Every healthcare provider likely works with clients trying to manage dysmenorrhea. The Merck Manuals Online Dictionary, defines dysmenorrhea as the pelvic pain experienced during a menstrual period and is otherwise known as menstrual cramps. More than one in every two women suffers painful menstrual periods each month, and about one in four are so badly affected that they have to take time off from work or school. Fortunately, massage therapists have access to methods capable of reducing the agony associated with dysmenorrhea.
Understanding the distinction between the types of dysmenorrhea can assist a bodyworker’s treatment plan. While a massage therapist is not equipped to make this distinction, determining a client’s medical history can reveal the reasons behind their pain or can encourage a client to seek a physician’s care.
Primary dysmenorrhea has no identifiable cause and may affect more than 50% of all women, usually starting during adolescence. In 5 to 15% of those with primary dysmenorrhea, the pain is severe enough to interfere with daily activities and result in absence from work or school. The pain occurs only during menstrual cycles in which an egg is released, and likely results from prostaglandins released during menstruation. Prostaglandins are hormone-like substances that serve three primary functions: they cause the uterus to contract, reduce blood supply to the uterus and increase the sensitivity of nerve endings in the uterus to pain. Women with primary dysmenorrhea have measurably higher levels of prostaglandins.
Secondary dysmenorrhea indicates that a physical condition is responsible for menstrual pain. Some of the reasons a person may have secondary dysmenorrhea include endometriosis, fibroids, adenomyosis, pelvic congestion syndrome and pelvic infection. In a few women, the pain results from passage of menstrual blood through a narrow cervix (cervical stenosis). A narrow cervix may be genetic, or result from polyp removal or cervical treatment (for dysplasia or cancer of the cervix). Abdominal pain due to other disorders, such as inflammation of the fallopian tubes or abnormal bands of fibrous tissue between structures in the abdomen, may be worse during a menstrual period. If an increase in pain or a sudden change in the menstrual cycle occurs, a woman should consult a physician.
The Menstrual Experience
The experience of menstrual cramps can be different for all women. Some simply feel a passing discomfort with menstruation, while others could be doubled over in pain by it. Typically, the pain comes in cramp-like spasms, originating in either the lower abdomen or the lower back. The pain can remain centered in the body, radiate up the spine or down the legs; it may be accompanied by dizziness, nausea, vomiting or diarrhea in some women. These associated symptoms indicate clarification of etiology by a physician.
Mild primary dysmenorrhea typically causes women to experience pain a few hours before their periods start, and then eases once their menstrual flow begins. Occasionally, the pain continues into the second and even third day of their periods.
Prostaglandin’s Curse and Blessing
The hormone responsible for causing so many women pain has a critical role in preserving the perpetuation of our species. Each month the lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. If a pregnancy occurs, the fertilized egg attaches itself to the lining to be nourished as it develops into a baby. If the egg is not fertilized, the lining is not needed. Prostaglandins are then released, triggering the muscles of the uterus to contract and squeeze the lining out, resulting in menstruation. During childbirth, prostaglandins are released to contract the uterine muscles for pushing out the baby.
Altering the prostaglandin levels represents a chemically-induced way of relieving menstrual cramps. However, bodyworkers have other tools to provide dysmenorrhea relief:
1. Hydrotherapy – The use of heat has a long history of relieving menstrual cramps. Warmth increases circulation, thus reducing muscular tension. A warm bath or hot pack on the abdomen can bring enormous relief. An all-natural fiber hot pack using moist heat (such as the Therapac or Body Shawl) is a top choice by bodyworkers to reduce menstrual pain.
2. Acupressure – According to Alexis Phillips, a medical massage instructor and supervisor of the Peter Ling Clinic of the Swedish Institute in New York City, “the foot contains acupressure points that are believed to be connected along internal energy pathways to the pelvic area.” Phillips advises to feel for sensitive spots during menstruation in the depressions above either side of the heel and along the Achilles tendon. Traditionally, massage over the Kidney, Liver and Spleen meridians will balance hormone production. Acupressure on the foot and calf, specifically on tender spots found on the three mentioned hormone-related meridians, has the effect of reducing muscular tension and increasing uterine blood circulation.
3. Abdominal Massage – In addition to many Asian bodywork styles, abdominal massage is also part of many Swedish massage routines. Abdominal massage is a direct technique to increase uterine circulation, thus reducing localized muscular tension. A 2005 Korean study involved administration of abdominal meridian massage for 5 minutes per day during 6 days from the fifth day before menstruation to the first day of menstruation. Their results demonstrated that abdominal massage was a very effective treatment for dysmenorrhea.
4. Aromatherapy – Many women experience menstrual cramp relief with the use of aromatherapy. Certain essential oils are known to have relaxing effects on the mind and on cramping muscles. Some of the essential oils reputed for this specific use include rosemary, lavender, chamomile (German and Roman), cypress, clary sage, rose otto, ginger and marjoram. Blended with carrier oil, a therapist’s chosen essential oils can be gently applied to the abdomen, hips and lower back for immediate uterine cramp relief.
In conclusion, massage therapists have a myriad of options available to them to deliver pain relief to over half of their female clientele. Whether using heat therapy, acupressure, abdominal massage, aromatherapy or any variation, bodyworkers can reduce uterine spasms without hormone therapy or surgery.
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