Period pain is common, but not normal (and how to test your hormones)

Painful periods is something I see every single day I’m in the clinic. It breaks my heart when I hear stories of women who have been struggling for years with crippling pain, because no one ever told them it wasn’t normal. You shouldn’t feel anything more than mild discomfort when menstruating, at its worst it should easily be managed with some Panadol or a hot water bottle.

If you have lots of pain, firstly it’s important to confirm it’s what we call primary or functional dysmenorrhea. Which essentially means it’s not caused by anything else, like endometriosis, adenomyosis, Pelvic Inflammatory Disease, Pelvic Congestion Syndrome or fibroids. FYI if you go to your GP and tell them you’re in pain and their only suggestion is to take the pill, especially without investigating any of the above, find a new GP.

When you have painful periods in the absence of these conditions it’s usually caused by a relative oestrogen excess. The problem with high oestrogen is it drives a prostaglandin imbalance. Prostaglandins are inflammatory signalling molecules that are released when implantation does not occur. They’re there to get your uterus contracting (needed for you to shed your lining) and to decrease the flow of blood to the endometrium so you don’t bleed to death when you do get a period. When you have too much oestrogen, the prostaglandins become too inflammatory, and this causes strong and frequent uterine contractions, leading to a reduction of blood flowing through uterine muscle and excessive cramping. The high oestrogen and prostaglandin load also lead to high histamine, which further contributes to inflammation and pain.

Sometimes it’s not anything to do with the oestrogen per se, but rather either (or both) of the below-

- Your PROGESTERONE is too low relative to your oestrogen levels (this is more commonly the case as opposed to straight up excess oestrogen) – progesterone balances out oestrogen and buffers against its effects in the body. If your progesterone is too low, something has gone wrong with ovulation (the release of the egg from the ovary)

- The baseline inflammatory load in your body is so high then when you get the natural monthly surge in oestrogen-driven inflammation, it tips you over the edge. Think about issues with your gut (including food intolerances), immune dysregulation (such as autoimmunity) and lifestyle factors like sleep and movement.

Testing your hormones is a simple process, but it needs to be done right! While there’s nothing as important as a thorough, detailed case history, the body has an annoying habit of displaying the same symptoms for excess as it does for deficiency. An example would be something like premenstrual breast pain, which can be a symptom of either oestrogen excess OR progesterone deficiency (alongside other triggers).

A simple blood test from your GP can give you a PLETHORA of information about what’s going on with your cycle. The issue is that when doctors recommend these tests, they rarely tell you what day to get them.

Our sex hormones literally go from zero to over 1000 over the course of the month, and they’re supposed to be in certain ranges at different times – it’s not just a free-for-all. So, if you get a referral for a blood test for your hormones there are 2 specific times you should get them done:

💫 Day 2 or 3 of your cycle: this is your baseline. We’re checking your oestrogen to make sure you’re both making enough and clearing it properly, and your follicle stimulating hormone (FSH) and luteinising hormone (LH) to ensure you’re going to be able to develop and release your egg properly at ovulation.

💫 “Day 21”: this is when we check your oestradiol and progesterone. The level of progesterone tells us how well you’re ovulating, and the oestradiol tells us how well you’re metabolising your oestrogen. In reality, this could be a different day, the “day 21” refers to what day falls in the middle of the luteal phase (the second part) of an average 28-day cycle. But since a normal cycle can be anywhere from 25 to 34 days, “day 21” often isn’t correct. Really this test just needs to be done 7 days before you expect to get your period/7 days after you’ve ovulated.

If your GP really doesn’t want to do any hormone testing, we can arrange this ourselves in clinic. We also offer other testing options for hormones, including saliva and urine.