The statistics regarding period pain in women are high, we're talking anywhere from 45 to 95%
of menstruating women. Despite this, I often find period pain is dismissed by some health professionals because that's just something women have to deal with right?
Although period pain is super common, I don’t agree it should be classified as 'normal', because the reality is, it doesn't have to be. If your period pain is debilitating, or impacting your day to day life, it's time to have it investigated further and reach out for support.
Dysmenorrhea is the medical name we give to period pain. This mostly involves pain in the pelvic area, but the pain can also radiate impacting the legs and back. Sometimes symptoms of nausea, vomiting, diarrhoea and headaches may also be present alongside the pain. The experience of pain can vary, but some describe it as heavy, aching, cramping or stabbing.
What causes period pain?
In those with period pain, we see an increase in specific chemicals called "prostaglandins" during menstruation. Prostaglandins cause an increase in uterine muscle contractions which support the shedding of the uterine lining and stimulate our pain receptors. Prostaglandins also reduce blood flow and oxygen delivery to the uterus.
It's important to remember that other conditions can also cause pelvic pain, which is why telling women it's completely normal to be in debilitating pain each month isn’t helpful and can lead to a delayed or missed diagnosis. Conditions such as fibroids, ovarian cysts, endometriosis, adenomyosis and pelvic inflammatory disease are other conditions which can cause significant levels of pelvic pain.
Should I have my hormones tested?
Are there any useful tests for those with period pain? The majority of my clients experiencing pelvic pain will be referred for further investigations, sometimes this involves blood tests and ultrasounds.
In regards to testing hormones, the most important thing to remember is that we want to test on specific days of your cycle to help identify whether or not the hormones are out of balance.
For period pain in particular, I generally recommend testing about 7 days after ovulation, which shows us if oestrogen and progesterone (two very important hormones when it comes to period pain) are in balance. Some hormones however, such as LH & FSH are better tested on day 2 or 3 of your cycle, so whilst you're bleeding.
If your cycle is irregular, this can be a little tricky to predict, but ideally, test around 7 days before your expected period and make note of what day of your cycle you're on.
Some tests to consider include:
Oestrogen (one of our main sex hormones which if raised, can worsen period pain)
Progesterone (released after ovulation, we need adequate amounts for easy, manageable periods)
SHBG (binds to hormones making them less active)
Testosterone & DHEAs (these can be high in those with PCOS which is a condition that can cause menstrual issues)
Cortisol AM (our major stress hormone which can impair ovulation due to stress)
LH/FSH (hormones from the brain that support egg development & ovulation, best tested on day 2 or 3 of the cycle)
It’s important to have these results interpreted properly by someone trained in this area!
Holistic strategies for managing period pain
When managing period pain holistically I generally recommend looking at immediate pain relief and strategies to help reduce reliance on painkillers like Nurofen and Naproxen. This generally involves reducing some of those inflammatory prostaglandins we spoke about earlier and relaxing the uterine muscles.
Secondly, we need to treat the areas of the body which might be contributing to hormonal imbalances and higher amounts of inflammation in the first place. The latter is generally more individualised and may involve supporting the gut, stress levels and nutrient levels.
Nutrients to reduce period pain:
Magnesium: magnesium can be supportive in so many menstrual-related issues, and period pain is no different. The reason I love magnesium so much for period pain is that it relaxes the smooth muscles of the uterus, which can reduce the intensity of cramps. Magnesium also reduces the prostaglandins we spoke about earlier.
I generally recommend a minimum of 300mg of magnesium per day for period pain and generally use it in the form of magnesium glycinate or citrate.
Calcium: low calcium levels are known to cause muscle spasms and contractions. Calcium plays a role in relaxing smooth muscles, including the uterus muscles. Calcium may reduce abdominal cramps, as well as back pain and general aches associated with period pain.
Calcium is more effective for relieving period pain when also combined with magnesium. Ideally, we want to look at the dietary intake of calcium before considering supplementation, although supplementing can be beneficial when done right.
Herbal medicine for period pain:
Anti-inflammatory herbs: herbs such as turmeric and ginger help to reduce inflammation, reduce prostaglandins and improve blood flow to reduce period pain severity and duration. There is some good research on the use of ginger to reduce period pain and it's even been compared against some common painkillers with impressive results.
You can start with a strong tea to begin, letting it brew for at least 5 minutes. Ginger or turmeric capsules would be another option, which generally have a more concentrated form of those anti-inflammatory compounds. Of course adding these herbs to your soups, curries and stir-fries can also be beneficial.
In addition, herbs that act on reducing smooth muscle contractions such as cramp bark, as well as those that promote blood flow and reduce pain such as corydalis, can be useful in managing period pain. I've had some positive results using a combination of cramp bark, corydalis and ginger together just before and during menstruation for pain relief. However, please do chat to a professional before adding in any herbs.
Can diet play a role?
Those with period pain may benefit from increasing anti-inflammatory omega 3 fatty acids in the diet found in fish and some seeds (chia, hemp, flax). In addition to increasing omega 3s, reducing the intake of omega 6 fatty acids found in vegetable oils like canola and sunflower oil (specifically fried and heavily processed food) may reduce excess prostaglandin production. Supplementing with a high quality fish oil (and I emphasise high quality here because this is so important) is another option for those who don't get enough omegas from their diet.
In addition, we want to limit the amount of heavily processed foods we're consuming and focus on the amount of nutrient dense whole foods that support healthy ovulation and have anti-inflammatory properties. Overconsumption of foods high in sugar & refined carbohydrates (white bread, pasta, pastries) can cause an imbalance in blood glucose levels which can interfere with a healthy menstrual cycle and worsen the pain.
We know exercise is good for us, but regular exercise throughout the month at least 3 times per week for 45 to 60 minutes can reduce the severity of period pain. During menstruation itself you may prefer to take it slow, sticking to walking or yoga, really this depends on your individual needs.
Don't forget about the impact of stress
What know that high stress levels, especially when chronic, can disrupt the communication between the brain and the ovaries disrupting ovulation. We want healthy ovulation to occur because this is how we produce adequate amounts of a hormone called progesterone, secreted after ovulation. We want healthy amounts of progesterone because progesterone has an anti-inflammatory action and helps to regulate the amount of prostaglandins that cause period pain.
Stress management looks completely different for everyone, but some form of daily movement (yoga, walking, pilates, weight training) and mindfulness (breathing exercises, meditation, journaling) practised consistently throughout the month are good places to start. Looking at the amount of caffeine you consume may also be an important step in reducing excess stress hormones.
Still need support?
As a naturopath, there are so many different tools we can draw on depending on individual needs. These are just a few simple suggestions to get you started. Of course, we also want to address any underlying imbalances, ranging from hormonal imbalances, excess inflammation & digestive issues, as well as correcting any nutritional deficiencies or lifestyle concerns.
If you're needing a little extra support, or just someone to guide you in the right direction, please reach out!