Many women experience difficulties during the menstrual cycle, ranging from the emotional rollercoaster of PMS to painful cramping to heavy, debilitating flow. While many women consider this an issue solely for their Gyn to handle, it is important that women with a rheumatological disease understand that there is a deeper connection between these menstrual symptoms and their rheumatological disease!
1) PMS: The exact cause of PMS is still unknown but the most recent evidence points to neurotransmitter imbalances. Specifically, PMS is linked to alterations in GABA, Serotonin, and opioid levels. These neurotransmitters normally cause a relaxing, calming sensation within the nervous system, however, the complex neuroendocrine connections of the body cause a disruption in these neurotransmitters in the days before the menstrual flow begins. Interestingly, these same neurotransmitters are implicated in the pathogenesis of Fibromyalgia. If you suffer from PMS and Fibromyalgia, it is important to have these neurotransmitter levels tested to find if there is a link between the cause of these two conditions.
2) Painful Periods: Also known as dysmenorrhea, this condition is very common. Oftentimes, no cause for the painful cramping can be found. A thorough gyn exam and imaging usually reveals no cause for the pain. The latest research suggests that painful periods are due to an excess of an inflammatory prostaglandin called PGE2. This same prostaglandin also promotes inflammation and pain in women with rheumatoid arthritis. Indeed, a woman's painful periods may be a sign that PGE2 excess is occuring, which may indicate that the body is in an inflammatory state. Luckily, a diet rich in omega-3 fatty acids inhibits the production of PGE2. A women may choose to have her omega-3 levels tested, or simply load up on walnuts and wild salmon!
3) Heavy periods: Also known as menorrhagia, heavy periods often occur when there is too much estrogen in relation to progesterone. This can happen for a number of different reasons. First, if a woman does not ovulate, she will not make enough progesterone. This can cause heavy menstrual bleeding. Next, fibroids in the uterus can cause heavy bleeding. The presence of fibroids is a sign that the uterus is responsive to excess estrogen in the body. Another cause of heavy, painful bleeding is endometriosis. Endometrial tissue also responds to excess estrogen in the body. Ultimately, heavy periods may indicate that there is too much estrogen in the body. Estrogen is known to enhance a certain arm of the immune system, called the TH2 response. Women with Lupus have a dominance of TH2, which leads to autoantibody production and autoimmunity. For women with Lupus, the presence of heavy periods can indicate that estrogen dominance might play a role in the pathogenesis of the autoimmune disease. These women may want to have their hormones tested to determine if this is a contributing factor.
In summary, the human body cannot be separated into parts. A woman's gynecological symptoms cannot be separated from her rheumatological symptoms, and in fact, these symptoms give us a clue about contributing factors to rheumatological disease.