Cramps and PMS have become pretty standard terms in the standard American language. Just like acid reflux, low back pain, and chronic tiredness, we’ve come to embrace horrible periods as a fact of life, not as a sign that maybe some of the things we’re doing on a regular basis are pushing us into a pathologic type state of health.
Some of the problem, I believe, is a problem of wording. There is a place (especially in younger women with developing endocrine and reproductive systems) for your regular, run-of-the-mill uterine cramping during menstruation. That can be entirely normal and it makes intuitive sense that an organ contracting may cause some pain.
Unfortunately, cramping can also be used to describe lower abdominal pain so severe that is causes women to stay home from work/school/regular activities, is accompanied by sweating, dizziness, nausea/vomiting (aka: vasomotor symptoms), and gastrointestinal symptoms that you wouldn’t wish on your worst enemy. Sure, we can all these “cramps” as well…but I think it’s fairly easy to see why this scenario is entirely different from the first and warrants some serious health digging.
Stress and Cramps
To makes matters more complicated, a woman can travel between these two extremes from month to month. Some months, a period can come and go with just some minor inconveniences. (Ever go on vacation and have a period that is surprisingly benign?) Other months, a woman may find herself completely flattened for a few days.
One reason for this, as many women have accurately noticed, is determined by their stress state. In this post, I’d like to explain why this happens and why your period course is actually determined weeks before it actually happens. So let’s get started!
Side Note: what we won’t be discussing here are structural causes of cramps such as adhesions (scarring) in the pelvis. Women with these problems have more going on than just the endocrine and autonomic nervous system so they will require further interventions to deal with the symptoms. However (this is a big however!), most women with these problems usually have a change in stress response as well so the topics we will be talking about today may still apply!
We’re going to be talking about 2 main systems in the body for this topic: the autonomic nervous system and the hormonal/endocrine system.
The Hormonal/Endocrine System
This system is the one most talked about when it comes to severe cramps. This system, turns out, all starts in your head. The hypothalamus (a dangly organ below your brain) is in charge of sending out appropriately timed signals to the pituitary, thyroid, and adrenals. These three organs, in turn, communicate a lot of information to the ovaries about when it’s time to do certain things. The ovaries respond to these signals by maturing an egg and making sex hormones, namely progesterone and estrogen.
Estrogen dominates in the first half of the cycle and encourages the the uterus to make a nice endometrial lining for an embryo to implant. By the second half of the cycle, progesterone steps up to thicken and stabilize this lining so that the embryo can actually stick around to develop. (I’m talking about it in baby terms because that the reasoning behind why your body is doing what it’s doing. But even if you don’t care about getting pregnant, you’ll see below why this matters for you!)
When there are inappropriate changes to the quantity and timing of estrogen and progesterone release, changes to the uterine lining directly impact the quality, duration, and painful-ness of our periods. The two most common hormonal imbalances are when estrogen is too high and progesterone is too low.
High estrogen levels (whether they are high in the absolute or in relation to progesterone sense) can cause the lining of the uterus to become overly thick and irregularly stacked. When the lining sheds, there is disordered bleeding and inflammation that happens which leads us to have heavy periods and painful cramps.
Low progesterone causes instability of the uterine lining which can lead to pre-period spotting and a disorderly shedding of the lining when period time actually arrives. Even though you would thinking shedding is shedding is shedding and the way the lining sloughs off wouldn’t matter…but it does when it comes to causing you pain!
Because high estrogen and low progesterone usually feed into one another, a disorderly shedding of an abnormally thick lining is what really does you in.
Stress and the Hormonal/Endocrine System
The way stress plays a role in messing with estrogen and progesterone levels is incredibly complex and interferes at a variety of points in the cycle. It’s also the reason that your stress levels determine how your period will go weeks before it actually happens.
Stress is registered first at the level of the hypothalamus and this organ uses the information to determine whether the body is at a good spot to reproduce or not. If stress levels are abnormally high or constant, the hypothalamus will change the frequency and intensity of the signals it sends to the pituitary, thyroid, adrenals, and ultimately the ovaries. This means hormonal synthesis and release won’t happen as they normally should…and symptoms will rear their ugly heads.
Stress will also directly impact what’s going on at the level of the adrenals. Since cortisol (the “stress hormone”…though it’s definitely not all bad!) and progesterone share a common precursor, pregnenolone, the production of excess cortisol will come at the expense of too little progesterone being made.
Side Note: having problems with your hormonal system that are making you miserable? Megan of GingerNewtrition and I have teamed up to create a Healthy Hormones Group Program that is specifically geared to help women with their hormonal and stress problems. We’re soon coming out with a FREE video training series about adrenal health so keep your eyes peeled for that by signing up for our emails!
The Autonomic Nervous System
The autonomic nervous system isn’t talk nearly enough about when it comes to our health, in my opinion. Because when it comes to cramps and painful period problems, it plays an enormous role!
The autonomic nervous system is made up of the compilation of nerves that travel from your brain, out from your spinal cord, and out to your organs and governs everything you do…from breathing to beating your heart to making you sweat. This roadmap of signals is why you can think of an embarrassing incident that happened to you 5 years ago and physically blush right now. It’s why our thoughts–and therefore our stress levels–have real and powerful influences over the normal functioning of our organs.
Note: I have several posts on how nerves work in our body from the level of the brain to the rest of the body so check those out if you’re interested in learning more. How Nerves Work, Thoughts and the Central Nervous System, How Our Internal Environment Affects Our Neurons.
Norepinephrine is one of the most commonly used stress compounds in the autonomic nervous system. (Again, it’s important to note that norepinephrine isn’t actually bad. Without it, you wouldn’t be able to do anything you do. Abnormal amounts and inappropriate signaling is where we go wrong!) When we get stressed, norepinephrine is released throughout the body to help us deal with whatever is going on.
Norepinephrine, just like any other signaling molecule in the body, acts on receptors and the action on those receptors determines what we feel. There are many kinds of receptors and each organ systems has a unique (and ever changing!) collection of receptors for norepinephrine to act on.
The uterus, as it turns out, has a unique set of receptors for epinephrine as well. Unfortunately for us, norepinephrine only acts on the receptors in the uterus to make it contract harder (beta-1, for all you science nerds out there) but not on the receptors that cause it to relax (beta-2). While there are normally plenty of other signaling molecules that make the uterus relax, a stressed state where norepinephrine prevails–especially in a setting of a period–has real and unpleasant consequences for our pain levels.
Our autonomic nervous systems is constantly responding to our internal and external environment on a microsecond by microsecond level. (It’s even faster than that but you get the picture.) However, the body is also really good at learning patterns so it will get good at doing whatever you most often ask it to do (it’s efficient like that!). Constant stress in the body will set up an environment where the body is primed and ready to react to stress. When it comes to painful periods, it’s not just our stress levels at the moment we’re having cramps–though that matters as well–but our stress levels in the recent past that will determine our symptoms.
As you can tell, there’s nothing simple when it comes to female menstrual cycles! And there are a lot of things that can impact the quality, duration, and pain levels associated with our periods.
But, I believe, understand why things happen the way they do is a powerful motivation for us to take our health into our own hands and make positive changes accordingly. Sure, our stress levels won’t just magically go away just because we want them to…but we can certainly take steps to deal with our stressors in a more proactive and healthful manner.