Menstrual-related problems in the workplace

More and more companies are changing how they look at menstrual-related problems in the workplace—creating menstrual policies and support systems to try and help their employees. Although this is a significant first step in many ways, it is not enough; we MUST tackle the root causes head-on.

A little-known connection between PMS & period issues such as period pain (dysmenorrhea) and gut health. (1)

Phase 1 and 2 estrogen detoxification happens in the liver; then, it’s transported in bile through the gut and eliminated by passing stools.

Certain gut bacteria manage estrogen metabolism, and certain bacteria can ‘unpackage’ estrogen by producing an enzyme called beta-glucuronidase. This can cause estrogen levels to increase, which can be a component of PMS / period issues. (2)

Painkillers are negatively associated with both gut and liver health, therefore affecting all 3 stages of estrogen detoxification.

Short and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause upper and lower GI damage, predominantly in patients with predispositions (Bjarnason et al., 2018). About 30 to 50% of NSAID users have endoscopic lesions in the GI tract. Small intestine permeability is present in 50–70% of long-term NSAID users, while inflammation is present in 60–70% of them (Tai and McAlindon, 2018) (3)

Other medications, including hormonal birth control, are correlated with causing poor gut health (4). The common scenarios of using painkillers for pill bleed pain (pill bleeds on the mini pill are not periods) or general use whilst also being on birth control places a lot of stress on the gut and liver. Compounding to make symptoms worse creates a further reliance on medications, and the vicious cycle continues.

So not only does just taking painkillers make the underlying problem worse you might be covering up something more serious such as Endometriosis, which does not get the attention it deserves. Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility. Endometriosis affects roughly 10% (190 million) of reproductive-age women and girls globally- WHO.

Endometriosis and gut health.

In a 2018 paper, the researchers concluded; “The authors have learned from their continuous study for the last 15 years that, as an inflammatory mediator, LPS could be the initial trigger and bacterial contamination its source in the intrauterine environment that could be the primary cause in the growth regulation of endometriosis” (Khan et al.).

This is one reason women with Endometriosis are more likely to experience IBS symptoms. Considering women with Endometriosis will probably use more painkillers, you can see how this becomes a vicious cycle.

In those who suffer from infertility, it’s thought to be prevalent in between 30 – 50% of cases. Considering the number of women affected and the painful / life-changing symptoms, the fact it takes, on average 8 years to get a diagnosis is incredibly sad and worrying.

Because of this, we cannot endorse menstruation policies and workplace support that promote this. Although these policies and support systems are a great first step in many ways, some of the features of these policies and support systems can be counterproductive and have dangerous implications; especially when there are natural alternatives which have been proven to be effective and treating these symptoms.

In the best case, you’re not addressing the underlying problem while making the root cause worse. Worst case, you’re covering up something more sinister that needs diagnoses and treatment.

A 2020 meta-analysis reviewed 9 studies assessing ginger, cinamon and fennel and their impact on period pain intensity and duration. Each of the three spices appeared appeared to reduce period pain intensity significantly, and cinnamon also reduced pain frequency. Additionally, in one study, ginger was even found to be as effective as NSAIDs in treating period pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328489/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871956/

We, of course, support occasional NSAIDs use as needed to manage pain, but we believe in informed consent and addressing the root cause, not just symptom management.

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