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Periods and menstruation and hypnosis?

7th April 2021

One would have thought there was a lot of evidence about the effectiveness. And maybe there is, but I can't find it, so I would appreciate your anecdotes! As part of the wellbeing agenda accelerated by COVID, my hospital has got excited about periods and period poverty, which has led me to look for the evidence around hypnosis and menstrual pain.

Looking at periods or menstruation, they're painful mostly because the uterus cramps with about 120mmHg of pressure, causing ischaemia. Pathology can make menstruation more painful - endometriosis, masses, fibroids, infection, cancer; and whilst these are important triggers, managing the pain they cause is the mainstay of treatment.

The hormone changes around periods can also cause constipation or diarrhoea, nausea and vomiting, headaches, dizziness, bloating and other symptoms.

Periods can also cause pain if they are associated with anxiety (will I leak, will it hurt, will everyone know?), trying to conceive, and loss of sleep.

Periods are also not well discussed, and people don't understand or know a lot of the treatment options because they don't talk about it. Non-steroidals reduce pain for 80%, reduce flow by about 30%, and can help with period diarrhoea (which I bet you didn't even know or talk about). Looking at all these causes for pain probably explains why having orgasms helps relieve menstrual pain, as evidenced in the "menstrubation" study, which unfortunately was still small with only 341 participants https://menstrubation.com/ . Needless to say, hypnosis should be used as an adjunct in period pain management whilst any required investigations are ongoing.

 https://twitter.com/DrJenGunter/status/1221501982126399488

So firstly, looking at the literature specifically around hypnosis and menstrual pain I've found two papers with very small study groups. One said hypnosis helped in 7/9 people, and another said it didn't make any difference compared with pain relief. So, we have two interesting studies - one with a group too small to be statistically significant, and other comparing hypnosis with analgesia and inferring lack of effect from that, because pain relief was equivalent. So, I think we can say hypnosis is almost certainly as effective as analgesia.

https://www.tandfonline.com/doi/abs/10.1080/00207144.2014.869128  

https://www.sciencedirect.com/science/article/abs/pii/S0002937843903606

When we look at hypnotic techniques that will almost certainly help menstrual pain, I wonder if periods are chronic or acute pain presentations. I suspect the category will depend on what circumstance you are seeing the patient in, and certainly treatment will depend on the current presentation.

My suggested strategies would be:

Acutely:

  • Warm imagery to stimulate vasodilation - sunlight, or a warm glove
  • River and flowing imagery to aid bowel motions (progesterone pre-menstrually causes constipation)
  • Control room and pain dial

Chronically:

  • Suggestions of nocturnal bleeding that happens subconsciously and causes no bother
  • Ideomotor signalling to ask unconscious mind about the pain

So, you won't be surprised that I'm considering doing some research around the effectiveness of hypnosis, depending on what the trust considers. I'm not an experienced researcher, and wonder how many people would like to be involved. It feels like the stars are aligned. My proposal would be an opt in, with arm one: standard care, 2: standard care + listening to pre-recorded period comforter script (https://soundcloud.com/charlotte-davies-39 ), 3: standard care + pre-recorded period pain script with quantitative improvement on pain scales, and qualitative interviews about feelings.



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