How To Resolve Ovulation & PMS Cramping
I recently saw an article prescribing a square of dark chocolate a day to ward off menstrual cramps…..
The idea being that research has shown magnesium can help with cramps and chocolate as far as food goes is considered high in magnesium. Yum right?
For sure. But in my experience, this isn’t nearly enough to deal with tough period related cramps.
I love the idea of food being thy medicine, I’m a naturopathic doctor after all! And I love chocolate (like really love it), but if you’ve found this measly 40ish mg of magnesium didn’t put a dent in your cramps, don’t worry, it’s not you.
That is a very small dose of a mineral that so very many of us are deficient in as it’s used as a co-factor in around 300 chemical reactions in your body. And some of us due to adrenal stress issues or having PCOS are even more likely to be deficient because we pee out so many minerals thanks to our aldosterone imbalance (an adrenal hormone that helps regulate blood pressure and electrolyte balance).
Wondering if you’re low? Ideally you’d have your RBC (red blood cell) magnesium checked, which is the amount inside the red cell vs. the blood stream. This is a better indicator of stored and tissue levels of magnesium than the standard blood test. However, magnesium on a standard chem panel from you doc is pretty easy to come by and the value should be between 1.8 and 2.1, I like personally to see 2.0 to 2.2 mEq/L.
However if you’ve been under stress or have PCOS or any other hormone imbalance, it’s safe to say you’d benefit from a bit of magnesium.
Magnesium can be a tricky supplement because it is found various forms including oxide, glycinate, malate or citrate to name a few; and it is known to cause an upset tummy and possibly diarrhea at even fairly low doses.
This side effect is much worse with the oxide form and can happen for many with the citrate form as well. I’ve foudn the glycinate to be the best tolerated by a woman’s tummy and it provides a bit of glycine which is a useful amino acid for relaxation and sleep as well. I also see good results with other chelated forms such as magneisum malate and if mag glycinate doesn’t help you sleep, magnesium threonate may as it seems to get into the brain better (this is often called NeuroMag).
Back to your uterus: To nip cramps I often use 400-600mg per day. This is about 10 times more than a square of chocolate. But because of bowel issues, go up slow and see if you tolerate this dose a couple times per day and you need to take it throughout the cycle to boost your stores and make sure your body pool of magnesium comes up so that come period time there’s plenty left for the smooth muscle of the uterus to contract gently. You can also use a topical magnesium during your period or when you’re having cramps to give that tissue an added boost.
My other go to tool for lessening period cramping is balancing essential fatty acids. I use 1 gram evening primrose oil and 4-6 grams of omega 3 fatty acids from a fish source. It’s like magic.
If these things do not help then it’s important to look at estrogen dominance issues often seen in PCOS and other hormonal problems including endometriosis and fibroids and determine if the uterine lining is responding excessively to estrogen. As well it’s important to look at the balance of estrogen and progesterone to be sure it’s not low progesterone leading to more cramping.
This one is a bit different and is less related to nutrient status such as magnesium and EFAs. This type of cramping has to do more with the pain that arises from a follicle rupturing or “popping” in an attempt to release an egg (which may happen or may not, such as with PCOS where follicles are faulty and don’t always produce a healthy egg or in peri-menopause when ovarian egg reserve is dwindling).
This follicle “popping” so to speak is the result of that follicle releasing a burst of estrogen in response to the hormone FSH (follicle stimulating hormone). The follicle here is also known as a physiologic or functional cyst and is totally normal. This type of cyst should make estrogen and then become the corpus luteum which will make progesterone and they should come and go as part of a normal cycle.
Some women feel a twinge or slight cramp or sensation with ovulation, many women do not have any noticeable signs of ovulation and that’s also totally normal.
But sometimes that pain is not so slight, here are some reasons why:
+ Sometimes the cyst is just bigger. Larger ovarian cysts are more likely to cause pain even though larger ones aren’t any more “dangerous” than smaller ones.
+ Abnormal cysts on the ovaries can be uterine tissue on the ovaries (which shouldn’t be there) as part of endometriosis. This can range from slightly to extremely painful. They could also be a cystadenoma vs. a functional cyst which gets filled with thick fluid or blood and they can rupture or cause some twisting of the ovary and be quite painful. There could also be a dermoid cyst which is the funkiest thing we learn about in medical school in my opinion. It’s a cyst filled with different types of cells including possibly hair or teeth. Usually these are also painless but can become larger and more painful.
+ PCOS or polycystic ovaries. In many cases of PCOS there are multiple faulty follicles that don’t respond properly to normal hormonal signals and don’t release an egg. The cysts are like little water balloons and not usually painful, but they can be.
+ Finally while a small amount of pressure or sensation – even a bit of bloating – is normal with ovulation, more pain or increased bloating can be an indication of more serious issues like gallbladder problems or adhesion (tissue sticking to other tissue) due to past infections (i.e. STDs such as chlamydia, which is often symptom-less, or post childbirth) or due to past pelvic or abdominal surgery. Many women experiencing adhesions also can have pain during intercourse.
With all of these various types of ovulation pain it would be important to treat the cause of the pain which could range from estrogen metabolism support (i.e. endometriosis, PCOS), follicle health and response (PCOS, insulin resistance, etc.) or treat the infection or adhesions.
As for chocolate…..
You can totally still have chocolate. Unless of course you are, like me, dealing with PCOS and chocolate ramps up your cravings for lots and lots more chocolate, then maybe be thoughtful with how you medicate those cramps.
For me chocolate, like wine, is something I enjoy from time to time as I consider it a food that “doesn’t work well for me” (more on that type of thinking here). I have it once in awhile but not every day and I know it exacerbates my insulin resistance which is at the crux of PCOS so I think twice about relying on that for my cramps or daily cravings when I have other options that may work better for my physiology and goals.
But let’s not totally eschew using chocolate. It’s got some magnesium but it’s also got some other great stuff as well like antioxidants and phenylalanine which boosts dopamine and can help with cravings, mood and focus. So if you’re like me and want to harness chocolate but want to be mindful of sugar try this: 1 heaping tbsp of organic cocoa powder + natural low carb sweetener of your choice (few drops of stevia, tsp xylitol or pack Truvia) if you tolerate these natural sweeteners (can cause digestive upset for some). Pour over with boiling water and voila! You’ve got a craving fighting, sweet tooth satisfying, mood boosting, yummy treat that won’t perturb your hormones.
Here’s to a painless period!
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