing on lower-intensity workouts with more recovery time.

Also, rather than being able to easily access stored carbohydrates, your increase in hormones has that energy locked up tight. Now, your body needs fuel from extra carbs and calories from the outside (that is, your plate). Plus, your body also needs more water during the luteal phase – more hormones means a greater risk of dehydration.

Why women’s athletic research is catching up – the role of hormones

Let’s address the big question in the room. Why haven’t we discovered this sooner? It all comes down to the primary focus of early sports medicine science: male athletes. As a result, many of the results from past nutrition and training research apply perfectly to men, but not so much for women.

Fortunately, as the field has become more diverse, more recent women’s sports medicine research has produced a wealth of information on how the female bodies interact with activity and nutrition. And it shouldn’t come as much of a surprise that the more we study, the more we discover just how distinct and different a woman’s needs really are.

Even more importantly, we’re finding that those needs aren’t particularly constant from week to week. A woman’s hormones – affected by age, maturity and pregnancy history – set the pace for her reproductive system and physical performance. On the below episode of the For Health’s Sake podcast, physical therapist Jackie Voight summarizes the current state of research on menstrual cycles and exercise, and she offers a few pieces of actionable advice.



For health’s sake · Menstrual cycle and exercise


We’re finding that hormone levels can influence everything from a woman’s susceptibility to certain injuries to how your body processes food and even how flexible your joints are. Of course, as physicians and dietitians, we’re just starting to scratch the surface – plenty more research needs to be done in a lot of areas. However, there’s a lot you can do with what we know now to hack your menstrual cycle and make it work for you.


Getting to know your cycle by tracking your period

Of course, the first step of taking advantage of your menstrual cycle’s phases is actually knowing when they are. Fortunately, there are many tracking apps out there on both Apple iOS and Android. Here are some popular apps:

  • Clue
  • Flo
  • FitrWoman

You can also track your cycle through your Garmin, Apple Watch or Fitbit – both provide tools within their respective apps.

Exercise and nutrition tips for the two phases of your menstrual cycle

Once you start to see patterns emerge from the app that you choose, you can start to train and eat according to the phase that you’re in.

The follicular phase

  • Go for it – As we mentioned earlier, this is the phase where your body is better able to use the energy from stored carbohydrates. Feel free to attack higher-intensity workouts that build fitness, as well as focus on resistance training to build muscle.
  • Iron woman – At this phase, your body is craving iron. Familiar sources like red meat, dark chicken meat and shellfish should be on the menu. However, don’t forget that whole grains and legumes like beans, peas, chickpeas, lentils and soybeans can also deliver the iron you need.
  • Get fishy – In addition, eating foods high in omega-3 fatty acids will help fight increased inflammation. Think salmon, mackerel, tuna, herring and sardines, along with nuts, seeds and plant oils. As with iron, you can use supplements to get what you need, but getting these nutrients from food is best.
  • Relax with the water – Your body has an excellent handle on staying cool and hydrated during this phase. Definitely make sure you’re getting enough water, but don’t make it a massive priority.

The luteal phase

  • Tread lightly – Your body is in prep mode, so it’s not a great time to go hard on your training. Switch up to low-intensity workouts with more recovery time than usual. You can try pushing the intensity, but listen if your body is begging you to stop.
  • Eat up – This is when you need to get your fuel from carbohydrates both before and during workouts.
  • Listen to your body – During these weeks, you will probably feel hungrier than usual. This is completely normal. In fact, your body uses up 5-10% more calories during this premenstrual phase. Don’t fight it and listen when your body is telling you to eat.
  • Be “water aware” – It can be more difficult to stay hydrated during the luteal phase, so keep water at hand, especially during and after workouts.

Working with a sports dietitian

As physicians and dietitians at TRIA, we use this knowledge every day to help women improve their performance and prevent injury. We find that once women realize this close connection between their menstrual cycle and athletic performance, they understand that their period doesn’t have to be a negative thing. Once you know how your body functions, you can work with it and not against it. And that’s incredibly empowering.

Of course, every woman has a different situation with different needs. That’s why it’s a good idea for active females – exercise newbies and junkies alike – to make an appointment with a sports dietitian. During a visit, we can talk about your current training routine, diet and health history. Then, we can create a game plan that addresses your specific needs, helping you to be at your very best.

Even better, you don’t need a referral to meet with a dietitian. To make an appointment with a dietitian, give us a call. To make an appointment with a sports medicine physician or another expert on our Women’s Sports Medicine team, call or make an orthopedic appointment online.




Treatments for cramps don’t cut it. Why aren’t there better options?

One day last fall, Kiran’s period cramps became so painful they woke her up from a nap. The 19-year-old took some ibuprofen, but found little relief.

“The pain was so bad, it felt like someone was punching me,” said Kiran, who asked to be referred to by only her first name for privacy. It felt “like I was giving birth.”

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The standard treatment for menstrual cramps — non-steroidal anti-inflammatory drugs (NSAIDs) like Midol, Motrin, and Aleve — provide Kiran with a few hours of relief at most, if they even work at all. She’s tried the other common treatment for cramps, hormonal birth control, but it gave her nausea and fatigue so severe she couldn’t stay on it.

That intractable pain is a monthly reality for many others who menstruate. It’s estimated that nearly 1 in 5 people with dysmenorrhea — or painful periods with or without an underlying medical issue like endometriosis or uterine fibroids — don’t get relief from existing treatments.

And yet, period pain has long been seen as a solved problem. There’s little funding for research into dysmenorrhea. Studies of treatments that looked promising — including research on Viagra to treat menstrual pain — have all but stalled for lack of investment or participation from patients.

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The problem starts, experts said, with how unclear the science still is on the various causes of cramps. The prevailing theory behind cramps is a group of compounds called prostaglandins. At the beginning of menstruation, levels of the hormones progesterone and estradiol drop, leading to an increased production of prostaglandins. The compounds cause the uterus to contract to help it expel tissue, but may also cause painful cramps.

NSAIDs stop the production of prostaglandins. This should provide pain relief, especially if the drugs are taken before pain begins. The fact that they don’t work for everyone could be due to absorption issues, but it also hints that a different mechanism might be at play.

“In short, there are probably many mechanisms responsible for menstrual pain,” said Kevin Hellman, a menstrual pain researcher at the University of Chicago. Uterine contractions are a likely cause, and abdominal muscle soreness, inflamed tissue, pelvic floor muscle fatigue, and a number of other factors could also be at play, he said.

Having a better understanding of what’s causing the pain could help researchers develop more effective treatments. It could also help doctors know how to better treat those who don’t find relief from NSAIDs.

“There’s a whole raft of these newer treatments that we can test out if we just know who to use them on,” said Frank Tu, an OB-GYN and menstrual pain researcher at NorthShore University HealthSystem.

Those include electrical stimulation, sensory integration therapy, and even cognitive behavioral therapy, but clinicians have no way to assess which patients might benefit from which treatments.

“I envision a future where, if a woman is not responding to a medication, we might be able to do a series of tests and provide some guidance on what treatment might help her,” Hellman said.

One of those possible treatments is the erectile dysfunction drug Viagra. Sildenafil citrate (the generic version of Viagra) increases blood flow by dilating blood vessels. Prostaglandins, the compounds blocked by NSAIDs, may build up inside the blood vessels in the uterus, which could contribute to pain.

Theoretically, dilating blood vessels in the uterus could “lead to kind of a flushing away of those painful stimulants,” said Richard Legro, an OB-GYN and reproductive endocrinology researcher at Penn State who launched a clinical trial in 2007 to study the treatment. He also hypothesized the drug could bring more oxygen to the uterus — low oxygen levels can change the local pH and stimulate nerve endings, leading to pain. That’s why tourniquets and blood pressure cuffs can be painful. Dilating blood vessels would make room for more fresh, oxygenated blood.

Participants received sildenafil citrate or a placebo drug — administered vaginally in the hopes of getting a stronger effect and bypassing any absorption issues — while menstruating.

The small study of 25 people produced promising results. At the beginning of the treatment, the participants rated their pain with an average of 93 on a 100-point scale. The average pain rating for the women who received sildenafil citrate decreased to 23 within two hours, and 9 after four hours. There was a placebo effect, however — pain for the women who received the placebo decreased to 73 within two hours and 51 by four hours.

But the study ran out of funding before Legro’s team could recruit enough participants, and Legro’s application for an additional grant from the National Institutes of Health has been rejected twice. Legro said the reviewers didn’t think dysmenorrhea was worth studying. “I just feel they’re out of touch with women’s health,” he said.

They also had issues with the study’s design, in which each participant would receive both the placebo drug and sildenafil citrate at different points. Yet the FDA has backed that study design, and outside experts who spoke to STAT said they did not have concerns about it. Legro said reviewers were unfamiliar with why it was a suitable design for a dysmenorrhea trial.

“Those were the two issues that still burn almost a decade later,” Legro said. Legro published his results in 2013 and the study hasn’t progressed since.

Chen X. Chen, a menstrual pain researcher at the Indiana University School of Nursing, has similarly struggled to get funding to expand on a promising line of research into how the vaginal microbiome might relate to dysmenorrhea symptoms. In 2019, Chen ran a small study of 20 women that found that those with more severe period pain had less “good” bacteria, and more bacteria linked to inflammation.

Chen’s applications for further grant funding have been rejected twice, and two other applications are still under review. “The other day I was joking with a colleague and said, ‘It’s a practice of resilience and perseverance to get a grant funded,’” Chen said.

Chen’s experience points to one of the primary challenges of menstrual pain research: securing funding. Much of the funding comes from the federal government, specifically the National Institute of Child Health and Human Development (NICHD) within the NIH.

“There’s no foundation to pay for menstrual pain research,” Hellman said. “There is for endometriosis, there is for fibromyalgia, there is for Crohn’s disease, but there’s no philanthropic organization to pay for menstrual pain research.”

The institution does support research into dysmenorrhea, and has even put out calls for more grant applications on the condition.

But “there is always a portion of people who review grants who don’t really see [dysmenorrhea] as necessarily that important, in part because NSAIDs work really well for a portion of the population,” said Laura Payne, a clinical psychologist at McLean Hospital who has received NICHD funding to study menstrual pain as a risk factor associated with developing chronic pain.

Even if they get funding, many menstrual pain studies struggle to recruit enough participants. The Viagra study recruited women for over three years, but only ever enrolled 25 of its targeted 62 participants.

The study participants must be willing to come into the lab when they are menstruating and in pain. “That is an incredible challenge,” Hellman said. “We’re willing to do that — we have a high cancellation rate — but it’s very hard. You have to be in contact with a large number of women and keep track of their cycles.”

Researchers are getting creative about how to carry on their work despite those challenges. Hellman developed an MRI technique to visualize what’s going on in the uterus during menstrual cramps. He is currently using the technique in a clinical trial to test whether NSAIDs stop contractions. If NSAIDs don’t work for someone, this method should reveal why. It could be a drug absorption issue, but if the person never had contractions to begin with, there may be a different cause for the pain.

Payne is studying how emotions and pain perception interact with dysmenorrhea. “There’s that emotional component to the pain experience that we know can make the pain experience worse,” she said. Some people with dysmenorrhea have a higher risk of developing chronic pain, and she is studying if pain perception plays a role. If it does, she said, cognitive behavioral therapy may stop chronic pain from emerging, although no research has demonstrated this yet.

And the Viagra study may get a second chance. Tu said he and Hellman, who frequently collaborate, still hope to pick the sildenafil citrate project back up. It’s all a matter of playing the funding game. Tu hopes to include a small sildenafil citrate study as part of a larger, multi-arm trial testing different treatments with a strong chance of approval, like sneaking vegetables into a picky eater’s favorite meal. He already does this with bladder pain and dysmenorrhea studies.

“We think it could be done,” Tu said. “We just have to be patient.” While he strategizes and waits for the right opportunity, people like Kiran will continue dealing with their pain, month after month. They’ll wait for new treatments too — just not as patiently.

This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund. 

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To understand why the lower back can hurt before menstruation, it is necessary to remember the anatomy of the female reproductive system

The uterus, fallopian tubes and ovaries are located in the pelvic cavity, in the projection of the sacrum. That is why physiological, natural changes in their structure and functions associated with hormonal changes during the normal menstrual cycle can cause the appearance of pain in the lumbar region. Also, the causes of severe back pain associated with the menstrual cycle can be some diseases and pathological conditions. Let’s look into this in more detail:

Physiological causes

  • Enlargement of the uterus due to the growth of the endometrium and blood supply – the organ can increase, deviate back and compress the tissues and nerve fibers adjacent to the sacrum, thereby causing pain
  • Increased sensitivity to pain after ovulation due to the production of progesterone (the hormone that controls the second phase of the menstrual cycle) and prostaglandins (biologically active substances) that affect pain receptors
  • Slight swelling of the pelvic tissues caused by fluid retention. Progesterone
  • is also responsible for the reduced excretion of water from the body.

  • Intermittent uterine contractions before menses. This is a normal process caused by increased production of prostaglandins by the body. They help the uterus to renew itself faster due to spasms. However, it must be remembered that when using an IUD (intrauterine device), these contractions can be more intense and can cause severe pain
  • Low pain threshold and heredity. High sensitivity to pain, genetic factors, for example, well-established facts of painful menstruation in relatives, should also not be discounted

Natural causes of lower back pain, as a rule, cause a moderate pain syndrome, which resolves on its own within 3-5 days from the moment of occurrence. As a rule, this coincides with 1-2 days of menstruation. In order to reduce pain, you can use the following drugs: antispasmodics (no-shpa tablets, rectal suppositories with papaverine), analgesics (ibuprofen, analgin, etc. ). Many women benefit from vitamin supplement therapy, which includes prophylactic doses of folic acid, vitamins A, D, E, selenium, and zinc.

Pathological causes

  • Inflammatory diseases of the pelvic organs. In chronic inflammation in the pelvic area, for example, adnexitis (inflammation of the uterine appendages – fallopian tube and ovary), adhesions form in the abdominal cavity. These strands of connective tissue change the normal position of the organs, disturb the blood circulation of the tissues, tighten the nerve fibers, so that in the 2nd half of the cycle the pain becomes more intense
  • Benign tumors in the area of ​​the uterus and appendages. Ovarian cysts and uterine fibroids change the size of the uterus due to their volume. The larger the size of the formation, the more pronounced the pain syndrome due to compression of the surrounding organs and tissues.
  • Violation of hormonal regulation. Endocrinological diseases, such as thyroid diseases, often lead to changes in pain sensitivity due to hormonal imbalances
  • Ectopic pregnancy. If the fertilized egg is fixed and begins to grow in the tube, it will cause severe pain due to the stretching of the walls of the fallopian tube. This is a serious life-threatening condition that requires immediate medical attention!

If abdominal pain persists for a long time, increases and does not go away under the influence of antispasmodic and mild analgesics, you should immediately consult a doctor. Do not self-medicate, make an appointment with a competent doctor who will find out the cause of the pain and help you cope with it!

Make an appointment with a gynecologist

For more details, consult a qualified specialist at the Semeynaya clinic.

To find out the prices for a gynecologist’s appointment or other questions, follow the link below:

Tags Lower back painGynecologistWomen’s health

What to do when your period is painful

articleContent Menstrual pain is a nightmare for many women. Sometimes the pain during menstruation is so severe that it disrupts the normal way of life. Each of us wants to cope with discomfort, but not everyone knows how to do this without the use of drugs and painkillers.

Most often, menstrual pain in women is not very strong, but they can cause discomfort. Many women suffer from nausea and diarrhea during their periods. Sometimes back pain is added to these spasms.

READ ALSO: Our Health: Chronic Fatigue Syndrome

Why do period pains appear?

Tiredness and lack of sleep. Chronic lack of sleep is one of the causes of painful periods. Against the background of fatigue, hormonal imbalances can occur, which will lead to an increase in the duration of menstruation, cramps and pain.

READ ALSO: How and When to Eat Fruit: 5 Nutritionist Tips

Overexertion. If the pains are irregular, they may appear due to a decrease in the threshold of pain sensitivity, which occurred through psychological or physical overstrain.

Diseases. In addition, pain during menstruation can occur as a result of a disease of the nervous system or genitourinary organs, with an underdeveloped uterus or one that has an inflection, through inflammatory processes, cicatricial narrowing of the cervix, tumors, cysts.

READ ALSO: Cyclic or Intermittent Fasting: Fast Effects Without Harm to Your Health

How to Reduce Period Pain?

Women with painful periods should keep a calendar, which indicates the duration of menstruation, symptoms, intensity of bleeding, nature of pain. In the diary of menstruation, it is also worth fixing options for pain relief. This will further help determine the effectiveness of a particular tool. In addition, the schedule of your periods will help the gynecologist determine the cause of the problem. So, an irregular menstruation schedule indicates a hormonal failure, and it is easy to correct it with medication.

We have selected ways to help you reduce menstrual pain.

articleContent Yoga and meditation

Pain during menstruation is a consequence of overexertion in the abdomen. One of the most effective ways to relieve tension is to relax these muscles. Sign up for a yoga or meditation course. Asanas will help to physically relax and tidy up the emotional state. Yoga can be practiced at home on your own, you just have to consider that not all asanas can be performed during menstruation.

Heat

articleContent The best option is to crawl under the covers and sit with a cup of hot tea. You can apply a heating pad to the lower abdomen, but this is not always possible. If you need to get out of the house and do business, dress warmly. Choose clothes that do not create discomfort in the abdomen – without strong belts. A warm shower will help too.

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Nutrition

Proper diet has a positive effect on the course of menstruation and the general health of women.