Time to 'un normalize' menstrual cramps or period pain: Understanding your root causes.
If your struggling with period pain, uncomfortable menstrual cramps, or mildly annoying and painful periods each month your not alone. About 50% of all women are struggling with you. In one study in New Zealand half the women reported some dysmenorrhea, and 520 had 'significant period pain (1). It is so common that women often think it’s normal (2) and don’t seek help for it(3). I am here to tell you that pain is never normal, and you don’t have to put up with it! There are effective, natural ways to combat period pain, so you can feel more like yourself all month long.
What is Period Pain?
Also known as dysmenorrhea, it describes the painful abdominal cramping that starts at the very beginning of your period(4). It usually peaks after 24 hours of starting, and decreases again at the 48 hour mark, (5) (typically). The pain may also affect your lower back or legs,(6) or be accompanied by nausea, vomiting or diarrhoea (7). Unsurprisingly, period pain can negatively affect your wellbeing and enjoyment of life (8).
Why Does It Hurt?
In order for the uterus to expel its lining each period, uterine contractions occur (9). Normally, these contractions are a painless process. However, in women with dysmenorrhea, the contractions have become more intense (and hence painful), (10) due to high levels of hormone-like signaling molecules called prostaglandins (11). Therefore, beating period pain involves lowering pain-triggering prostaglandins to a minimum.
Too Much and Not Enough.
High prostaglandin levels can be caused by imbalances in oestrogen or progesterone, the major hormones which control the menstrual cycle.
Firstly, excess oestrogen exposure throughout the month can increase the production of prostaglandins, contributing to your pain. An oestrogen excess can develop due to inflammation, gut dysbiosis (estrobolome), or exposure to endocrine-disrupting chemicals or ‘EDCs’. These chemicals behave similarly to your natural oestrogens. They encourage the thickening of the uterine lining A thicker uterine lining means a lot more cramping for your uterus to expel it. More circulating estrogens also result in increased prostaglandin levels and worsen your period pain. Unfortunately, EDCs are now an unavoidable part of our environment, though there are ways to reduce your exposure. Firstly going green (chemical free) with your household cleaning products, makeup and toiletries is a good place to start reducing your EDC exposure.
Your oestrogen levels are also influenced by your body’s ability to efficiently metabolise and clear excess oestrogen – one of the way this happens is via your liver, so supporting healthy liver function can help manage healthy hormone levels too, leading to a smoother menstrual cycle. Oestrogen metabolites, after your liver metabolises them need fiber to bind to to be taken out of the body through the bowel. Therefore this is where a mainly plant based diet (high in fiber) has been shown to reduce period pain which I will talk more about below.
Low progesterone levels, caused by oestrogen excess and high levels of stress,(12) may also contribute to period pain (13) as insufficient progesterone is associated with high prostaglandin levels (14). Low progesterone is also associated with PMS, so if you ride the emotional rollercoaster in the lead-up to your period, your progesterone levels may need support!
What’s a Girl to Do?
1. Manage Your Symptoms
Did you know that there are effective, natural remedies that can help you manage dysmenorrhea? Like commonly used pain medications (e.g. paracetamol, aspirin and ibuprofen), (15) these natural options are anti-inflammatory and pain-relieving.
Turmeric is an Indian culinary herb which reduces prostaglandin levels (16). As an added benefit, turmeric has also been shown to reduce premenstrual syndrome (PMS)(17). Add it to your foods, curries, soups and chop up turmeric root to make a tea.
Ginger is another anti-inflammatory culinary herb, shown to help reduce period pain. A recent scientific review found that taking 750 to 1000 mg of supplemental ginger during the first three to four days of a period significantly reduces pain (18). You can get ginger capsules to get this higher dose of ginger and use them as pain relief while you work on balancing your hormones overall.
Magnesium bisglycinate is a highly absorbable form of magnesium. Magnesium reduces prostaglandin levels(19) and also reduces smooth muscle spasm, calming the intensity of those cramps. Low magnesium has been associated with both dysmenorrhea and PMS (20).
2. Rebalance Your Hormones for the Longer Term
Herbs can offer effective support in balancing the activity of oestrogen and/or progesterone, depending on what’s causing your symptoms.
Vitex agnus-castus increases progesterone production, (21) reducing levels of pain-promoting prostaglandins. It does this by inhibiting high levels of a hormone called prolactin which disrupts the body’s production of progesterone (22). High prolactin levels can be caused by stress, (23) and can contribute to PMS as well (24).
Soy isoflavones (constituents in soy foods) decrease excessive oestrogen activity by binding to and stimulating the body’s oestrogen receptors (binding sites on cells), reducing the negative effects of oestrogen excess. This triggers signals that reduce the inflammatory effects of oestrogen. The constituents in soy also assist oestrogen clearance via the liver, helping support healthy oestrogen metabolism and lower prostaglandin levels. A great place to get these are in foods such a tofu, ground flaxseed and legumes.
Milk thistle and rosemary support liver detoxification which, as aforementioned, contributes to healthy oestrogen levels; reducing prostaglandin levels, and pain. You can make rosemary tea, or add the herb to cooking.
There are many more herbs I utilize with my clients depending on their unique presentation such as ginger, cinnamon, Withania Somnifera, and nutrients such as vitamin D, and Iron.
3. Develop Healthy Hormonal Habits
Your health habits have the power to shape your periods. Incorporate the following diet and lifestyle strategies to reduce your pain and benefit your overall health at the same time.
Exercise reduces stress, decreases pain sensitivity, and lowers prostaglandin levels (25). A recent review of the research found that moderate levels of physical activity throughout the month can reduce pain intensity(26). Aerobic exercise (27) and yoga also increase quality of life for period pain sufferers(28). I recommend walking for 40minutes to an hour every day.
A healthy diet high in fruit and vegetables and low in ‘trans fats’ (found in fried and processed foods) and low in animal proteins is anti-inflammatory and considered beneficial for overall health, it has also been shown to reduce period pain in just 2 to 3 months. In one study, going vegetarian for just 2 months significantly improved period pain. You don’t need to go vegetarian to get the rewards of less pain. Just increase your servings of vegetables, and fruit to 8 times per day. Make sure the 3/4 of your plate is vegetables, legumes and whole grains to increase your fiber and reduce inflammation that contributes to period pain. Remove sugar and processed foods, and increase healthy plant based fats like ground flaxseed.
Reducing EDC exposure can reduce oestrogen excess, as discussed above.
Here’s a short summary list of the sources of EDCs in our lives:
Firstly; Plastics contain phthalates and other chemicals that leach into our food from packaging and plastic food storage containers. Switch to glass storage containers or tin as much as you can.
Secondly; Herbicides, pesticides, antibiotics, and other pharmaceuticals contain chemicals that end up in our food and act as direct toxins to our hormonal system. Choose un sprayed produce from farmers markets and know the Environmental Working Groups Clean 15 and the Dirty Dozen so that you can avoid the most heavily sprayed vegetables and fruit and buy these organic instead.
Thirdly; Go clean and green with your household cleaners and other common household chemicals. Eco store products are affordable and help you remove unwanted chemicals from your home.
Fourthly; Makeup and your cosmetics are a big exposure of endocrine disruptors. This includes body products including lotions, sun screen, shampoo, conditioner, and much more. The environmental working group has a great resource to check your products and what they have in them that may be disrupting your hormones. Check it out here.
Reducing Stress
Us women operate in cycles. This means we need to begin to listen to our bodies and slow down before we develop symptoms not just when we feel exhausted. It also means unlike men, our energy fluctuates over a month and we naturally feel more restful the week before our period. As this time pushing harder can increase the PMS symptoms and period pain we experience. When we push harder we often sacrifice sleep, and this creates more inflammation which leads to more pain. Develop a practice of once a week doing a deeply restorative action. Notice what it feels like to slow down this much and rest. This may look like going to and lying on your bed to read a book for an hour or it might be playing your favorite music while slowly stretching. What ever it is for you just do it! Full permission!
Get support!
Figuring out what is the underlying cause for you may be overwhelming, I have found so many of my clients find so much relief from applying these recommendations above and having support from a naturopath along the way. Its time to “un normalize’ period pain.
In Summary:
Adopt a anti-inflammatory plant based diet. Remove inflammatory foods, aim for at least 8 servings of fruit and vegetables per day.
Remove unwanted EDC’s from your environment as much as you can, get smart about what foods your buy non organic and organic. .
Supplement your nutrients to optimal levels including magnesium, iron and vitamin D.
Use herbs instead of medications to reduce pain and balance your hormones long term.
Slow down weekly, prioritize sleep and rest one week prior to your cycle ending.
References
1. Pullon, S., Reinken, J., & Sparrow, M. (1988). Prevalence of dysmenorrhoea in Wellington women. The New Zealand Medical Journal, 101(839), 52-54.
2. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015 Sep 7;21(6):762-78.
3. Subasinghe AK, Happo L, Jayasinghe YL, Garland SM, Wark JD. Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women. Aust Fam Physician. 2016 Nov;45(11):829.
4. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015 Sep 7;21(6):762-78.
5. Mavrelos D, Saridogan E. Treatment options for primary and secondary dysmenorrhoea. Prescr. 2017 Nov;28(11):18-25.
6. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015 Sep 7;21(6):762-78.
7. Mavrelos D, Saridogan E. Treatment options for primary and secondary dysmenorrhoea. Prescr. 2017 Nov;28(11):18-25.
8. Subasinghe AK, Happo L, Jayasinghe YL, Garland SM, Wark JD. Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women. Aust Fam Physician. 2016 Nov;45(11):829.
9. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015 Sep 7;21(6):762-78.
10. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015 Sep 7;21(6):762-78.
11. Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Research. 2017;6.
12. Schüle C, Nothdurfter C, Rupprecht R. The role of allopregnanolone in depression and anxiety. Prog Neurobiol. 2014 Feb 1;113:79-87.
13. Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Research. 2017;6.
14. Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Research. 2017;6.
15. Subasinghe AK, Happo L, Jayasinghe YL, Garland SM, Wark JD. Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women. Aust Fam Physician. 2016 Nov;45(11):829.
16. Khayat S, Fanaei H, Kheirkhah M, Moghadam ZB, Kasaeian A, Javadimehr M. Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2015 Jun 1;23(3):318-24.
17. Khayat S, Fanaei H, Kheirkhah M, Moghadam ZB, Kasaeian A, Javadimehr M. Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Comp Ther Med. 2015 Jun 1;23(3):318-24.
18. Daily JW, Zhang X, Kim DS, Park S. Efficacy of ginger for alleviating the symptoms of primary dysmenorrhea: a systematic review and meta-analysis of randomized clinical trials. Pain Med. 2015 Dec 1;16(12):2243-55.
19. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 11;332(7550):1134-8.
20. Abraham GE, Lubran MM. Serum red cell magnesium levels in patients with premenstrual tension. Am J Clin Nutr. 1981;34(11):2364-6.
21. van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013 May;79(07):562-75.
22. van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013 May;79(07):562-75.
23. Sonino N, Navarrini C, Ruini C, Fallo F, Boscaro M, Fava GA. Life events in the pathogenesis of hyperprolactinemia. Eur J Endocrinol. 2004 Jul 1;151(1):61-5.
24. van Die MD, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013 May;79(07):562-75.
25. Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2018 Apr 7. doi: 10.1016/j.ajog.2018.04.001.
26. Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2018 Apr 7. doi: 10.1016/j.ajog.2018.04.001.
27. Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2018 Apr 7. doi: 10.1016/j.ajog.2018.04.001.
28. McGovern CE, Cheung C. Yoga and Quality of Life in Women with Primary Dysmenorrhea: A Systematic Review. J Midwifery Women’s Health. 2018 Jun 14. doi: 10.1111/jmwh.12729.