Period pain is often treated as something women are simply expected to tolerate. The message that painful periods are part of life lands early and lands often, even when the pain is severe enough to stop someone working, resting, eating, or moving comfortably. Recurrent, exhausting, disruptive pain deserves proper attention rather than dismissal, and a clearer picture of why it happens is one of the most useful places to start.
Period pain and endometriosis sit at the intersection of several systems at once. Inflammation, prostaglandin biochemistry, nervous system wiring, hormone signalling, and chronic stress responses all interact, and they shape both the experience of the pain and how it changes over time. In endometriosis, that interaction can lock the body into a recurring pain cycle that affects digestion, energy, mood, and daily functioning far beyond the menstrual window itself.
Quick answer: Period pain and endometriosis are linked through inflammation, prostaglandins, nervous system sensitivity, and chronic stress responses in the body. Mild cramping during a period can be common, but significant pain is not normal. Understanding why pain happens is the first step toward reducing fear, describing symptoms clearly, and using practices that calm the nervous system.
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takes 3 minutes to completeUnderstanding period pain starts with understanding pain itself. Pain is not automatically a bad thing. In many situations it is protective, alerting the body to danger and helping prevent further injury. A cut, a burn, or a sharp pressure sends danger signals through nerve receptors, up the spinal cord, and into the brain, which then registers the sensation and helps the body respond quickly. The system is designed to react fast when it senses a threat.
Pain signals begin through a network of nerve fibres and receptors throughout the body. These receptors respond to different kinds of stimuli, including mechanical pressure or pinching, heat such as burning or extreme warmth, and chemical signals such as inflammatory substances. Once a threat is detected, the signal travels to the brain, which interprets what is happening and decides how serious it is.
What is often missed is how much context shapes that interpretation. The same physical event can feel more or less intense depending on previous experiences with pain, trauma or fear associated with previous pain, current stress levels, and whether the body feels calm or threatened. This is why pain can feel worse when someone is exhausted, stressed, overwhelmed, or emotionally depleted. The brain does not interpret pain in isolation. It reads it in the context of the whole system.
This is one of the most important questions, and the answer is clear. Period pain is common, but it is not normal when it is significant. Slight cramping may happen during menstruation. Pain that requires regular painkillers, stops normal functioning, or spreads beyond mild discomfort should not be brushed off.
This content is for educational purposes only. It has been reviewed for scientific accuracy, but it does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional regarding medical questions or fertility treatment decisions.
Reviewed for scientific accuracy by: Dr. Mona Bungum
Last reviewed: May 2026
Lifestyle matters for fertility. A BMC Public Health study found that women with 4–5 healthy habits had a 59% lower risk of infertility.
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takes 3 minutes to completeThe distinction between common and normal matters because so many women are told their pain is expected. That message delays support, delays diagnosis, and creates confusion about what the body is trying to communicate. Many people who have rebuilt their relationship with period pain through nutrition, nervous system support, and clinical care report moving from heavy painkiller reliance to needing none, which suggests that severe pain is not something the body has to stay stuck with forever.
When painful periods are normalised, people stop questioning what is happening. Asking the right questions earlier, and supporting the body with practical self-care for period pain alongside any clinical care, often makes a meaningful difference to how the experience evolves.
Two clinical terms help describe period pain more accurately: primary dysmenorrhea and secondary dysmenorrhea. They are useful both for understanding your own symptoms and for speaking more clearly with clinicians.
Primary dysmenorrhea refers to pain that appears around the first three days of menstruation. It is the type of pain most people think of when they hear the phrase 'period pain' and is tied closely to the menstrual phase itself.
Secondary dysmenorrhea is different. The pain can happen at other times during the month and may show up in several areas or situations. It includes pain with bowel movements, pain when urinating, pain around ovulation, pain during sex, ongoing pelvic pain, and ongoing back pain. This pattern suggests something more complex than typical menstrual cramping.
For someone with endometriosis, secondary dysmenorrhea is often part of a much wider chronic pain picture. A complete guide to endometriosis is often the clearest way to see how the menstrual symptoms fit into the broader condition and what to expect over time.
Period pain is largely chemical-induced pain. It is driven by inflammatory compounds in the body rather than by a cut, burn, or physical injury. The key compounds involved are prostaglandins, hormone-like chemicals that help trigger the breakdown and shedding of the uterine lining during menstruation.
The complication is that not all prostaglandins act in the same way. There are broadly two patterns: anti-inflammatory prostaglandins, linked to omega-3 fatty acids, and pro-inflammatory prostaglandins, linked to omega-6 fatty acids. Neither omega-3 nor omega-6 is automatically harmful. The issue is the imbalance between them.
In a Western-style diet, omega-6 intake is often much higher than omega-3 intake, sometimes by a ratio of around 20 to 1 when a balanced ratio would be closer to 1 to 1. That imbalance pushes the body toward producing more pro-inflammatory prostaglandins. Since the uterine lining has prostaglandin receptors, this influences how strongly the uterus contracts and how painful menstruation becomes. Targeted anti-inflammatory strategies can directly shift this balance.
This is also part of why a structured diet for endometriosis often produces noticeable changes in pain over weeks rather than days. The body responds to the biochemical environment it is given, and consistent inputs slowly change what it produces.
Research suggests that women with endometriosis can produce up to four times the amount of pro-inflammatory prostaglandins compared with women who are not in pain. This helps explain why menstruation can feel so severe in endometriosis. The tissue is already inflamed, and the body is also generating stronger chemical pain signals on top of that.
It is also why anti-inflammatory nutrition matters so much in endometriosis care. The body is not just reacting to tissue. It is reacting to an inflammatory biochemical environment that drives stronger contractions, sharper pain, and more sensitivity overall.
Endometriosis affects more than the experience of pain. The same inflammatory environment is part of why endometriosis and infertility are so commonly linked, with the pelvic environment influencing both menstrual symptoms and the wider reproductive picture.
Acute pain and chronic pain are not the same. Acute pain happens when something hurts, the body reacts, and then healing follows. Chronic pain is different. The body does not fully return to safety.
Pain lasting longer than six months that cannot be fully alleviated by medical treatment is generally considered chronic. Women with endometriosis frequently fall into this category. Even when the pain is not constant, it returns over time. It becomes intermittent, recurring, and wired into the body's stress response in ways that go beyond any single flare-up.
When pain keeps returning, the nervous system starts to stay on alert. It becomes harder for the body to fully calm down between episodes. Instead of moving smoothly back into a relaxed state after a threat passes, the system stays partially prepared for the next flare. A stressful day, a sudden fright, the altitude of travel, pain during bowel movements, or relationship tension can all feed back into the pain experience. The body is no longer simply responding to pain. It is anticipating it.
One of the more important pieces of recent research is the finding that nerve fibres are present within endometriosis lesions, and within the endometrium and myometrium themselves. This matters because it shows that pain in endometriosis is neither imagined nor exaggerated. There are real pain pathways within the affected tissue.
Hormonal therapy has been shown to reduce the number of nerve fibres in lesions, which further supports how connected pain sensitivity, hormones, and tissue activity are in endometriosis. It also means that the pain experience and the underlying biology are tightly coupled, and that interventions that influence one usually influence the other.
The HPA axis stands for the hypothalamus, pituitary, and adrenal axis. This system controls how the body responds to stress, and in endometriosis it matters because the body is often under stress in multiple ways at once.
Stress is not only emotional. It can also be physical and biochemical, including inflammation, chronic pain, poor digestion, nutrient depletion, financial strain, relationship strain, work pressure, and fertility stress. Many people with endometriosis are quietly under several of these at the same time.
Under sustained chronic stress, the HPA axis can become dysfunctional. Some people overproduce cortisol and other stress hormones. Others gradually shift toward lower adrenal output and underproduce. Either way, the system becomes less resilient, and stress and pain start to amplify each other. Flare-ups often follow emotionally difficult events, travel, overwhelm, or intense exhaustion, because the body is already stretched and loses flexibility.
The most useful response is to identify specific stressors rather than treat stress as one vague problem. Some can be changed. Others cannot. But even when a stressor cannot be removed, understanding it makes it easier to work with. Structured managing stress approaches can build daily calming techniques into life so that the body does not remain in constant fight-or-flight mode.
One of the clearest concepts in endometriosis pain is the feedback loop. It explains why the pain can feel so relentless and why interrupting it requires more than waiting for inflammation to settle on its own.
When tissue is inflamed, nerves send signals to the brain saying there is danger. The brain reacts to that danger, which increases the body's overall sense of threat. The stress response then increases inflammation, which sends more danger signals, which reinforces more pain. The cycle has roughly five stages that compound on each other:
Over time, more nerves become involved, more organs can be affected, and even areas outside the pelvis may start to hurt.
Some women with chronic endometriosis pain feel pain down the legs or even into the joints. This is not always a sign of a separate disease. Sometimes it reflects how inflamed and sensitised the system has become overall.
It also helps explain symptoms like bloating, brain fog, digestive dysfunction, and widespread discomfort. Chronic pain in endometriosis is rarely a uterus problem on its own. It can become a full-body nervous system problem, with the original pelvic source still present but no longer the only thing the system is responding to.
A practical and often underrated skill is learning to describe pain more accurately. Vague language tends to invite vague responses, both from clinicians and from the people around you. Precise descriptions make it easier for a healthcare professional to understand the experience and easier for you to track patterns and improvements over time.
Useful questions to keep coming back to include:
Keeping a pain diary, even a short one, can reveal patterns that are easy to miss in real time. Over weeks, it becomes clearer whether pain changes with menstruation, stress, food, sleep, travel, treatment, or emotional strain. A diary also gives a record of progress, which matters because people often forget how far they have come once symptoms improve.
One of the most useful framings in pain science is that calming the system is not only about removing danger. It is also about deliberately adding safety. If the nervous system constantly receives danger signals, pain remains amplified. If the body starts receiving safety signals consistently, it can begin to shift.
Simple practices act as safety signals because they speak to the parts of the nervous system that regulate calm. Breathing exercises are among the most accessible, since the breath is one of the few autonomic functions that can be consciously influenced.
Building regular meditation practice into daily life is another well-documented way to lower baseline activation. Many people find five to ten minutes a day produces more useful change than occasional longer sessions.
Guided imagery practices, including a happy place visualisation or affirmations and visualisation specifically for endometriosis, work along similar lines. They use the mind to feed the nervous system the kind of input that tells it the body is safe.
Time in nature, grounding practices, cooking, mindfulness, reading, deep rest, and any activity that genuinely feels safe and nurturing all qualify. These often get dismissed as optional or indulgent, but the science argues that they are not extras. When the nervous system is constantly activated, they are part of healing.
The vagus nerve is the tenth cranial nerve and the longest in the body. It runs from the brain down through the body and connects with major organs including the lungs, stomach, liver, pancreas, intestines, and colon. It is the main driver of the parasympathetic, or rest-and-digest, branch of the nervous system.
Healthy vagal tone means the body shifts smoothly into a calm state when the threat is gone. Digestion works better, stress is easier to recover from, and the body can move into repair mode more effectively. In chronic pain and endometriosis, this balance often gets disrupted, with the system spending too much time in fight-or-flight and not enough in rest-and-digest.
Poor vagal tone or vagus nerve dysfunction can show up as poor digestion, blood sugar instability, chronic pain, anxiety, depression, sleep difficulties, chronic fatigue, and easy overstimulation. The vagus nerve can be affected by inflammation, trauma, chronic stress, spine or head injuries, whiplash, thyroid dysfunction, diabetes, and inflammatory disease processes. Since endometriosis is inflammatory, it fits naturally into this picture.
Practices that directly influence vagal tone include slow breathing, humming, cold-water exposure, and gentle meditation. A shift your energy meditation is one example of a structured practice designed to nudge the system back toward parasympathetic dominance.
The honest message from the science is that pain reduction in endometriosis is not solved by a single intervention. It involves several layers working together.
Four key areas tend to come up across the most useful frameworks:
Fear itself amplifies pain. Someone who has experienced repeated painful sex, painful bowel movements, or recurring pelvic flares may start bracing in advance, which increases tension and tends to make the experience worse. Learning how pain works does not make the pain disappear, but it reduces the emotional threat around it.
Inflammation remains a central driver. The more inflammation the body carries, the more pain signals the nervous system receives, which is why nutritional support matters so much for endometriosis. The broader relationship between stress and fertility also points back to the same systems, since chronic stress feeds both pain and the wider reproductive picture.
Structural issues matter too. Overtight pelvic muscles, postural patterns, and physical guarding often develop alongside chronic pain. Myofascial release and structured movement can be useful in this layer. Underneath all of this sits self-care and self-compassion, since the body responds far better to kindness and consistency than to perfectionism or self-criticism.
These are some of the most common questions people search for about period pain and endometriosis. The answers below reflect current pain science and clinical understanding of endometriosis.
Endometriosis pain is driven by a combination of inflamed tissue, increased pro-inflammatory prostaglandins, nerve fibres growing within lesions, a sensitised nervous system, and chronic stress responses. These factors reinforce each other, which is why the pain can feel disproportionate to a single source.
No. Mild cramping during a period is common, but pain that requires regular painkillers, stops daily life, or extends beyond the first days of menstruation is not considered normal. It deserves a proper clinical workup rather than being dismissed.
Primary dysmenorrhea is pain that happens around the first three days of the menstrual period. Secondary dysmenorrhea is pain that occurs at other times during the month and can include pain with bowel movements, urination, sex, or ovulation. Secondary dysmenorrhea often suggests an underlying condition such as endometriosis.
Prostaglandins are hormone-like chemicals that trigger the breakdown and shedding of the uterine lining. Pro-inflammatory prostaglandins, linked to omega-6 fatty acids, drive stronger uterine contractions and amplify pain signalling. Women with endometriosis often produce significantly more of them.
Yes. The balance of omega-6 to omega-3 fatty acids in the diet directly influences which type of prostaglandins the body produces. Anti-inflammatory dietary patterns over weeks to months tend to reduce inflammation and ease pain for many people with endometriosis.
Chronic stress activates the HPA axis, which increases inflammation and reinforces the pain feedback loop. Over time, the nervous system becomes more sensitised and pain responses become easier to trigger. Reducing baseline stress activation often softens flare-ups.
It is a cycle where inflammation triggers pain signals, pain signals increase threat perception, threat perception drives stress, stress increases inflammation, and inflammation produces more pain. The loop reinforces itself and becomes harder to interrupt the longer it runs.
It can. Chronic endometriosis pain sometimes spreads to the legs, back, or joints, and can contribute to bloating, brain fog, digestive dysfunction, and widespread body discomfort. This usually reflects a sensitised nervous system rather than separate diseases.
The vagus nerve drives the rest-and-digest branch of the nervous system. Healthy vagal tone supports calm, better digestion, and quicker recovery from stress. Poor vagal tone is associated with chronic pain, anxiety, fatigue, and difficulty calming down between flare-ups.
Be specific about the quality of the pain (sharp, dull, cutting, exhausting), where it sits, when it happens, and whether it links to specific activities such as bowel movements, sex, urination, or ovulation. A pain diary kept over a few cycles often makes patterns much clearer.
Yes, when used consistently and alongside medical care. Breath work, meditation, visualisation, gentle movement, anti-inflammatory nutrition, and sleep are all supported by current pain science. They are not replacements for treatment but they meaningfully change how the system responds.
Understanding period pain and endometriosis begins with rejecting the idea that severe pain is simply something to tolerate. The pain is real, measurable, and shaped by a powerful combination of inflammation, prostaglandin biochemistry, nervous system wiring, stress physiology, and past experience. Once that picture comes into focus, the pain becomes less mysterious and less frightening, even when it remains difficult.
Reducing pain is not only about chasing a symptom. It is about supporting the whole system that produces the experience. Identifying specific stressors, describing pain more clearly, addressing inflammation, calming the nervous system, and bringing in steady safety signals all act on different parts of the feedback loop at once. None of them is a single cure. Together, they are how the loop loses its grip over time.
The path is rarely fast or linear. Endometriosis is a long-term condition, and the nervous system patterns that develop around it take weeks to months to soften. But the path exists. The same body that learned to brace can learn to release. The same nervous system that ramps up can be shown how to settle. Pain reduction in endometriosis is a real, layered, ongoing project, and understanding why pain happens is where it begins.
If there is one quiet lesson at the centre of all of this, it is that pain that has been built over years tends to soften in layers, not in a single intervention. The work is slow, but it compounds. The body is responsive, even when the condition itself does not disappear.
00:00:04 So let's get started. So first of all, we're going to talk about understanding pain. So pain in the brain, you know, I want to, I'm going to cover all about how pain works, the science behind these pain signals, you know, is period pain normal? You know, why do you get period pain and then the whole chronic pain and endometriosis and how we can describe and measure this pain to help when we're talking to medical professionals and then what can we do about this? You know, why do you get period pain and then the whole chronic pain and endometriosis and how we can describe and measure this pain to help when we're talking to medical professionals and then what can we do about this? so first of all how does pain work well pain is a really good thing first of all it keeps us alive I mean if you think in a scenario of cutting your finger you know if you burn yourself on the oven or something more you know serious like a serious burn pain is is a good thing it stops us walking further into danger and so it I'll go through in a minute kind of like how you actually walking further into danger and so it I'll go through in a minute kind of like how you actually
00:01:02 cut your finger how that works but it's that pain signal helps to put us into high alert so that we can then seek a way to address that pain and then heal afterwards so it comes from signals in our brain and it comes from our our body as a network you know we have our nervous system we have all these nerve fibers and they carry right through to the skin but also in our organs everywhere and we have these pain receptors and these pain receptors can tell whether we feel organs everywhere and we have these pain receptors and these pain receptors can tell whether we feel pain both mechanical pain um chemical pain um mechanical chemical and then there's one more which i've just forgotten off to my head but there's three three ways that you can feel pain
00:01:46 um so when we injure ourselves these pain signals get sent back to our brain um and then to to make us move away from that okay so this is this is kind of like a basic the basic idea so this is us move away from that okay so this is this is kind of like a basic the basic idea so this is shown here if you cut your finger um for example if you were chopping um a cucumber and you cut your finger open it's like ow and it's instantaneous it's amazing how instantaneous that is and those pain receptors literally send those danger signals via spinal cord up your brain stem and then the pain is registered so your body and it depends of course have you experienced this before it might be a new pain or it might be something where you've cut it before and depending on your
00:02:28 experience depending on whether you've had a traumatic event depending on whether you're experience depending on whether you've had a traumatic event depending on whether you're highly stressed at this particular point in time or whether you're actually very calm will depend on how how you register that pain and how painful it is and that's why you can hear of people who walk across hot coals you know that should be something that's painful but it's because they put themselves in a mind state where they are able to not actually feel that pain response okay um so after you remove yourself from that threat you know you've taken the knife away um so after you remove yourself from that threat you know you've taken the knife away
00:03:02 um or you've you know put your hand under the cool water you stop burning your hand the body then starts to heal goes through this process and that the pain eventually reduces so this is just a very quick and easy way of doing it um so like i said how you're feeling is absolutely you know really really key if you're scared um if you have memories or trauma around something like this this is where pain will increase particularly if it's a repeated repeated element and coming back this is where pain will increase particularly if it's a repeated repeated element and coming back to the three stimuli it's mechanical so like a pinch or a pressure heat that's what i forgot heat and chemical so is period pain normal and the answer is no it is not it is really really common
00:03:47 but it is not normal and I think you all you all know this um or if you don't I'd like you to know this it is not normal to have period pain maybe a twinge but not pain where it's extreme so when this it is not normal to have period pain maybe a twinge but not pain where it's extreme so when you have period pain it's known as dysmenorrhea um there's primary dysmenorrhea and then there's secondary dysmenorrhea primary dysmenorrhea is when you get pain around the first three days your period where secondary dysmenorrhea is around at any point during the month um and it can happen in different areas so you might have pain associated with bowel movements urination around ovulation um during sex ongoing back and pelvic pain so that's known as secondary
00:04:24 around ovulation um during sex ongoing back and pelvic pain so that's known as secondary dysmenorrhea and it is quite useful to know these technical terms because if you're talking to your doctor and if you understand these terms um you know in the future in the past if you you know if you've got relatives who are going through you know a similar journey or who have endometriosis or you think might have endometriosis or got painful periods you're able to advise them of this because i think knowledge is a really key thing around period pain um because even the this because i think knowledge is a really key thing around period pain um because even the medical community just don't know enough about this um during your period you get much you should
00:05:08 get mild cramping nothing that you require a painkiller um you know it's just a slight twinge normal not normal is not the word sorry when you have no period pain you should just have slight cramping that doesn't require any period any painkillers of any sort that is kind of what you're aiming for and it does happen you know many of the clients that I've worked with they've gone you're aiming for and it does happen you know many of the clients that I've worked with they've gone from taking tons to nothing um and it is totally achievable depending on your situation everybody's situation is different and it depends on the layers behind that so the question is why do we get painful periods um so period pain is a chemical induced pain so when we come back to those three
00:05:56 the heat chemical and mechanical it's a chemical induced pain because it's caused by these the heat chemical and mechanical it's a chemical induced pain because it's caused by these inflammatory prostaglandins now you'll see in these two boxes we've got two boxes here where we've got green for good anti-inflammatory prostaglandins known as pge1 um and these that they are made from omega-3 fatty acids whereas bad pro-inflammatory prostaglandins pge2 the building blocks for this is from omega-6 fatty acids now omega-3 omega-6 there's no good pge2 the building blocks for this is from omega-6 fatty acids now omega-3 omega-6 there's no good or bad between them the problem in our society today is that we're imbalanced you want a balance
00:06:40 between omega-3 and omega-6 a one-to-one balance unfortunately with our western style diet most ratios that come up is about 20 to 1 so 20 being omega-6 is being really high it's the amount of omega-3s now as you can see there if you've got a very high amount of omega-6s amount of omega-3s now as you can see there if you've got a very high amount of omega-6s this is going to push you towards having lots of pro-inflammatory prostaglandins not these good anti-inflammatory prostaglandins and the thing is the uterus has prostaglandin receptors in the lining and these are thought to be responsible for the uterine lining contractions okay so prostaglandins are involved in starting the disintegration and shedding of the womb uterine
00:07:24 lining and research has shown that women with endo can have up to four times the amount of bad lining and research has shown that women with endo can have up to four times the amount of bad prostaglandins i.e pg2 compared to those that are not in pain so it's about finding this balance And actually one of the ways that you can see what, you know, your lipid levels, a very basic test. I mean, you can do more, more comprehensive tests, but asking your doctors to test for a lipid panel, particularly including the LDL and HDL. So LDL being bad, we say bad fats, not necessarily bad fats, but sort of the omega-6s, HDL, the omega-3s. So LDL being bad, we say bad fats, not necessarily bad fats, but sort of the omega-6s, HDL, the omega-3s. So you want this to be balanced. You want HDL more than three millimoles per liter and you want LDL below three, ideally around 1.5.
00:08:12 So you actually want it kind of like slightly imbalanced because the HDL is much more protective. So chronic pain and endometriosis. Now, chronic pain is different from just cutting your finger and you heal. chronic pain is classified as pain that lasts longer than six months and cannot be alleviated chronic pain is classified as pain that lasts longer than six months and cannot be alleviated by medical treatment um and women with endometriosis fall into this category okay it's not constant but it's intermittent regular and it continues over time you know with every monthly cycle so it is classified as chronic pain now when you have cut your finger your nervous system responds to that and you can calm down and you can heal but with chronic pain your nervous
00:08:56 system responds to that and you can calm down and you can heal but with chronic pain your nervous system starts not be able to fully relax because you're in this heightened sense of stress okay and this is a really key part to understand because when we come on to the sort of how to help work with reducing pain it is important to register the fact that the nervous system is part of this because you're constantly in pain your nervous system is constantly in this state of sort of fight or flight or very easily triggered and when I say triggered it's like your nervous sort of fight or flight or very easily triggered and when I say triggered it's like your nervous system you might be okay and then you have a stressor at work or I don't know you break when
00:09:37 you're driving very suddenly and you're you know you might feel that tingling at the end of your fingers and you suddenly feel very stressed very quickly anything can trigger you and you can end up having um you know you can end up being bloated you end up being in pain again and that's because your nervous system is just so used to being in this heightened state is very very easy to trigger your nervous system is just so used to being in this heightened state is very very easy to trigger you now they've actually found that there are similar nerve fibers to the rest of your body within the endometriosis lesions the endometrium and the myometrium um and they've also found hormonal therapy so when they've given hormonal therapy to help with endometriosis to get rid of
00:10:21 the pain, this can actually reduce the amount of nerve fibers within the lesions, which I find really interesting. So if you've got a lot of nerve fibers in there, and your nervous system really interesting. So if you've got a lot of nerve fibers in there, and your nervous system is very heightened, and very, very sensitive, and sensitive to inflammation, this is where the inflammation comes in, because pain and inflammation, it's all part of the picture, when you, and I'll talk about this in a minute, it's like a vicious cycle, you're always going to end up in that pain okay um so as i've said here the brains you know the brains of women you know of women with endometriosis you're constantly feeling under threat so your nervous system is just
00:10:56 going to be so sensitive to this extra pain you're not going to feel as relaxed as you should do going to be so sensitive to this extra pain you're not going to feel as relaxed as you should do so this then comes on to something i talk about with many of you is the hypothalamus pituitary adrenal access so hba access now i would say every single one of you when i do a health history has got some issue of dysfunction with your hba access whether that's low or excess adrenal hormone output and this is due to chronic stress now stress we always think of stress as like being hormone output and this is due to chronic stress now stress we always think of stress as like being a stress associated with work or you know an emotional stress but it's not just an emotional
00:11:40 stress stress comes from physical so it can be emotional it can be from a whole variety of things but it can also be from the physical stress so inflammation is stressed um you know chronic pain that is stress on your body if your digestive function is not functioning properly you're not digesting your food properly this is stress on your body because you're not getting those nutrients digesting your food properly this is stress on your body because you're not getting those nutrients to help your liver function to help reduce inflammation all these things and so having dysfunction of the hpa access you're going to constantly be either pumping out too much cortisol or you just haven't got enough to to deal with these stress situations and then this can trigger
00:12:21 pain as well um and make the pain worse and i don't know whether any of you've had like um a stressful situation and then you've had a flare-up afterwards whether you've made this um a stressful situation and then you've had a flare-up afterwards whether you've made this connection between stress because it's very easy to focus on the nutritional side of things but actually the stress side is massive yes we need to feed our body nutrients endometriosis is a nutrient hungry disease um and part of the reason we're not getting the nutrients is because our digestive function I'll come on to this in a bit isn't working properly because our nervous system isn't working properly um I mean I had uh I mean so many flare-ups I can think of I mean
00:12:58 isn't working properly um I mean I had uh I mean so many flare-ups I can think of I mean planes often you know you might not be stressed getting on a plane or the rest of it but even just the altitude you know when you're going up in a plane I've had that where actually I felt quite relaxed um but even just going up the altitude has then caused me to have a flare-up you know and I've ended up with this huge endo belly and I'm like well how did that happen but actually going in a plane going at altitude is a physical stress on your body but then equally but actually going in a plane going at altitude is a physical stress on your body but then equally and I'm sure you've had it where something I mean I mean I remember years ago 20 years ago
00:13:37 um I'd been traveling for a year and I had all these photographs and I've been on my own and I was trying to get them developed and the photo developers completely screwed it up and essentially I just it really just pushed me to the edge I was really stressed anyway from a number of things that had happened during that time and I literally had this huge it was just such a trigger I got that had happened during that time and I literally had this huge it was just such a trigger I got endo bloat like I was nine months and I actually physically fell over I couldn't hold myself up because my nervous system was so it had been wired for so long it didn't know how to relax and it was just triggered by something which actually was fairly small but it was just that
00:14:19 stress point so maybe have a think back have there been times where you've been stressed and you've had a endo flare you've ended up in pain you've ended up with endo belly um you've ended up just had a endo flare you've ended up in pain you've ended up with endo belly um you've ended up just being absolutely exhausted and that's where you've got you know the hpa hpa axis dysfunction you'll pump out that cortisol and if you've had chronic stress for a long time you just can't you know you have low adrenal output you won't have enough cortisol to cope with that so that's why I go on about calming your nervous system so much and supporting your HPA access and that's why it's really important also to identify what your stresses are and sometimes that can be the
00:14:58 really important also to identify what your stresses are and sometimes that can be the hardest thing is trying to understand what is it is it things that you can change sometimes it's things that you can't change and it's not necessarily about having to change those things it's about bringing in techniques so that you can um you can cope with the stresses that are going on around you because our bodies are so clever they should be able to deal with stress and not then push you into an inflammatory into a high pain state and then you experience the chronic pain then push you into an inflammatory into a high pain state and then you experience the chronic pain it's about calming your nervous system which i'll come on to in a minute so more with the chronic
00:15:39 pain and endometriosis the reasons for being stressed as i've said already is like chronic and persistent pain inflammation swelling floating um and excessive bleeding so all sort of coming from the lesions the endo lesions themselves from scar tissue from any you know pelvic pain where you've got scar tissue between organs between like tendons you might have you know a variety you've got scar tissue between organs between like tendons you might have you know a variety of pain issues associated with your pelvic area whether it's also like bladder pain whether it's passing urine passing your bowel movements all of that kind of area but then other stresses associated with the endometriosis and I think this is a big one is the lack of the medical support
00:16:18 and understanding and sometimes you might have amazing support and other times just nobody's listening to you and a lot of that comes with first of all trying to get a diagnosis but then even when you get a diagnosis is the treatment options understanding the treatment options even when you get a diagnosis is the treatment options understanding the treatment options maybe having treatment and then the treatment isn't successful um and just having that lack of a a roadmap or an understanding or support from medical staff that don't necessarily understand the disease and that is a massive massive stress in itself it might seem you know after you get your diagnosis it's a relief but then once you get past that relief there's more stressors
00:16:58 you know like I said before work stressors totally unrelated it could be unrelated to the endometriosis you know like I said before work stressors totally unrelated it could be unrelated to the endometriosis but it could also be you're in pain every month you can't go to work for three or four 10 days you may not be able to work at all as a result and these are stressors and they're ongoing stressors emotional stressors you know strain of relationships due to the endometriosis it could be strained because you know you're not able to have sex comfortably because you get have pain when you have sex and that then affects your relationships you know if you're going through pain when you have sex and that then affects your relationships you know if you're going through
00:17:31 infertility and you're struggling to have a baby that again strains your relationships um so so many things here you know your infertility journey which i said and then of course finances i mean the financial strain of of trying to support your health care whether it's um if you're not able to get insurance or go through the NHS in the UK to, to, you know, support with any operations or support with blood tests. But also then if you are, you know, going down the path, which we, support with blood tests. But also then if you are, you know, going down the path, which we, you know, you're, if you're working with me, then trying to find the, you know, alternative ways to support your body as part of the bigger picture, it is costly. And that can be very begrudging
00:18:13 that having to do that, but it's a stress. So these, so you can see there are so many stresses here but it's about learning these techniques to cope with it and I think that's really important but I think once you identify what your stresses are it's easier to then accept them easier to but I think once you identify what your stresses are it's easier to then accept them easier to understand them easier to kind of go okay that one I can't necessarily deal with but these ones I can so the pain feedback loop your nervous system is creating a feedback loop and your brain is constantly at threat which you know if it's this is with chronic pain it's constantly feeling at threat and it stresses the body it then increases inflammation so as you can see there when the
00:18:57 area is inflamed the nerves send a signal back to the brain saying it's inflamed it's it's area is inflamed the nerves send a signal back to the brain saying it's inflamed it's it's experiencing pain it releases these pain signals and then inflammation is part of like the healing process so when you're healing you get inflammation to heal but in this status because it's chronic you're then increasing your inflammation so it's like reinforcing this feeling of threatened and it worsens the pain signal so you end up in this kind of like you know negative feedback loop going round and round and it's about breaking that cycle and over time um our nerves you know other round and round and it's about breaking that cycle and over time um our nerves you know other
00:19:35 nerves get involved and we're unable to calm down on our pain response resolve the issue we end up getting more nerves more organs and areas other areas become involved you know your digestive system starts to not be able to function properly your liver then gets clogged as part of the picture and because your nervous system isn't necessarily working so all of these interlinked elements and inflammation spreads not just in your pelvic area um many of you may have felt elements and inflammation spreads not just in your pelvic area um many of you may have felt you know your joints hurting and this is where inflammation is spread not just from your pelvic area into you know around your body and this isn't that you've got arthritis it's just that you're
00:20:14 inflamed and if you've had chronic pain for a long time um your nerves are so sensitive um you know many women with endometriosis feel you know horrific pain down their legs as well and it's just your your nerves are just so sensitive and it's any kind of stress can trigger that um it's just your your nerves are just so sensitive and it's any kind of stress can trigger that um you know and as pain continues your brain stops releasing the natural pain relieving chemicals like dopamine so you don't even get these calming feeling you don't get that sort of pain relief and so it's really really important to break this cycle so that you can bring back that sort of um stop the nerves being so sensitive essentially so what can we do about it um one understanding
00:20:57 stop the nerves being so sensitive essentially so what can we do about it um one understanding the pain um is really important because then we can remove the fear around the pain because there's also a lot of fear um you have that emotional trauma around the pain as well i mean one example is painful sex for example you know if you've had painful sex and you've tried it in different ways just every time it's painful you start to then fear having sex which then obviously affects your relationship when you feel guilty um but you also then tense up your nervous system is then relationship when you feel guilty um but you also then tense up your nervous system is then heightened and you're not relaxed and it's no longer a pleasurable experience and then obviously
00:21:39 if you're trying to have a baby it's just you know it really isn't helping the situation so the way that we calm down the pain response is by reducing the danger signals and increasing the safety signals so really it's kind of the best way to go about this and you will have heard me talk about nutrition this way is crowding out it's a bit like initially rather than going right i'm about nutrition this way is crowding out it's a bit like initially rather than going right i'm going to give up gluten and dairy and do that straight away it's like crowd it out by bringing in nourishing foods and this is the same here crowd out those danger signals by bringing in lots of safety signals bringing in and when you start bringing the safety signals the danger
00:22:21 signals start to reduce um it's normally about addressing inflammation so a big part of this is addressing inflammation if there are any structural issues um with regards to pelvic pain is addressing inflammation if there are any structural issues um with regards to pelvic pain if there's muscles that are overtight so using myofascial release and we'll go into this and calming the nervous system so these are like three big things addressing inflammation looking at structural issues and calming the nervous system okay so this is none of this actually brings in nutrition i mean nutrition and supplements are part of it but those are key okay um like i said nutrition i mean nutrition and supplements are part of it but those are key okay um like i said
00:23:01 we need to crowd out the danger signals so one of the other things I think is really important is to when we talk about pain and this is in the the pain management guide which I will put alongside this presentation if you haven't already seen it and it is in the academy as no it's not in the academy actually I just give it out when we come to it so I will put it alongside this is to be able to describe and measure your pain so that you can communicate with your doctor this is to be able to describe and measure your pain so that you can communicate with your doctor your IVF you know with your gynecologist your IVF clinic whether it's your endo you know adeno specialist whoever it is your nutritional therapist you're not working with me or your
00:23:41 acupuncturist whoever it is it is actually really really useful to understand some of the terminology around the pain so that you can describe whether it's jumping whether it's flicking is it sharp is it cutting in is it exhausting is it sickening so here you'll see I've just taken um some from the guide um there's a whole list here this is actually taken from crash 1991 um um some from the guide um there's a whole list here this is actually taken from crash 1991 um as seen in mills and vernon um and i'll put it in that guide you'll see the the link to the reference there as well and i think it's just really good to understand um those pain signals but also in there is actually you'll see um three uh you know three areas of your body is to be able
00:24:26 to mark down where you're getting that pain and that's just useful so that you can like really to mark down where you're getting that pain and that's just useful so that you can like really really pinpoint um you understand it and then it's much much easier to then communicate um but also you can then monitor the differences and changes over time so when you're improving you can look back and go oh yeah because it's it's incredibly easy to forget it's amazing the human body forgets things I mean I was working with um one of you recently and you know it was remembering actually how far you'd come and it was like oh yes I used to feel like that and now I don't I forgot I used how far you'd come and it was like oh yes I used to feel like that and now I don't I forgot I used
00:25:03 to feel like that so actually having some sort of record of like where the pain at its worst when it's like that and you might want to write some notes for yourself and there is space in the guide there's lots of space because it's like a workbook so that you can do that so one of the call to actions that I'd you know recommend is keep a diary occasionally there is kind of like a a month diary here you might be able to see it there's um all the sort of like um feelings of a month diary here you might be able to see it there's um all the sort of like um feelings of pain or areas and then days of the month and you could tick off and put numbers there's a little um you might find that a little bit small but there's uh symbols as well that you can put here
00:25:43 depending on whether it's during your period at any other point of time just to kind of like you can then start seeing patterns because obviously if we're working together and we've done a health history then I try and pull out and tease these things but the more that you understand yourself what is going on the easier it is for you to describe what's going on to other people what is going on the easier it is for you to describe what's going on to other people but also to monitor the improvements and I think this is really important. so calming down the pain response um like i said before safety signals we can see here um some of the safety signals to bring in is breath work it's free it's easy it is one of the biggest
00:26:23 things that you can do and i think often we and i'll come on to it more often we don't put enough significance on this one um meditation yoga being in nature i mean that being in nature and being significance on this one um meditation yoga being in nature i mean that being in nature and being grounded and connected to the earth is huge and again they're they're very they're cheap they're easy they don't cost a lot but sometimes it's about getting ourselves there it's about making a plan it's making commitment to it and I think it's also understanding the significance which is why I wanted to do this masterclass to kind of explain the relevance to the nervous system which I'm going to go into a bit more detail in a minute on the vagus nerve cooking mindfulness
00:26:59 which I'm going to go into a bit more detail in a minute on the vagus nerve cooking mindfulness anything that makes you feel safe safe nurtured calm whether it's reading a book in a swinging chair going to a spa whatever it can be expensive it can be really really cheap it's it's just bringing in and don't I think a lot of time as women we find that these are things that that are looking after ourself and we feel that we don't not deserve it's the wrong thing that that are looking after ourself and we feel that we don't not deserve it's the wrong thing that we don't prioritize our own self-care and actually the doc funnily enough I think it was a couple of years ago um I think in Wales they were starting to actually write prescriptions to go and spend
00:27:48 time in nature and I was like that's fantastic not writing a painkiller but actually writing a prescription spend more time in nature and this will actually you know is part of a healing process And I think because we don't see this as a pill for an ill or anything like this, we don't put it as a priority and it needs to be. And I think because we don't see this as a pill for an ill or anything like this, we don't put it as a priority and it needs to be. So this can then help reduce the danger signal. So you see there the danger signals of feeling unsupported, inflammatory triggers, unresolved trauma, pain and bloating, depression, anxiety, brain fog and endless to do lists. I mean, if you're anything like me, having those to-do lists and then feeling really crappy about yourself because you've just not had the energy, you know, you've got brain fog, you feel like you've crossed nothing off, you know, that triggers you. I mean, if you're anything like me, having those to-do lists and then feeling really crappy about yourself because you've just not had the energy, you know, you've got brain fog, you feel like you've crossed nothing off, you know, that triggers you.
00:28:37 It triggers your nervous system so that, you know, in terms of safety signals, make plans, but be realistic. Maybe you only put one thing on your list. So then it makes you feel safe because you tackle one thing. You don't write 15 things down on there. There might be 15 things, ideas that you can do over the next two or three months and you can tick them off slowly, but you don't have to do them all at once. There might be 15 things, ideas that you can do over the next two or three months and you can tick them off slowly, but you don't have to do them all at once. So, you know, try and reduce those endless lists because then it can reduce this danger signal. So the vagus nerve. So the vagus nerve is part of the nervous system.
00:29:15 It is one of 12 cranial nerves in the body. It's actually the 10th cranial nerve and it is the longest. So it runs in the brain down the spine and it taps into every major organ. As you can see in this figure here, everything from lungs, spleen, pancreas into your small intestine, stomach, liver, colon. As you can see in this figure here, everything from lungs, spleen, pancreas into your small intestine, stomach, liver, colon. It is so important. I mean, it's so, so important. I mean, there are lots of books now actually on the polyvagal theory to do with the vagus nerve, because I think we're now understanding the sheer importance. And the funny thing is the vagus nerve is one of the nerves that underpins, you know, these amazing therapies is the wrong word. And the funny thing is the vagus nerve is one of the nerves that underpins, you know, these amazing therapies is the wrong word.
00:30:02 These amazing Eastern ways of looking, you know, Eastern medicine. So when you look at acupressure, you look at acupuncture, you look at Ayurvedic medicine, they've known about the vagus nerve for thousands of years. They haven't necessarily known how it exactly works, but they have known about it. They've known the importance. And that's why working on various points in your body can tap into the vagus nerve and calm it down. so it controls multiple sensory and motor functions including digestion which is key to so it controls multiple sensory and motor functions including digestion which is key to understand this because this is where the expression rest and digest comes from you know if you're calm you will digest also breathe and feed so again if you're calm your fertility will be turned on
00:30:48 you will have that ability to digest your food so when your vagus nerve is turned on as it were and you're in this rest and digest this is when you're parasympathetic so your body is like split and you're in this rest and digest this is when you're parasympathetic so your body is like split into two it's split into the parasympathetic and the sympathetic well there's the autonomic and the nomic i'm not going to go into that but the parasympathetic is this rest and digest the sympathetic is the fight or flight um which is that stress response and we should be in the parasympathetic we should be in that rest and digest for 80 90 percent of the time and then when we have a stressor then we our nervous system flicks over to our sympathetic nervous system
00:31:24 when we have a stressor then we our nervous system flicks over to our sympathetic nervous system it pumps out cortisol from our adrenals and various other hormones that enable us for our heart to pump faster our eyes dilate we start to sweat we can we get you know loads of blood sugar our blood sugar increases so that we can pump blood sugar around our body so our you know our muscles can move and we can run away from that danger that that's how it works and then when that day just passed you flick back into that rest and digest state now the vagus nerve can be damaged that day just passed you flick back into that rest and digest state now the vagus nerve can be damaged by many things not just damage it can be damaged it can also be known as the vagal tone so it can
00:32:09 just not be very strong um and this can be in terms of damage spine and head injuries particularly including whiplash this is this is a classic one trauma and chronic stress can cause damage to it or cause your tone to be very poor inflammation hyperthyroidism diabetes and then diseases and conditions i mean endometriosis is an inflammatory condition so it comes back to that inflammation conditions i mean endometriosis is an inflammatory condition so it comes back to that inflammation so it affects this vagus nerve um now if you've got poor vagal tone um or it's damaged you'll struggle to stay in this parasympathetic state in this rest and digest state and you'll find that you're you really get stressed very easily you get triggered very very easily and
00:32:56 you may feel wired all the time you may feel actually quite pumped quite um excited by stuff you may feel wired all the time you may feel actually quite pumped quite um excited by stuff and that's when you've just got too much cortisol running around your body and that's great until you're so fatigued you have nothing and then you feel knackered the whole time but anything could trigger you to be stressed and it could be that you suddenly you cry very easily you get bloated you suddenly feel exhausted um very very easily so the other things that then you can struggle with is like i've said is poor digestion your blood sugar management um can go down because with is like i've said is poor digestion your blood sugar management um can go down because
00:33:31 your pancreas is not functioning properly and this kind of then again affects your digestion because your digestive enzymes chronic pain um you can end up with more chronic pain it can end up causing autoimmunity conditions. And again, if your vagal tone is not very good, depression, anxiety, sleep difficulties, chronic fatigue, I mean, go on. The importance of having good vagal tone is really important, but also to understand if you've actually got some damage
00:33:59 to your vagus nerve or physical obstructions. to your vagus nerve or physical obstructions. And I will come on to how we can tell that in a minute.
