This post is a continuation in a series on Menstrual Disorders, and is best understood by reading the prior post.
So why do these problems occur? Is it genetics? Hormones? Poor nutrition? Stress? Possibly yes to all, although some of these influences may be more impactful for some individuals than others. Is there anything we can do about it? Absolutely!
In reality, the cause of menstrual disorders (MD) is most likely a combination of factors, as is often the case with many diagnoses. If you go to the most noted authority on the topic (the internet), you get all kinds of proposed causes for MD. (I said most noted, not most accurate.) Certainly some causes may play more heavily into certain diagnoses than others. But there is so much overlap that I decided to not try to correlate them with a specific diagnosis. Here is the list of proposed causes of MD that I have compiled (I may have missed some), in alphabetical order:
- Abdominal scar tissue
- BMI (body mass index)
- Cancer
- Depression/stress/anxiety
- Diabetes
- Eating disorders
- Fascial dysfunction – related to trauma, injury, surgeries, and fractures anywhere
- Genetics
- Heavy exercise
- Hormone/chemical imbalances
- Hypermobility
- Menopause
- Neuro/musculo/skeletal
- Nutrition
- Reproductive system disorders (adenomyosis, cervical stenosis, cysts/PCOS {polycystic ovarian syndrome}, endometriosis, fibroids, polyps)
- Reproductive system infections (STD {sexually transmitted disease}, PID {pelvic inflammatory disease})
- Sexual trauma
- Smoking
- Thyroid
This is where assessment by a qualified medical professional comes into play: sinister possible causes of MD like cancer or infection must be ruled out. Certainly there are cases that require interventions like surgery and medications. But in the absence of red-flag conditions, more often there are multiple lower tier options than surgery or medications which warrant consideration. For instance, many conditions like ENDOMETRIOSIS and PCOS may exist in a completely benign fashion – meaning they do not always cause pain. This is not just my opinion: the research and literature support this. Typically people are surprised to hear this as these conditions are often blamed for a host of issues including MD. The presence of such conditions certainly signals that something is wrong, but the research shows that women can have these issues without pain. So when a woman seeks help for some symptom-producing problem and presents with these conditions, it’s good to appreciate that her symptoms may be coming from something else – especially before proceeding with surgery or medication to cover the symptoms. Something to ponder.
Remember that this listing is of possible and proposed causes, not absolutely confirmed. The broad span of these potential origins for MD could be associated with other diagnoses as well, like IBS, prolapse, hernia, or low back pain. I can’t help but point out that many of these causes listed above could be turned around and explained by their fellow causes; for instance, depression could stem from hormone imbalances. By the same thought process, MD could cause an eating disorder and/or BMI issue as opposed to just being caused by them. Many of the MD are associated with the sad statement so common with multiple medical conditions: “The etiology of this heterogeneous condition remains obscure….” In other words, they really don’t know what causes it. But some very good theories exist as to the cause behind MD, which we’ll look at next. I’ll say here too that some elements, like genetics or past trauma, are not changeable. But I encourage everyone, regardless of the issue, to change what you can and maybe what you can’t change won’t have such a huge impact.
As you might expect, I am biased in my belief that fascial dysfunction can play a huge role in MD. This is based on scientific as well as empirical evidence. First, let’s look at the science. There is a growing body of literature exploring the role of fascia and connective tissues in movement, pain, and disease/dysfunction. The RESOURCES section I have compiled has some articles dealing with this topic, although there are many more than I have loaded. One in particular that I would direct you to is THIS ARTICLE by colleagues in Italy. It outlines two case reports using Fascial Manipulation®, one of them on a young lady with dysmenorrhea who responded very well. I would also direct you to the sections I have on Fascial Manipulation® (FM) and Fascial Manipulation® for Internal Dysfunction (FMID) under the Interventions tab. MD would be grouped into the category of FMID. In summary, MD occurs in response to the faulty fascial environment in which the reproductive organs are trying to function. The organs are not the problem, which could explain why so often the tests examining the organ (uterus, ovaries) are negative. We’re always glad when it’s not cancer, but then what is it? Fascial dysfunction is a very viable consideration supported by science.
In addition to the science, my own empirical evidence – what I experience every day in clinical practice – also supports fascial dysfunction as a plausible explanation for MD. It makes my heart sing to have a female of any age return to me in follow up after treatment and tell me that her last period was much less painful, involved less bleeding, required no pain medication, and did not put her on the couch for three days missing work, sports, and life. I have experienced these results repeatedly over the years – often enough to prompt me to submit a proposal to speak on this topic at a national physical therapy conference, which was accepted (American Physical Therapy Association Combined Sections Meeting February 2022, San Antonio TX, presentation title: “Dysmenorrhea: Managing the Monster”). Writing this series on MD here on my site is part of my preparation (okay so I’m double dipping). In hindsight I wish I would have made the presentation title broader to reflect the full spectrum of MD, but the talk will be all inclusive because the treatment for dysmenorrhea is really no different than the treatment for menorrhagia in the FM method. It approaches the body globally, regardless of diagnosis, taking into account all the past and co-existing problems a person has to determine the best treatment plan. From my perspective this is essential for addressing the root cause of a problem and moving beyond just treating symptoms.
As with the possible origins of MD being multi-causal, so should the treatment approach. Sources cite multiple intervention options, which I’ve listed below in alphabetical order. While FM is my fundamental approach, I also utilize other compatible interventions (noted below in italics). This isn’t to imply the other interventions are inferior; some are currently outside of my scope of practice or I don’t use them much:
- Acupuncture
- Birth control
- Cupping
- Dry needling
- Education
- Exercise
- Fascial Manipulation
- Joint mobilization
- Lifestyle changes
- Massage
- Medication
- Nutrition
- Surgery
I have many of the above interventions I utilize explored on this website, and encourage you to explore them. Cupping can impact the autonomic nervous system, which is the driving force behind all involuntary functions of our body, such as the menstrual cycle. Dry needling can be very effective in changing the physiology of the connective tissues and restoring an environment more conducive to homeostatis. This is true whether one believes they are targeting a myofascial trigger point, fascial densification, muscle knot, or whatever. Sites needled might be in or around the pelvic segment, but could also be into the lower limb which is often involved, for instance in the case of an old ankle sprain. Dry needling powerfully impacts the body at the local, segmental, and systemic levels. Education (lots of sources under the resources tab) is a huge part of what I utilize, hence this website. I believe the more people understand about their body and their problems, the more hopeful, confident, and successful they will be toward recovery. Education on such items as percussion/vibration tools and cupping equip and enable people to participate in their program as well as future management and prevention. Educating people as to activities of daily living and needed Lifestyle Changes that may be crucial to modify for recovery is also essential. Exercise has its place for supporting changes made in treatment and combating the negative effects of what we do all day, such as prolonged sitting. This is where a regular exercise program (yoga, Pilates, running, biking) can also be very helpful. None of these interventions by itself is the answer, and not all of these interventions is what every person needs. It takes a customized approach addressing the specific needs of the individual.
I hope this has been helpful for you or someone else you might share it with, and I appreciate feedback. In my final post on this topic I plan to relate my personal experience with MD. Until then,
Wishing you health and joy!
Colleen