It is ironic that I am writing this while sitting with a hot pack over my abdomen and drinking herbal tea for period cramps but here we are! I, like many of you, still have pain with my period occasionally. However, perhaps unlike you, I do not recognize this as ‘normal’. In fact, painful periods could be a sign that there is an underlying issue to be addressed or that something in your life (whether it be diet, lifestyle or environmental factors) needs to be re-assessed to find the culprit of your pain. The fact that many women put up with and suffer through pain monthly is a testament to our strength, perseverance and stoicism, however, I doubt it’s necessary for us to have yet another example of this! So, let’s get down to business and let me tell you a bit more about what this is and how to treat it naturally.
Period pain in the medical world is called dysmenorrhea; ‘dys’ meaning difficult and ‘menorrhea’ meaning menstruation. Symptoms may include cramping pain in the low abdomen and/or low back which may extend down into the legs, nausea, vomiting, diarrhea, headache and dizziness. Symptoms occur before or at the onset of menses and last 1 to 3 days. There is a large variation in a woman’s experience of these symptoms, some of which are mild and others quite debilitating and interfering with daily activities. It probably won’t surprise you to know that over half of menstruating women will experience some pain with each cycle and that this is the most commonly reported menstrual disorder. And it’s costly! Projections have shown that 600 million work hours are lost annually equating to a $2 billion annual loss.
There are two broad classifications of dysmenorrhea; primary and secondary dysmenorrhea. Primary dysmenorrhea is pain caused by menstruation itself. It typically occurs in adolescents with the onset of menstruation with peak severity in 20-24 year olds. Primary dysmenorrhea typically improves over time. The pain is caused by a chemical in the uterine lining called prostaglandins which is released as the lining sloughs off. This creates a cascade of uterine contraction, altered blood flow and increased sensitivity of the nerve endings. The nature of the pain is often described as colicky or cramping. The amount of pain is correlated to the amount of menstrual flow and therefore typically begins before or at the onset of flow and lasts for 24 to 72 hours. Anti-inflammatory medications, like ibuprofen, are usually effective in managing the pain.
Secondary dysmenorrhea is pain caused by an underlying disorder within the reproductive tract. Typically, secondary dysmenorrhea begins later than primary (onset after age 20) and tends to worsen over time rather than improve. The pain can begin 1-2 weeks before menstrual flow and continue until a few days after menstruation has ended. Secondary dysmenorrhea is caused by the underlying condition however the same prostaglandin cascade seen in primary dysmenorrhea also plays a role. The pain is more dull and achy in nature and is less likely to respond to anti-inflammatory medications like Ibuprofen. Some of the conditions known to cause secondary dysmenorrhea are:
- Endometriosis – growth and attachment of uterine tissue outside of the uterus (bladder, ovaries, fallopian tubes) and formation of scar tissue
- Adenomyosis – the tissue that normally lines the uterus grows into the muscle layer of the uterus
- Pelvic Inflammatory Disease – a bacterial infection caused by sexually transmitted infections such as Chlamydia or Gonorrhea of the upper female genital tract
- Intrauterine device (IUD)
- Fibroids – growths on the uterus (in either the outer lining, within the wall or the inner lining)
If you are concerned that your dysmenorrhea is secondary to an underlying disorder, it is important to address this with your health care provider, get diagnostic testing to confirm a diagnosis and begin treating the root cause.
Conventional Treatment Options
Conventionally, dysmenorrhea is treated with non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen by way of inhibiting prostaglandin synthesis and therefore inhibiting the cascade that leads to pain. This is an option for treating pain although you do need to be aware of how much and how often you are taking this medication. NSAIDS can cause gastrointestinal inflammation, bleeding and ulceration and should be avoided/used with caution if you have a history of heart or kidney disease. You should pay particular attention if you are someone trying to conceive as there has been some research to show that taking NSAIDS for pain control can significantly inhibit ovulation. Furthermore, if you are taking a significant amount of ibuprofen to manage pain during your period it does beg the question, why are you having so much pain? Has anyone investigated the root cause of your pain? Could you be palliating a problem that has a better solution?
The other commonly prescribed medication for dysmenorrhea is birth control in the form of an oral pill or IUD. This treatment option I have a hard time getting behind for a few reasons which are beyond the scope of this post (but stay tuned for a future blog post)! In short, it has not been shown to be an effective treatment option for primary dysmenorrhea and there are several side effects. As with NSAIDs, hormonal birth control is a band-aid solution and does not give you answers as to why you are having dysmenorrhea in the first place. It is not uncommon for someone to be put on birth control at a young age only to come off with the hopes of conceiving and find out there is an underlying issue affecting their fertility and reproductive health. To be clear, I am specifically referring to birth control as it pertains to treatment of dysmenorrhea and absolutely support women to make whatever choice best suits them to avoid unwanted pregnancy.
6 natural treatment options to say goodbye to dysmenorrhea
There are lots of natural solutions to lessen or completely resolve dysmenorrhea. Before we get into the supplements that I commonly prescribe, it’s important to establish a healthy foundation to support a pain-free period.
Let’s start by talking about diet. The main goal with respect to diet is to avoid inflammatory and allergenic foods and increase your intake of nutrient dense food that will promote optimal functioning of the reproductive system. Diet alone can make a big difference for many women in reducing (even eliminating) their symptoms. Remember that dysmenorrhea is caused by an inflammatory response with release of prostaglandins as the lining sloughs off which promotes uterine contraction. So, decreasing inflammation through our diet will help dampen that response. Furthermore, avoiding foods that you are allergic or sensitive to (for many women this is dairy) will help to reduce the inflammatory response in your gut as well as reducing digestive upset (bloating, gas, constipation) which can contribute to and escalate the pain response. Instead, focusing on foods that provide you with vitamins and minerals such as b vitamins, vitamin c, magnesium, calcium, potassium as well as fiber will help to support circulation, blood vessel integrity, waste elimination and reduce muscle tension, inflammation and water retention. Use the list below to help guide your food choices:
More of this:
- Vegetables and fruit
- Whole grains
- Fish (salmon, tuna, halibut)
- Nuts and seeds (especially flaxseed, hemp, pumpkin, sunflower and sesame seed)
Less of this:
- Foods high in arachidonic acid (poultry, red meat, egg yolks)
- Deep fried foods
- Foods high in saturated fats (red meat, poultry, palm oil, coconut oil)
The second foundational component to reducing dysmenorrhea is exercise. To be honest, the jury is still out with conflicting research on the benefit of exercise for treating dysmenorrhea. However, although much of the available research studies are small with poor methodological quality, I still recommend it and here’s why. From a physical perspective, physical activity is going to promote blood circulation, enhance metabolism and promote weight loss all of which are helpful for reducing inflammation and exposure to excess estrogen. However, exercise is also a significant factor for reducing stress and improving mental well-being. Have you ever been under alot of stress and noticed that your experience of bodily pain is amplified? I have! Higher levels of stress can be a cause of more dysmenorrhea in the following cycle and will have an effect on your tolerance and ability to cope with that pain. What’s good for stress? Among many options like meditation and warm baths, exercise is a great option that will have an impact on multiple levels. An even better option may be to choose yoga which has some promising research to suggest that it decreases dysmenorrhea and improves quality of life.
3. Reduce exposure to Endocrine Disrupting Chemicals
My final foundational recommendation for kicking dysmenorrhea to the curb is taking a look at your exposure to chemicals called endocrine disrupting chemicals (EDC’s). These chemicals build up in our bodies over time and have negative impacts on our endocrine system which includes our thyroid, thymus, adrenals, reproductive organs, pituitary gland and pancreas. One group of EDC’s are xenoestrogens which include chemicals like bisphenol A, phthalates and parabens. They are structurally similar to and mimic our Estrogen hormone. This creates higher levels of Estrogen in the body which will create a thicker uterine lining leading to more cramping and heavier bleeding. There are lots of ways that you can reduce your exposure to EDCs but let’s start with some of the basics: use glass instead of plastic to store your food, avoid processed foods in order to avoid the food packaging, use non-toxic cleaners in your home (hello vinegar!) and use the Think Dirty or Good Guide phone apps to help you choose the healthiest cosmetics and body products.
There are a number of supplements that have been shown to be effective at treating dysmenorrhea such as vitamin e, calcium, fish oil and a number of botanicals such as black cohosh and crampbark. I am going to focus on 3 that I have found to be the most successful and that I use regularly.
- Ginger – I have a deep fondness for the numerous health benefits of ginger. Ginger has comparable effectiveness to NSAIDS for relieving period pain and as an added bonus significantly reduces heavy bleeding (by up to 50%)! This is a personal favourite of mine as my clinical experience very much mirrors the effectiveness displayed in the research.
- Magnesium – this is a go to treatment for me because a growing amount of evidence suggests that magnesium deficiency is a factor in many gynecological concerns including premenstrual syndrome, dysmenorrhea and postmenopausal concerns. It works by restoring normal uterine contractility and preventing the hypercontractility associated with cramping. This is why it is also a helpful treatment for prevention of preterm labour.
- Thiamine – otherwise known as Vitamin B1 has been shown to be an effective treatment option for moderate to severe dysmenorrhea in young women. Who knew vitamins could be so powerful?
With all of these treatment options, it’s best to gauge its success after at least 3 months of use. To determine how and if these treatment options are suitable for you given your medical history, I would recommend discussing with your Naturopathic Doctor.
It’s worth a repeat mention that if you are having severe period pain that is not controlled with pain medication such as ibuprofen or any of the natural and lifestyle options that I have suggested here, it’s imperative to seek medical attention to address a possible underlying cause.
I truly believe that women do not need to suffer through something that they think is just part of being a woman. Please reach out to me if you have any questions, concerns or would like to share your success story! If you need help navigating your health, I’d love to work with you to find the solutions you need. You can book an appointment with me here.