ENG: Types of female pains

This article is based on my talk for the female pains and how to deal with them at the event of the Foundation Endometriosis Bulgaria on March 25, 2018 in Soho. It’s also part of the topic of pain I’ve been focusing on these last months here on the blog.

The English translation was specially requested by some women on an English-speaking facebook group about endometriosis support. The original text is Видове женски болки. 

The article is about cycle pain that can be experienced by many women, but I focus on those that are characteristic for women with endometriosis (and adenomyosis), because these pains are the most serious and varied that I know of. There are types of pains associated with ovulation, but this article will focus only on those that occur during or around the bleeding. It doesn’t include pain during sex either. 

I have personal experience with most of the pains I describe but I don’t have any medical expertise except as a woman diagnosed with both endometriosis and adenomiosis who had debilitating pains and over the course of two years managed to reduce them to zero. What I’ve learned in this experience I now apply to dealing with any type of pain I encounter – including headaches, cramps or sprains. So far it has worked flawlessly for me. I didn’t know in how much pain I live before getting rid of it! 

My approach is first identifying the type of pain I experience, then finding the cause of it and then finding the right way to reduce the pain or get rid of it. 

I was diagnosed with endometriosis in 2007 but I didn’t have a lot of pain at that time and I never linked it with the endo. But in 2014 I was already living in constant pain that was debilating and seriously impacted my life and my mental health as well as my relationships and my ability to work. I was lucky enough to never find any releief for it (I didn’t know about anti-inflamatory drugs at the the time) and my doctor was constantly telling me everything is just find. So I had no other choise but to find ways to live with the pain as normally as possible. It was very difficult but it had one beneficial effect – it gave me the opportunity to observe closely my period pains. At that time of the month I wasn’t able to do anything else than lying in my bed for days at the time drug or no drugs. So I stopped taking them and realised I don’t have only one period pain, I could feel several different types. I’ve learned a lot about myslef and how my body works thanks to these observations and had the information I needed to start searching for solutions.

What did I learned? Endo sisters tend to explain almost all period pain with the effect of endometrial lesions. And doctors often tell us it’s normal to hurt during your cycle. But my own experience and after all the conversations with other women with pains tell me that most often we experience not one but a combination of different types of pain that often compliment each other and even intesify each other to a point that the pain becomes intolerable. I think the monthly bleeding cause a cascade effect that wakes up other problems too and all of them cause the pain we feel at that time of the month intensify. And after several years this can damage nerves or the brain response to pain and at that point most painkillers don’t work anymore.

The first thing you need to do to start the healing path is to:

Discover the types of pain you have

and then:

Take care of them one by one by finding the right way to treat each one of them

As I have written in the previous article (I will soon translate this one too), I now look at the pain like a symptom that something is wrong in the body and needs a fixing rather than something that needs a painkiller to be stopped. And once I turned my mind from „Why it hurts me so much!“ to „What exactly does this pain mean and what information it gives me? What is wrong in my body and how can I fix it?“ things started to improve slowly but sensibly. The holistic approach isn’t a quick fix. But I can guarantee it is lasting one.

Below is a list of various pains you may recognize (it is quite possible to add new ones in the future, because the list is based on what I have been experiencing and this is probably not every possible type of pain out there). The main types of pain during menstruation that I recognise are:

Pain caused by adhesions

Adhesions limit the normal movement of pelvic organs that are otherwise positioned so that they can easily change their position relative to each other. If you experience pain during certain body movements, sexual penetration, bowel movement, walking to the toilet, it is most likely the pain caused by the stretching and pulling of the attached to each other internal organs.

Here laparoscopes can help a lot because the adhesions themselves are removed when possible during the surgical intervention. The problem is that any invasive procedure can cause forming of new scar tissue and thus the cycle of more and more operations begin and some women can have up to ten operations and have more and more adhesions in their pelvic area. If you ever wondered why we need to start walking as soon as the effect of the anesthetic wears out – this it – movement prevents forming of the scar tissue. So if you are recovering from a laparoscopy, start walking and walk as much as possible every single day. Lack of movement in the pelvic area is our worse enemy.

There is a holistic aproach that proves to be quite potent too. Some exercises of yoga and pilates help in the movement of organs in the pelvic region. The stretching of the scar tissue can help for destroing it. Abdominal massages and self massages can help the expercises and acupuncture is a sure way to release a lot of the adhesions between internal organs. I had recently tested the effect of the proteolytic enzymes nattokinase and serapeptase and they work very well too, although for me the best aproach is to use all mentioned methods at the same time to have the best possible effect as quick as possible.

The combination of enzymes I use are:

Serapeptase from Doctor’s Best

Nattokinase from Now

Plant Enzymes from Now

Or an alternative can be Doctor’s Best Proteolytic Enzymes that include bromelain, fungal protease and serratiopeptidase:

It is also a good idea to pay attention to the specific adhesions thay you may have. For example, if you have adhesions on the colon, it is important to have regular bowel movements and help the digestive process as much as possible. Any delays in bowel movements can cause unnecessary pain. This means you should do everything possible to avoid constipation.

If you have adhesions on the bladder, never hold and go to the toilet in a timely manner (well, this is a good idea for everyone!). It is also good to check for any infections that may be missed on regular check ups – in many cases they greatly increase pain during urination. These might be yeast infections, or any type of bladder infections.

Pain from inflammation

When my stomach becomes stiff, slightly swollen, and the feeling of hot pain is spread evenly across the lower abdomen, I know it is due to inflamation. You’ve probably heard of endo belly – one of the reasons for it can be inflamtion (as well as soom food intolerances and other digestive issues).

The anti-inflammatory diet helps reducing inflammation, which guarantees a much lighter abdominal pain at the end of the month.

For me, it was the greatest relief when I started my first steps in this direction. I’ve been keeping a food diary for quite a while, and I’ve also noted the levels of pain I feel in a cycle before I find out what works for me and what does not. For a lot of women these are caffeine, alcohol, dairy, meat in large quantities (red meat espessially), gluten, processed foods and a number of other individual food and chemical intolerances can increase the pain. So a detox and a chemical detox are some the things that can help a lot. This includes getting rid of toxic cosmetics too.

Ovarian pain

Most women distinguish these pains relatively easily. They may occur if the ovary is adherent, if the tubes are closed, if there is an inflammatory process in the ovary itself, or cyst. And of course, if the cyst bursts. My pains are sharp and clearly localized, but for some time I did not associate them with the ovaries, especially on the left side, because I did not realize that after my ovary was shifted, it was logical and the pain from the ovary to feel at a different place too (mine is at the back of the uterus). Which means it’s helpful to ask for detailed information from doctors about the position of your uterus and overies. Not everyone is trained to read echograph pictures, but the information is valuable.

In my case these pains are strongly influenced by my emotional state – I can feel piercing pain at times when I’m under severe stress, overworked or severely irritated, so I’m working on my emotional problems and try to not overwhelm myself. I used to have job that included daily heavy weight lifting that was causing this kind of pain too. Anouther trigger for me is cool and humid weather.

Some women can feel the cysts in their ovaries and sometimes particular movements can cause pain due to the adhesions. In these cases massages and youga work quite well. Also, as I’ve found out recently, stopping coffee and black and green tea can stop cysts from growing and the proteolitic enzymes help reducing their size.

Pain in the uterus

I also have adenomyosis and I have miomas at the uterus, so I’m not sure if this type of pain is specific to endometriosis or it’s only for those with adeno. But many women have miomas or fibroids so I decided to include it. The pains assosiated with the uterus are two kinds. The first one is low dull and throbbing pain in the abdomen and can occur during the cycle or after orgasm. The other one is acute pain in the lower back, under the waist.

The anti-inflammatory diet relieved this pain a lot for me, and after surgery, when they removed a mioma, things got better. But I still have a problem if I have been immobilized for a long time. I find that some yoga poses and energy practices help me greatly. I had some moments that I literally felt as if I was untieing a knot there. For these pains ad most affected by my depression and the nervous crises I sometimes do and by some sexual traumas that I had (nothing serious just some bad experiences with past boyfriends that obviously affected me in ways I could never imagine at the time). So for me finding piece of mind is crucial, also dealing with these past traumatic experiences helped a lot. And of coarse, a good acupuncture specialist can releive the pain quite easy, but will do it for a time and they usualy tell you you need to work on emotions and do specifique exercises if you what the effect to last.

Sometimes the pain in the lower back can be due to adhesions or pressing of the organs against the back wall of the pelvis, where the base of the spine is, so if you feel tension there, it may also be due to it. Again, yoga poses, stretches, massages and proteolitic enzymes can help tremendlesly.

Pain in the waist and legs

The strongest and most intolerable pain for me was the pain in my waist. When I started working on it, I found it was caused by more than one thing. It comes from the uterine pain I described above. It also due to not enough movement and exercise. Especially when I spent two or three days in bed because of the pain, the pain in my waist was so strong that it did not allow me to move my legs normally.

The third thing that cause pain in the lower back is when there are any sorts of displacemnt of the spine or the pelvis. Displacement can occure after pregnancy, when you have bad posture or even after a few days with a sprained ankle that can affect the way you walk and after that the position of the pelvis and the spine. I work on a computer all day, and my posture is not too straight, so I often bend, which immediately affects the pelvis. During the month I feel it just as a tension on my lower back, but it becomes a serious pain during my cycle. An ostheopath can fix the bones and your posture and that combined with something for the posture like yoga or thai chi can help getting rid of that pain. In my country there are yumeiho spesialists who practice a japanese thecnique on fixing the bones that works great for me.

Many women also have a pain problem that goes on the upper legs. I’ve had it, but it wasn’t very strong. It may be due to poor posture, pelvic tension, distortion, it is also most often experienced by women who have given birth, so it is often associated with pelvic bone displacement as well as sudden weight gain, which also puts tension on pelvic bones. Some of these things can even affect the nerve and turn it into the worst pain you experience. If left untreated, these problems get worse over time. Many massages help relaxing the the nerves, as well as heat and movement. It is best to address the root cause first and go to ostheopat to fix the bones and then focus on relaxing the nerves.  After that you can use heating, massages, acupuncture, deep breathing and other relaxation thechniques to relax them. Anti-inflamatory diet and herbs help a lot in this case too, as well as some herbal teas.

Other types of pain

It is quite possible, especially if you have endometriosis, but not only, that your cycle may intensify or awaken other problems that we traditionally do not consider gynecological. Infections in other organs such as the kidneys or the bladder, spleen, liver, everything in the pelvic area can hurt, and we (and doctors) often think of them as menstrual pains if the occure or intensify during the period. These pains could be early symptoms that you have to stop loading your liver or your adrenal glands so much, or that you have a kidney infection that can cause fever and other problems in a week or two. As I said, pains are a great indication, as long as we pay attention to them. But the only way to feel them is by experiencing them without painkillers that dull the feeling. You can wait a little bit before taking a drug so that you can identify the exact type of pain and then consult a doctor about it. Remember, doctors don’t get trained to recognise most types of pain, espesially those in the pelvic area, so it’s up to you to learn where each organ is and be able to explain and give specific information to the doctor. Otherwise you risk to be dissmised as just another overeacting woman that has a low pain tolerance.

Depression and anxiety

I’m not talking about clinical cases or even diagnosed depression or anxiety. But my personal observations tell me many women with a painful cycle are prone to negative thoughts, depression or anxiety. All of them have been shown to increase the sensation of pain, and pain itself contributes greatly to the increase of depression and anxiety, and so there is a closed circle that makes it difficult to see an exit when we are inside of it. In this case my best practise is to do something small that affects one of the problems – for example, to check if vitamin D levels are in norm, vitamin B12 too, to start moving more and spend more time outside on daylight and near trees or a forest if possible or a large bassin of water. Pain, depression, stress and anxiety all raise the levels of stress hormones in the brain, so everything that helps relaxing it is welcome in this case. When the body is in a state of stress, all the secondary functions such as healing processes or digestion are suppressed. Sometimes this dulls the pain too, but only for a while and then affects the brain in a strange way that make it more atuned to the feeling of pain. This is also what a lot of painkiller drugs like opioids do. So dealing with depression and anxiety are crucial to reducing any pain that you may feel.

Last but not least – do not let yourself get overwhelmed, do not get exhausted, recharge your batteries as often as possible, beware of colds and viruses (because they weaken the body and affect the nerves), drink plenty of water (dehydration increases the sense of pain), beware of stress and strive to think positively. Relax in every way possible and beleive me living pain-free is possible. 

You can contact me if you need some personal advise, more infomation, don’t know where to start or want to share your experience with pain or releiving the pain. I wish you all a pain-free life full of happiness and joy!