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Period Pain and Massage


Period pain, premenstrual tension, endometriosis and massage

There are many different reasons so many of us experience period pain, from light cramping to debilitating symptoms that interfere with our everyday life.

In this post, we will explore how massage, especially abdominal massage, can help alleviate period pain and cramping, pelvic pain and low back pain associated with menstruation and how it can be a management tool alongside other conventional therapies.


What causes period pain?

Period pain can be described as a dull ache to a sharp pain in the lower abdomin and can extend into the low back and thighs. It usually occurs in the preceding hours to a few days before your period starts and can last into the first few days of your cycle (NHS, 2022). It should be mild enough to not affect your daily activities, and may be reduced with warm compresses such as a hot water bottle or wheat bag, a bath, gentle exercise, massage and painkillers such as paracetamol or ibuprofen, if suitable (NHS, 2022). Period pain is usually caused by normal contractions of the smooth muscle of the uterus (womb). However, period pain can also be a sign of pathology such as endometriosis (where the cells that make up the lining of the uterus end up in other places they shouldn't be, such as on the fallopian tubes, ovaries and pelvic cavity) and/or adenomyosis (where the uterine cells start to grow into the muscle of the uterus abnormally) See Images below. (WHO, 2023). Endometriosis and adenomyosis can cause 'period' pain or pelvic pain throughout your cycle, pain during sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal pain, bloating, nausea, heavy bleeding during periods, fatigue and sometimes anxiety and depression and issues with fertility. When the cells that usually line the uterus move elsewhere within the body, they continue to behave as they usually would within the uterus. They grow and shed in a cyclical fashion alongside your menstrual cycle, and this can cause inflammation, pain and scar tissue, adhesion and fibrosis wherever they are located (WHO, 2023). There is currently no cure for endometriosis and treatment options are focused on managing symptoms. Pain relief can be in the form of painkillers, and anti-inflammatories (NSAIDS). Hormonal treatments to stop menstruation such as the oral contraceptive pill (OCP), implants, injections or patches, hormonal intrauterine devices (IUD) such as the mirena coil, can reduce or in some cases, stop periods and associated symptoms. However, hormonal treatments are not suitable for all and for those who are trying to get pregnant. Early diagnosis and management can slow down the progression of endometriosis until you go through menopause and menstruation ceases. This often resolves all symptoms although some cases of endometriosis persist in postmenopausal patients (Secosan, et al. 2020).


Endometriosis and period pain massage
Endometriosis

Adenomyosis and period pain massage
Adenomyosis

Period pain can also be caused by fibroids, infection of the uterus, fallopian tubes or ovaries, cysts on the ovaries (such as polycystic ovaries, or polycystic ovarian syndrome, PCOS), pelvic inflammatory disease, or an intrauterine device (IUD) in the first 3-6 months after it's been fitted (NHS, 2022). It is advisable to seek medical advice if you feel that your period pain affects your everyday life, if it is accompanied with other symptoms such as heavy blood flow, bleeding or spotting between periods, any of the symptoms listed above for endometriosis and adenomysosis, or that your symptoms are worse than normal or cannot be managed by over the counter painkillers, or if you experience pain during or after sexual intercourse, or whilst using the toilet (NHS, 2022).


How can massage help?

  1. Pain relief Massage, especially abdominal massage, has been shown to relieve muscle tension and reduce pain in the abdomin and surrounding areas by reducing stress and increasing circulation (Valiani et al., 2010 and Wurn et al., 2011). Abdominal massage has been shown, over time, to decrease the duration, pain and excessive menstrual bleeding (Wang et al., 2022).

  2. Stress reduction Our experience of pain heightens during times of stress, so massage can help reduce stress and anxiety which in turn can reduce our experience of pain (Field, 2014). Chronic stress can wreak havoc on our hormones, leading to irregular and heavier periods. Cortisol (a stress hormone) raises blood sugar levels, designed to help with the fight or flight mechanism by giving your muscles energy to leg-it, but if prolonged, this can tire out your insulin mechanism (which is in control of reducing blood sugar and storing it as glucose), leading to pre-diabetes and diabetes. This delicate hormonal balance is particularly sensitive in those with PCOS and those who are perimenopausal who already may be experiencing irregular or heavy, painful periods. By engaging in regular relaxation such as meditation, yoga, mindful activities and massage, it can help reduce cortisol levels and the negative effects chronic stress can have on our menstrual cycle (Hamidovic, et al., 2020).

  3. Better sleep Massage and relaxation helps better sleep, and this is essential when dealing with pain. Being well-rested helps our bodies cope with period pain and any associated symptoms or conditions, reduces inflammation and aids healing.

  4. Balance hormones Massage and other relaxation techniques helps reduce the activity of your sympathetic nervous system (involved with fight or flight), so that your parasympathetic nervous system can work properly (responsible for 'rest and digest' where your body has it's best chance of healing and regulating). Your sex hormones (oestrogen, progesterone, leutinising hormone, work in a delicate balance with each other and vary throughout your menstrual cycle. Stress hormones adrenalin and cortisol, can interfere with this balance of oestrogen, progesterone, follicle stimulating hormone and leutinising hormone. This can result in a delay or lack of ovulation and changes in length of your menstrual cycle, heavier flow and greater cramping of the uterus (NHS, 2023).


In conclusion, massage and abdominal massage can be a really useful tool in managing and reducing period pain and cramping, and associated low back and pelvic pain, reduce heavy flow, improve regularity of your cycle and reduce PMS. There are many different causes of period pain and if you find that it interferes with you everyday activities, is worsening or sudden, causes pain whilst using the toilet or during or after sex, or you are concerned, then a trip to your GP is adviseable. If you suffer from period pains, endometriosis, PCOS or other causes of pelvic pain, feel free to get in touch to see how massage therapy could help you manage and reduce your symptoms.



Reference:

Field, T. (2014). Massage therapy research review. Complimentary Therapies in Clinical Practice 20(4). pp.224-229 [Online] Available at: Massage therapy research review - ScienceDirect (Accessed 13.11.23).


Hamidovic, A., Karapetyan, K., Serdarevic, F., Choi, SH., Eisenlohr-Moul, T., and Pinna, G. (2020). High circulating cortisol in the follicular vs. luteal phase of the menstrual cycle: A meta-analysis. Frontiers in Endocrinology 11. [Online]. Available at: Frontiers | Higher Circulating Cortisol in the Follicular vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis (frontiersin.org) (Accessed 14.11.23).


NHS (2023). Irregular periods [Online]. Available at: Irregular periods (nhsinform.scot) (Accessed 20.11.23).


NHS (2022), Period Pain [Online] Available at: Period pain - NHS (www.nhs.uk) (Accessed 09.11.23).


Secosan, C., Balulescu, L., Brasoveanu, S., Balint, O., Pirtea, P., Dorin, G. and Pirtea, L. (2020). Endometriosis in Menopause - Renewed AttentionOn a Contraversial Disease. Diagnostics (Basel) 10(3) pp.134 [Online] Available at:Endometriosis in Menopause—Renewed Attention on a Controversial Disease - PMC (nih.gov) (Accessed 10.11.23).


Valiani, M., Ghasemi, N., Bahadoran, P., Heshmat, R. (2010). The effects of massage therapy on dysmenhorrea caused by endometriosis. Iranian Journal of Nursing and Midwifery Research 15(4) pp167-171 [Online] Available at: The effects of massage therapy on dysmenorrhea caused by endometriosis - PMC (nih.gov) (Accessed 13.11.23).


Wang, G., Zhang, Z., Sun, J., Li, Z., Chu, Y., Zhao, D., Ju, H., Wu, X. and Cong, D. (2022). Abdominal massage: A review of clinical and experimental studies from 1990-2021. Complimentary Therapies in Medicine 70. [Online]. Available at: Abdominal massage: A review of clinical and experimental studies from 1990 to 2021 (sciencedirectassets.com) (Accessed 13.11.23).


WHO (2023). Endometriosis [Online] Available at: Endometriosis (who.int) (Accessed 10.11.23).


Wurn, BF., Wurn, LJ., Patterson, K., King, CR., Scharf, ES. (2011). Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual physical therapy: Results from two independent studies. Journal of Endometriosis 3(4) pp.188-196 [Online] Available at: Decreasing Dyspareunia and Dysmenorrhea in Women with Endometriosis via a Manual Physical Therapy: Results from Two Independent Studies - PMC (nih.gov) (Accessed 13.11.23).


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