Female Hormones - Dysmenorrhea & Prostaglandins
Everyday the human body works to maintain homeostasis; The Nervous System & Endocrine system are two major players in helping to execute necessary communication to maintain optimal functioning. However, sometimes, the decrease in specific hormones can cause unfortunate and even painful side-effects for certain groups of people. Primary Dysmenorrhea is a condition in some women that causes them to have severe lower abdominal pain during their menstruation cycle. Prostaglandins are unique-like compounds with hormonal effects that are one of the main causes for this severe pain. An article on Inflammatory markers in dysmenorrhea and therapeutic options states that "Prostaglandins play a major role in the pathomechanism of dysmenorrhea." (Barcikowska et al., 2020)
Menstrual cramps and other general side-effects of menstruation are pretty well-known and often spoken about amongst females. However, there are a select number of females who have extremely bad side-effects due to Primary Dysmenorrhea, which often will discourage them from exercising or doing any activity at all. As a fitness professional and a form of motivation for students and clients, it is important to know how you can help them during this time. Acknowledging the pain, understanding why it's happening, and knowing the correct exercise prescription to give them could greatly advance their health & fitness levels.
"Prostaglandins are lipids synthesized from a fatty acid (arachidonic acid) in cell membranes.”(Welsh, 2020, Pg. 306). Prostaglandins appear in the body where there is injury or illness. They control many processes, such as inflammation and blood flow. During a female's menstrual cycle, the lining of the uterine wall - the endometrium is at its thickest. Once her period begins, a steroid called progesterone decreases, which releases acid phosphatase and lytic enzymes. These lytic enzymes digest cells and cause the release of prostaglandins. "A decrease in progesterone also contributes to the inflammatory response that leads to exfoliation of the endometrium and menstrual bleeding". (Barcikowska et al., 2020) This menstrual bleeding is from the shedding of the uterine lining. Prostagalines rush to the site of uterine shedding, causing the smooth muscle in the uterine wall to contract, which results in painful cramping of the uterus and discomfort in surrounding organs.
"Dysmenorrhea is the occurrence of severe lower abdominal pain in women during menstruation. The pain often has a cramping nature and may radiate to the thighs or lower spine. Lower abdominal pain may be accompanied by vomiting, headache, back pain, diarrhea, fatigue, etc. Dysmenorrhea is classified as primary and secondary. Primary dysmenorrhea is characterized as pain resulting from excessive, pathological uterine contraction, without palpable, in clinical examinations, lesions within the lesser pelvis". (Barcikowska et al., 2020) In a study by Lundstorm & Green, they tested levels of prostaglandins in women, with and without dysmenorrhea. "In the group with dysmenorrhea, they showed that both the concentration of vasopressin and prostaglandin metabolites is statistically significantly higher in women with dysmenorrhea than in women without pain". (K. Green & V. Lundstrom & 1978) Prostaglandins also cause narrowing of the blood vessels that supply blood for the uterus, which causes increased sensitivity to the uterus and surrounding muscles.
Pain can be very discouraging and cause one to feel extremely lethargic, making it difficult to exercise. As a fitness professional, it is important to understand what your female clients and students are going through during these painful stages of their menstrual cycle. Due to increased prostaglandin production, causing pain in the pelvic area and restriction of blood flow, tightness in your lower back, hip flexors, and glutes can occur. Increasing blood flow through a modified warmup is key in helping to reduce pain. Certain stretches, yoga poses, light calisthenics and cardio (HR between 50-60%) can help warm up the body properly, and increase blood flow to the uterus and surrounding muscles. During my time as a trainer, I have had 2 female clients who significantly struggled with Primary Dysmenorrhea. Starting with light active stretching to open up the hip flexors, lower back, and activating the glutes is key. I typically will start with a circuit of 3-5 active stretches, performing 2-3 sets of 10 repetitions each. Some of these stretches include bringing one knee into the chest at a time from a supine position, figure-4 stretches, and a variety of psoas stretches. Once we get blood flow to the muscles, I start to introduce more dynamic movement, such as leg kicks, alternating lateral lunges, spinal twists, etc.. After this stage of the workout, it's important to check in with your client and assess their physical state and pain levels. If the pain starts to dissipate, we can start including more intensity, gradually getting the heartrate up with cardio and light strength training. Encouraging clients and students to repeat the warmup stretches before bed is also vital to continue proper blood flow to the uterus, helping to prevent additional pain throughout the night, and keeping them encouraged to continue to exercise.
References
Barcikowska, Z., Grzybowska, M. E., Hansdorfer-Korzon, R., Rajkowska-Labon, E & Zorena, K. (2020, February 13). Inflammatory markers in dysmenorrhea and therapeutic options. International journal of environmental research and public health. Retrieved February 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068519/
Green, K. & Lundstorm, V. (1978). Endogenous levels of prostaglandin f2alpha and its main metabolites in plasma and endometrium of normal and DYSMENORRHEIC women. American journal of obstetrics and gynecology. Retrieved February 11, 2022, from https://pubmed.ncbi.nlm.nih.gov/637076/
Welsh, C. J. (2020). Chapter 11, Page 306. In Hole's essentials of Human Anatomy & Physiology. MCGRAW-HILL EDUCATION.