Cyclical digestive pain every month like clockwork
June 26, 2017 9:45 PM Subscribe
Every month, for 1-2 days, I get pain and bloating that goes from the bottom of my ribcage to my pubic area. It feels like I am full of air/gas. If I press on my stomach, it feels tender. After 1.5 - 2 days, the gas begins to expel, odorlessly, and I feel completely better.
When it first started happening, I went to my GP. She ran blood work, including for celiac. Everything was normal except for anemia. She RX'd iron tablets and I took them. She had me get a stomach ultrasound, which turned up nothing. She suggested I try out some dietary changes to see if anything happened. I gave up added sugar, caffeine, alcohol, dairy, soy, wheat, rice, legumes, and potatoes for nine months. No changes. At this time I did start tracking what I ate and when the pain arrived, and this is when I discovered that it happens on the 20th day of my cycle.
So I went to my Gyn. She didn't palpate anything out of the ordinary, and said it was probably related to progesterone at that point in my cycle, and that I could do extra and vigorous exercise at that time of my cycle in order to speed up digestion to counter the progesterone, which slows digestion.
Some months I've been able to to do the extra exercise and some months I haven't (schedule issues). If it makes a difference, it is only modest (less pain, quicker to resolve).
What else can I look at? My other factors are:
- female, age 45. Normal weight, no medications, regular cycle. Moderately active ("core" yoga 3x a week, walking). Eat whole foods. Nonsmoker.
- Copper IUD, placed two months before this pain started.
When it first started happening, I went to my GP. She ran blood work, including for celiac. Everything was normal except for anemia. She RX'd iron tablets and I took them. She had me get a stomach ultrasound, which turned up nothing. She suggested I try out some dietary changes to see if anything happened. I gave up added sugar, caffeine, alcohol, dairy, soy, wheat, rice, legumes, and potatoes for nine months. No changes. At this time I did start tracking what I ate and when the pain arrived, and this is when I discovered that it happens on the 20th day of my cycle.
So I went to my Gyn. She didn't palpate anything out of the ordinary, and said it was probably related to progesterone at that point in my cycle, and that I could do extra and vigorous exercise at that time of my cycle in order to speed up digestion to counter the progesterone, which slows digestion.
Some months I've been able to to do the extra exercise and some months I haven't (schedule issues). If it makes a difference, it is only modest (less pain, quicker to resolve).
What else can I look at? My other factors are:
- female, age 45. Normal weight, no medications, regular cycle. Moderately active ("core" yoga 3x a week, walking). Eat whole foods. Nonsmoker.
- Copper IUD, placed two months before this pain started.
I have period-related digestive issues that sound similar to this, and have noticed it doesn't seem to happen if I'm eating very high fiber for a week or so starting a couple days before my period. Like, eating steel cut oatmeal and dried fruit for breakfast every day plus a salad for lunch.
The other thing to try might be avoiding whatever usually causes gas for you - vegetables like cucumber, broccoli, cabbage, cauliflower; beans; etc. Just for a few days when you'd usually get the pain and see if it helps a little. You could also try to eat simpler foods that are faster to digest, in general, if it is "digestion slowing down".
posted by Lady Li at 12:22 AM on June 27, 2017
The other thing to try might be avoiding whatever usually causes gas for you - vegetables like cucumber, broccoli, cabbage, cauliflower; beans; etc. Just for a few days when you'd usually get the pain and see if it helps a little. You could also try to eat simpler foods that are faster to digest, in general, if it is "digestion slowing down".
posted by Lady Li at 12:22 AM on June 27, 2017
I get period-related digestive issues sometimes too, and a friend who is a nutritional therapist advised me that it's not uncommon, and that it might help to cut out sugar and refined carbs for the week around my period.
It works, but I'm not gonna lie - sometimes I manage to get through it without chocolate, and sometimes I ruddy well do not.
posted by greenish at 3:55 AM on June 27, 2017 [4 favorites]
It works, but I'm not gonna lie - sometimes I manage to get through it without chocolate, and sometimes I ruddy well do not.
posted by greenish at 3:55 AM on June 27, 2017 [4 favorites]
My physician advised me to use NSAIDs (I like naproxen sodium) to treat not just the pain, but other progesterone-based symptoms of my period (which include digestive stuff sometimes). I start taking 2-3 a day a day or two before my period, and that's helped a lot.
posted by spindrifter at 5:43 AM on June 27, 2017
posted by spindrifter at 5:43 AM on June 27, 2017
Very common! In one study (Bernstein et al 2014) 73% of the healthy volunteers (n=107) had some GI issues, including pain, nausea, and diarrhea before and during their periods. Constipation is also common in pregnancy for the same reason. Progesterone.
So it's normal. But maybe the IUD is changing your hormones so that you're getting worse symptoms? It might be worth investigating a different contraceptive if it's really bothersome.
posted by epanalepsis at 6:36 AM on June 27, 2017
So it's normal. But maybe the IUD is changing your hormones so that you're getting worse symptoms? It might be worth investigating a different contraceptive if it's really bothersome.
posted by epanalepsis at 6:36 AM on June 27, 2017
Mid-40s, no IUD, and for the last 2 years I get diarrhea before my period. My GYN and I attribute it to how hormones fluctuate as the years go by. I swig of Pepto-Bismol knocks it out for me.
That said, next month I'm going to try the NSAID-in-advance advice.
posted by kimberussell at 7:25 AM on June 27, 2017 [1 favorite]
That said, next month I'm going to try the NSAID-in-advance advice.
posted by kimberussell at 7:25 AM on June 27, 2017 [1 favorite]
NSAIDs in advance + avoiding gas causing foods (and drinks; I love beer but it's a no go for 2-3 days a month) much more than you would at other times helps tremendously with this. Also, the pain component will likely go down as you get more months out from the Paragard being new. At least those were the anecdotes I read, dismissed as anecdata, and then had hold true for me after ~6 months.
posted by deludingmyself at 7:54 AM on June 27, 2017
posted by deludingmyself at 7:54 AM on June 27, 2017
Maybe not the same, but during perimenopause I had, I think, increased appetite once a month and then after dinner nausea, abdominal distress and usually vomiting at midnight, after which I would feel better. Usually preceded by a runny nose. Didn't pay attention to where in my cycle it actually fell. Later in life I did get a Mirena because my estrogen level was high relative to other hormones. My high estrogen may be coming from my body fat.
posted by puddledork at 10:28 AM on June 27, 2017
posted by puddledork at 10:28 AM on June 27, 2017
Bloating has always been a PMS symptom for me, it hadn't ever occurred to me to tell a doctor about it. It might be that you've been lucky all this time, and you've just drawn yet another delightful freakin' wildcard of perimenopause.
I usually have to use Gas-X at some point, though one dose seems to be enough to break the chain until the next cycle. There's not a ton I've been able to accomplish with dietary changes, except like someone else said beer is the worst. Like, almost unable to speak sort of pain, which will pass once I can lay down and let everything work its way toward the exit. Most of the rest of the bloating is just a loose-pants situation but that one's bad. That started around 42 for me, and not long after my cycle started getting unpredictable so now I'm rolling the dice every time I drink a beer.
posted by Lyn Never at 2:19 PM on June 27, 2017
I usually have to use Gas-X at some point, though one dose seems to be enough to break the chain until the next cycle. There's not a ton I've been able to accomplish with dietary changes, except like someone else said beer is the worst. Like, almost unable to speak sort of pain, which will pass once I can lay down and let everything work its way toward the exit. Most of the rest of the bloating is just a loose-pants situation but that one's bad. That started around 42 for me, and not long after my cycle started getting unpredictable so now I'm rolling the dice every time I drink a beer.
posted by Lyn Never at 2:19 PM on June 27, 2017
I think halogen is right that it's your copper IUD.
At some point late in your cycle, your body thriftily reabsorbs what it can from the lining of your uterus in preparation for your period, and picks up a little too much copper in the process, I'd guess.
The body sheds excess copper by putting it in bile salts produced by your liver and which empty into your intestines, where I would say they encourage the production of hydrogen and or methane gas by certain bacteria (hydrogen or methane because it turns out to be odorless), possibly because copper is toxic to most but not all bacteria, and consequently encourages activity by those that aren't as affected by it.
The fact that you experience this bloating from your ribcage to your pubic area instead of just in your abdomen makes me think the bacteria in question could be in your small intestine, where bacteria tend to be either hydrogen producing or methane producing. It might be worth trying to get your GP to give you a hydrogen breath test during the period of bloating.
According to the Mayo clinic, anemia is one of the risks of the Paraguard copper IUD, and since copper is a known cause of hemolytic anemia, that you seem to be anemic to some degree might be another indicator that you're picking up copper from your IUD.
posted by jamjam at 5:17 PM on June 27, 2017
At some point late in your cycle, your body thriftily reabsorbs what it can from the lining of your uterus in preparation for your period, and picks up a little too much copper in the process, I'd guess.
The body sheds excess copper by putting it in bile salts produced by your liver and which empty into your intestines, where I would say they encourage the production of hydrogen and or methane gas by certain bacteria (hydrogen or methane because it turns out to be odorless), possibly because copper is toxic to most but not all bacteria, and consequently encourages activity by those that aren't as affected by it.
The fact that you experience this bloating from your ribcage to your pubic area instead of just in your abdomen makes me think the bacteria in question could be in your small intestine, where bacteria tend to be either hydrogen producing or methane producing. It might be worth trying to get your GP to give you a hydrogen breath test during the period of bloating.
According to the Mayo clinic, anemia is one of the risks of the Paraguard copper IUD, and since copper is a known cause of hemolytic anemia, that you seem to be anemic to some degree might be another indicator that you're picking up copper from your IUD.
posted by jamjam at 5:17 PM on June 27, 2017
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posted by halogen at 9:52 PM on June 26, 2017 [3 favorites]