Why Your Period Causes Diarrhea
Do you experience diarrhea or other changes in your bowel movements around your period? You’re not alone. It’s a common problem. Let’s look at why this happens.
Before menstruation, a drop in progesterone stimulates the production of prostaglandins, which signal the smooth muscle of the uterus to contract and shed the endometrium. Some of the prostaglandins come into contact with the smooth muscle of the intestines, stimulating their contraction and causing diarrhea or loose stools.
Let’s take a deeper look at this process and what you can do about it.
Progesterone withdrawal, COX-2, and prostaglandins
Progesterone’s job is to prepare the body for pregnancy. With ovulation, progesterone rises. When the corpus luteum (fact check) isn’t fertilized, it decreases production of progesterone to prepare for the next cycle. Research has shown that this progesterone withdrawal stimulates the COX-2 pathway to promote the creation of prostaglandins [1,2]. As a result, these prostaglandins cause the smooth muscle to contract and expel the endometrium from the uterus. When the prostaglandins eventually make their way to the digestive tract, they promote the contraction of its smooth muscle just like they did in the uterus.
Hormone testing and treatment
Because progesterone withdrawal plays a role with initiating the COX-2 pathway, it’s important to have healthy and vibrant female hormone production. With the female hormones, it’s often progesterone that suffers first. As the body and mind become stressed, it prioritizes the stress hormone cortisol, often at the expense of progesterone. This has been termed “cortisol steal” since it steals resources for making other hormones to make cortisol.
The low production of progesterone often results in very sudden drops before menstruation occurs and may be associated with high prostaglandin production. This not only causes diarrhea or loose stools but is associated with painful cramps [3].
In these cases, I recommend doing a month-long hormone test to determine your production of the estrogen and progesterone hormones. The test can be done from home and uses urine strips. At the end of the month, you send the urine samples through the mail to the testing facility. Shortly after that you will get your results and see exactly whether your body is producing enough progesterone. A temporary hormone treatment protocol can then be tailored to your specific results. The hormone protocol is designed to retrain your body to produce a healthy amount of progesterone.
COX-2 Inducers
Progesterone withdrawal alone induces the COX-2 pathway. However, other factors can do the same throughout the month. If any of the following factors are placing a burden on the body, it can result in elevated prostaglandins and inflammation. These factors include:
- Free Radicals
- Lipopolysaccharides
- Cytokines
- Elevated Glucose
If any of these are a problem, it could result in a higher baseline of prostaglandin production. Combined with the elevated production during menstruation may be enough to create painful cramps and loose stool. Let’s take a look at how to reduce the impact of each of these factors.
Free Radicals
Free radicals steal electrons from vital molecules in the body to cause oxidative stress. The damage caused by free radicals is a major root cause of heart disease and cancer. Free radicals have been shown to induce the COX-2 pathway [4].
Oxidative stress can be determined by performing and organic acids test, which requires a urine sample.
A major cause of free radicals is exposure to toxins. This includes toxins from plastics, pesticides, and medications.
Antioxidants can be used to reduce the level of free radicals in the body. Glutathione is the chief antioxidant of the body and can be bolstered by taking N-acetylcysteine (NAC) or glutathione directly. Other major antioxidants include vitamins C and E.
Cruciferous vegetables help the body to create glutathione by providing sulforaphane, a necessary precursor. Be sure to eat cruciferous vegetables regularly.
Cruciferous vegetables include:
- Broccoli
- Cauliflower
- Cabbage
- Bok Choy
- Brussel Sprouts
- Radish
- Turnip
Lipopolysaccharides (LPS)
LPS are endotoxins produced by gram-negative bacteria. They create problems in the body by increasing insulin resistance and inducing the COX-2 pathway [5]. LPS forming gram-negative bacteria live in the gut. If the microbiome is unbalanced, with an overgrowth of gram-negative bacteria, this will result in higher levels of LPS endotoxins. The end result is higher levels of prostaglandins.
Once again, the gut shows that it is important for a healthy period. A stool test can be taken to check the state of your microbiome. If excessive gram-negative bacteria are present, an herbal protocol can be prescribed to modify the microbiome to lower your overall inflammation and prostaglandin levels.
Cytokines
Pro-inflammatory cytokines such as interleukin-1β have been shown to induce the COX-2 pathway [6]. Chronic inflammation should be managed to help lower the overall production of prostaglandins. Two of the most powerful anti-inflammatory supplements include curcumin (from turmeric) or fish oil (EPA/DHA).
Elevated Blood Glucose
If your diet consists of foods with added sugar or with a high glycemic index, it may be contributing to COX-2 activity and higher prostaglandin production [7]. This is especially a concern if you’re diabetic. However, you don’t have to be diabetic to have some level of insulin resistance. In the West, sugar is added to many products, and people are unaware of how much sugar they are consuming.
Dietary changes are important to address elevated blood sugar levels. I recommend removing added sugar from your food plan entirely. The sugars from fruits and vegetables are plenty for what your body needs. Consider an elimination diet to find out how food is affecting your health and get back on track.
Summary
- Decreasing levels of progesterone before menstruation induces COX-2 and prostaglandin production. This signals contractions in the smooth muscles of the uterus and intestines, causing diarrhea or loose stool.
- Progesterone production can be repaired by doing a month-long female hormones test and a temporary hormone protocol.
- COX-2 inducers should also be addressed. These include free radicals, lipopolysaccharides, cytokines, and elevated blood glucose.
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Disclaimer: This website does not provide medical advice. The information contained on this website is for informational purposes only. No material on this site is intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding a medical condition and treatment before undertaking a new healthcare regimen.
1. Künzel J, Geisler K, Maltaris T, et al. Effects of interactions between progesterone and prostaglandin on uterine contractility in a perfused swine uterus model. In Vivo. 2014;28(4):467-475.
2. Wang X, Zhang J, Si D, et al. Progesterone inhibits the expression of cycloxygenase-2 and interleukin-1β in neonatal rats with hypoxic ischemic brain damage. International Journal of Neuroscience. 2014;124(1):42-48. doi:10.3109/00207454.2013.817407
3. Strömberg P, Åkerlund M, Forsling ML, Granström E, Kindahl H. Vasopressin and Prostaglandins in Premenstrual Pain and Primary Dysmenorrhea. Acta Obstet Gynecol Scand. 1984;63(6):533-538. doi:10.3109/00016348409156715
4. Kiritoshi S, Nishikawa T, Sonoda K, et al. Reactive Oxygen Species from Mitochondria Induce Cyclooxygenase-2 Gene Expression in Human Mesangial Cells. Diabetes. 2003;52(10):2570-2577. doi:10.2337/diabetes.52.10.2570
5. Font-Nieves M, Sans-Fons MG, Gorina R, et al. Induction of COX-2 Enzyme and Down-regulation of COX-1 Expression by Lipopolysaccharide (LPS) Control Prostaglandin E2 Production in Astrocytes. Journal of Biological Chemistry. 2012;287(9):6454-6468. doi:10.1074/jbc.M111.327874
6. Taniura S, Kamitani H, Watanabe T, Eling TE. Induction of Cyclooxygenase-2 Expression by Interleukin-1.BETA. in Human Glioma Cell Line, U87MG. Neurol Med Chir(Tokyo). 2008;48(11):500-505. doi:10.2176/nmc.48.500
7. Madonna R, Giovannelli G, Confalone P, Renna FV, Geng YJ, De Caterina R. High glucose-induced hyperosmolarity contributes to COX-2 expression and angiogenesis: implications for diabetic retinopathy. Cardiovasc Diabetol. 2016;15(1):18. doi:10.1186/s12933-016-0342-4