Managing period pain…
I often hear the phrase “I have bad period pain but that is normal” in my office when asking people with uteruses about their periods. But this phrase often leads to another common one that I say a lot, which is “painful periods are common but not necessarily normal”.
I find that period cramps are something that most people have some to just accept as part of their regular menstrual cycle. But we are only meant to have brief, mild discomfort (if any). For most people though, this is not the case.
In Canada, we don’t have updated data on period pain. But a study done in 2005 on 1546 women found that 934 (60%) of the met the criteria for primary dysmenorrhea (lower abdominal pain that happens before the menstrual cycle), and 60% of these women described their pain as being moderate or severe. From this, 51% reported their activities had been limited and 17% had missed school or work because of their pain (1).
We need some new data on this topic to start. But we also need to address this pain.
If you are experiencing pain that is causing you to limit your activities or to miss work or school, you should be evaluated for endometriosis. Endometriosis is a condition where endometrial tissue (which normally lines the uterus) grows outside of the uterine environment and can cause severe pain.
Cramps can be caused by a variety of other conditions, like PCOS or fibroids, but if no underlying pelvic pathology exists the root cause can be difficult to identify. It is likely due to a combination of inflammatory mediators like prostaglandins, hormones, stress levels, nutritional status, our environment, and exercise. Assessing these areas and improving on them can help with managing menstrual pain. There are also natural alternatives to conventional pain medication to help minimize pain throughout your cycle.
Ginger: When it comes to period pain, ginger reduces the synthesis of prostaglandins, soothing inflammation and contraction of the uterus. It has also been shown to decrease inflammatory markers that increase pain. Studies have found it to be equally as effective at reducing pain when compared to ibuprofen (Advil). The studies have looked at capsules containing a standardized extract of ginger, although including it in your diet can be helpful (2). I generally suggest talking to your healthcare provider and using a product with the proper dose of the standardized extract to get the best, most consistent results.
Magnesium: Magnesium has many different jobs in the body and is involved in hundreds of reactions. It causes muscle relaxation and vasodilation (or opening of blood vessels). Magnesium also helps to decrease the synthesis of prostaglandins, which are the compounds that cause inflammation and contraction of the uterus (3).
There are multiple different forms of magnesium available. Depending on your health status and the types of medications and supplements you are taking, that will dictate which type of magnesium you need. Talk to your ND or health care provider before starting a magnesium supplement.
Omega 3 Fatty Acids : Omega 3 fatty acids are found in fish and fish oil supplements. Omega' 3’s help to decrease inflammatory prostaglandins, helping to decrease the frequency and severity of uterine contractions. Adding three servings of cold water fish (salmon, halibut) per week is one way to get adequate amounts of omega 3’s through diet. You can also do a fish oil supplement to get these amounts. I recommend talking to your ND about which type you should be using as you want to make sure it is sourced from the proper types of fish. If you are vegan or vegetarian, don’t worry! You can get plant-based forms from algae sources (4).
Diet + Exercise: It is important to exercise during your period. If you find your energy levels are lower, that is OK. Gentle forms of exercise like yoga or slower walks still promote movement and proper blood flow and can help to regulate prostaglandins. Diet also plays a role in the inflammatory process. Increasing fruits and vegetables, healthy fats and lean protein will all contribute to minimizing inflammation during your period and also provide adequate amounts of antioxidants (4).
Peppermint Oil: Peppermint oil has been used for menstrual pain and cramps because of it’s anti-spasmodic and anodyne properties. Anodynes lessen pain by reducing the sensitivity of the brain or nervous system. It helps to decrease the intensity of muscle spasms and relieves pain. Peppermint oil can be used topically on the abdomen. I commonly recommend using it in combination with castor oil, which has anti-inflammatory properties and can be a soothing topical treatment (5).
It’s important to rule out any underlying pelvic issues if you are experiencing painful periods. If you are experiencing moderate to severe menstrual pain during your cycle or changes in your cycle, you should talk to your healthcare provider about being worked up.
If you want to learn more about what you can be doing now to support yourself during your menstrual cycles and optimizing your hormonal health, you can book an appointment now here.
References:
Burnett MA, Antao V, Black A, Feldman K, Grenville A, Lea R, Lefebvre G, Pinsonneault O, Robert M. Prevalence of primary dysmenorrhea in Canada. J Obstet Gynaecol Can. 2005 Aug;27(8):765-70. doi: 10.1016/s1701-2163(16)30728-9. PMID: 16287008.
Chen CX, Barrett B, Kwekkeboom KL. Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2016;2016:6295737. doi: 10.1155/2016/6295737. Epub 2016 May 5. PMID: 27274753; PMCID: PMC4871956.
Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. 2006 Nov-Dec;51(6):402-9. doi: 10.1016/j.jmwh.2006.01.004. PMID: 17081929.
Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):162-71. doi: 10.1016/j.ejogrb.2013.03.028. Epub 2013 May 2. PMID: 23642910.
Masoumi SZ, Asl HR, Poorolajal J, Panah MH, Oliaei SR. Evaluation of mint efficacy regarding dysmenorrhea in comparison with mefenamic acid: A double blinded randomized crossover study. Iran J Nurs Midwifery Res. 2016 Jul-Aug;21(4):363-7. doi: 10.4103/1735-9066.185574. PMID: 27563318; PMCID: PMC4979258.
