Period Pain is Common NOT Normal

Dysmenorrhea, aka painful period cramps, disrupting your daily life?

Every day more than 300 million people menstruate in the USA, and every month more than 1.8 billion people menstruate worldwide. The average female will menstruate once a month, for roughly 35 to 40 years. That’s approximately 3000 days—more than 8 years—of periods during a lifetime. The population that menstruates can experience many unwanted symptoms each month which can interfere with basic daily living and functioning. 

More than fifty percent of cycling females experience painful periods in their lifetime with some estimates saying this is up to 84%. Missed school or work days due to painful menstruation affects between 32-40% of cycling females. Decreased productivity for those going to work while experiencing pain is as much as 33%, resulting in an average of 8.9 days of total lost productivity per year. The largest study done to look at productivity and menstrual complaints demonstrated that the stigma of missing work/school due to menstrual complaints lead up to 79.9% of absent females to not disclose the true reason for missing school or work. Such common complaints in such a large population should be discussed openly and without shame. 

There are two types of dysmenorrhea, primary and secondary.

Primary Dysmenorrhea

Onset shortly after menarche

Lower pelvic or abdominal pain, associated with onset of flow and last 8-72 hours

Back and thigh pain, headache, diarrhea, nausea, vomiting may be present

No abnormal findings on examination

Prostaglandins most common cause

Secondary Dysmenorrhea

Onset any time after first menstrual bleed, typically after 25 years of age

Complaints change in time of pain onset during menstrual cycle or in intensity of pain

Other gynecological symptoms, heavy flow, painful intercourse, may be present

Pelvic abnormalities on examination

Common causes include endometriosis, uterine fibroids, adenomyosis, endometrial polyps, pelvic inflammatory disease, cervical stenosis, and the use of intrauterine contraceptive devices (IUD) 

In the average female, primary dysmenorrhea decreases in severity as the female becomes older and after child birth, whereas in secondary dysmenorrhea the pain worsens as the female ages and often has anatomical abnormalities or changes to the reproductive organs. 

Prostaglandins are the primary cause of pain or cramps experienced during the menstrual flow. Prostaglandins are hormone-like lipids present in the uterine cells that cause the uterus to contract to help shed the lining each month. The lining is the blood released each month and as you rid the uterus of the lining you are decreasing your prostaglandin levels as well. Hence, potential debilitating cramps at the onset of your flow that improve as the menses lessens in blood flow.

Prostaglandins are involved in inflammation and pain response starting at ovulation, and as they increase the force of contractions increases on the uterine lining until the lining is shed. This explains why some menstruating people experience cramps and spotting from ovulation until seven days into the bleed. The more inflammatory prostaglandins around the worse your cramps can be felt. You need prostaglandins for proper functioning reproduction health, it is when and how much is made that starts to cause problems. IF you are shutting down the prostaglandin pathway with frequent or high dose medications like NSAIDs due to unwanted symptoms after ovation, you may decrease fertilization and implantation success rates. The correct balance of inflammatory (prostaglandin 2) and anti-inflammatory (prostaglandins 1 and 3) prostaglandins are needed for proper fertilization and implantation, and to prevent debilitating cramps and other unwanted symptoms.

Prostaglandins are so powerful that manufactured prostaglandins are used medically to induce labor at the end of pregnancy or an abortion. This emphasizes the importance of a balanced inflammatory process in the menstruating population.

Unfortunately, today’s modern living of highly processed foods ladened with omega-6 fatty acids not counterbalanced with good omega-3 status, low nutrient dense foods, high stress with little sleep, and unavoidable exposure to toxic environmental chemicals, such as endocrine disruptors, increases your inflammation. Preventing an uncontrolled inflammatory process is the best way to alleviate pain and cramps during menstruation, allowing for fewer missed school/work days and improved productivity when work is required during the monthly time of blood loss.

As noted above, an inflammatory process is necessary for proper functioning reproductive health. Keep that in mind when considering treatment for younger menstruating people. From a clinical perspective, we are seeing more and worsening complaints in long term NSAID, oral contraception, and IUD users who are now trying to conceive in adulthood.

Conventional medicine practice success comes from halting the inflammatory process in its tracks to not allow negative symptoms from being experienced. This works great for some, and may cause detrimental concerns such as stomach ulcers or ovulatory issues in others. Examples of conventional treatment include: 

Paracetamol, aspirin, NSAIDs to reduce cyclo-oxgenase (COX2) pathway thus inhibiting prostaglandin production. Short term NSAID use, 5-14 days, have been shown to cause fertility problems, gastric bleeding, and heart attack in women. 

Oral contraceptives to inhibit ovulation.

Levonorgestrel IUD to prevent uterine lining thickening. Note that non-hormonal IUDs may result in cramps/pain and may need to be removed to resolve symptoms. 

Holistic medicine practice success comes from correcting the cause of high prostaglandins, potential nutrient deficiencies, and hormone imbalances, not just stopping the process from happening. Consider starting with the following suggestions if you are not interested in the possible detriment that conventional treatments may create.

Diet: High fiber, plant based, Mediterranean style eating. Minimally processed foods. Avoid fatty foods, carbonated beverages, salty or sugary foods, alcohol and caffeine altogether or nearing your bleed time to reduce excessive prostaglandin production. Caffeine increases vasoconstriction in the blood vessels of the uterus, creating more pain.

Lifestyle: reduce exposure to endocrine disrupting chemicals by removing harsh feminine products, household cleaners, paints, herbicides, pesticides, antibiotics, plastics in form of phthalates and other toxins that leach into our foods from packaging and plastics, and personal care products. Do not microwave in plastic as a study showed significant reduction in pain for college aged females when they stopped microwaving with plastic. 

Exercise: release of endorphins and increased blood flow to the reproductive organs during moderate exercise naturally reduces pain signals to the extent medication was reduced or eliminated in a recent study.

Omega-3: balances the production of anti-inflammatory prostaglandin 1 and 3 with the inflammatory prostaglandin 2. Eat more cold deep water fish, flaxseeds, nuts and seeds, and less processed omega-6 foods including sunflower, corn, soybean and cottonseed oils. 

TENS: transcutaneous electrical nerve stimulation can be an at home therapy to reduce pain signals from being sent to the brain while improving blood flow. 

Acupuncture: shown to reduce inflammatory markers, improve blood flow to uterus, and lower the amount of NSAID drugs usually taken for menstrual pain.

Yoga: Cat-Cow, Child’s, Plank, Cobra poses help alleviate cramps

Sacral chakra balancing

Stress reduction with proper sleep hygiene habits.

Heat: Using a heating pad on your abdomen or lower back is useful in relieving pain from menstrual cramps.

Topical magnesium gel or castor oil packs applied to abdomen improve uterine cramping.

Nutrients: Vitamin E, magnesium, calcium, manganese, boron, zinc, phosphorus, Vitamins B1, B6 and vitamin D have all been associated with reduced menstrual pain.

Herbals: curcumin, chamomile tea, fennel seeds, cinnamon, ginger (as effective as ibuprofen), pycnogenol, dill (as effective as mefenamic acid), green papaya, cramp bark, motherwort, valerian, dong quai

Essential oils with massage: lavender, peppermint, rose, fennel can reduce pain especially if  massaging into the lower abdomen. 

This is not an exhaustive list of options, and you should always seek the guidance of a medical professional before starting anything new.

Experiencing menstrual cramps should never reduce your ability to attend work or school, or make you feel ashamed to say why you are missing these activities. Addressing cramps holistically, before disrupting the delicate reproductive system with synthetic chemicals, can greatly improve your symptoms. Future generations deserve better guidance in preventing and treating unpleasant menstrual complaints, especially when considering overall long-term reproductive health. 

Written by Dr. Nicole Kerr, ND, LAc