The Hormone Cafe

In this episode of The Hormone Café, Dr. Sarah Pederson, holistic OB-GYN and founder of Vera Health and Fertility in Westminster, Colorado, dives into the topic of painful cycles. She breaks down what a normal period looks like versus a painful cycle, explores the different causes, how to properly evaluate your pain, and shares treatment strategies to help reduce discomfort.

In This Episode, You’ll Learn:

💡 Definition & Differential Diagnosis

• Normal periods should allow you to function without needing excessive pain relief.
• Signs your cycle may be too painful: severe cramps requiring multiple ibuprofen doses, missed school/work, or reliance on heating pads for hours.
• Potential causes include:
  1. General inflammation (autoimmune issues, gut inflammation, leaky gut)
  2. Endometriosis or scar tissue on/around the uterus
  3. Adenomyosis (inflammation within the uterine walls)
  4. Endometritis (infection inside the uterus)
  5. Cervical inflammation
  6. Vaginal dysbiosis or infection
     

🩺 Workup of a Painful Cycle

• Labs: ANA, ESR, CRP to check for inflammation or autoimmune conditions
• Gut health testing for leaky gut or bacterial overgrowth
• Imaging: ultrasound or MRI to detect adenomyosis, cysts, or swelling
• Procedures: biopsy, laparoscopy, or vaginal swabs to check for endometriosis, infections, and bacterial imbalances
• Comprehensive evaluation is key, especially if prior treatments (like endometriosis surgery) did not fully relieve pain
  

🌿 Treatment & Management

• Lifestyle & Nutrition: Anti-inflammatory diet (low sugar, high magnesium, leafy greens, protein), regular exercise for blood flow
• Supplements: Omega-3, curcumin (turmeric), magnesium
• Medical Interventions:
  • Surgery for endometriosis or scar tissue
  • Antibiotics and probiotics for endometritis or vaginal infections
  • Long-term inflammation management for adenomyosis
• Advocate for yourself: proper evaluation can uncover treatable causes and significantly reduce period pain
  

Key Takeaways:

• Painful cycles are not “normal”—you should be able to function on your period.
• Multiple factors can contribute to pain, from gut inflammation to endometriosis and infections.
• A thorough evaluation is essential to identify and treat underlying causes.
• Lifestyle, diet, supplements, and medical interventions can all help reduce discomfort.