What’s the Deal with Painful Periods and What Can I Do About it?
A study published by the National Library of Medicine indicated that roughly 84% of women experience moderate to severe period pain, also known as dysmenorrhea. Of that 84%, 65.5% report that their period pain caused them to miss work and 68% report that their period pain caused them to miss social gatherings. Although no statistics are available on the estimated number of women who presume that moderate to severe period pain is normal, I predict that the majority of women think this. Many doctors don’t know that painful periods can be a sign of an underlying medical condition or of excess inflammation in the body. This is shown in the 29.5% of women who are prescribed hormonal birth control to decrease period pain. Birth control does not “fix” painful periods; it covers up the underlying issue and leads to worsened health outcomes for women. So, what really is the deal with painful periods and how can we go about living in harmony with our bodies?
“29.5% of women who are prescribed hormonal birth control to decrease period pain. Birth control does not “fix” painful periods; it covers up the underlying issue and leads to worsened health outcomes for women.”
Pain during menstruation isn’t necessarily abnormal. Mild pain (not requiring the use of medication) is an expected symptom of a swift drop in progesterone. Progesterone is a hormone that remains high after ovulation to keep the lining of the uterus (endometrium) in place for a baby to grow (to learn more about the importance of progesterone on overall health, read the blog post Estrogen and Progesterone’s Effect on Overall Health). Once the body recognizes that fertilization (a.k.a. pregnancy) did not occur, progesterone drops, causing the lining of the uterus to shed as seen in period blood. The shedding of the endometrium is multifaceted. We just discussed how progesterone plays a role in this process, although, there is another “p word” at play here: prostaglandins. Prostaglandins are a type of hormone-like chemical messenger (they’re not actually hormones) that cause pain, inflammation, and contraction and relaxation of soft tissue. More prostaglandins are made in response to the drop in progesterone right before the period. This causes contraction and relaxation of the soft tissue of the uterus, helping to shed the endometrium. These extra prostaglandins are also responsible for, you guessed it, period pain. In an optimal state of health, there should only be enough prostaglandins present to help shed the lining of the uterus. Therefore, little to no pain should be felt. If there is already inflammation in the body, more prostaglandins are already present. Therefore, when prostaglandins increase right before the period, more pain is felt.
More inflammation = more prostaglandins = more pain
Since inflammation is the main reason for moderate to severe period pain, it is important to decrease inflammation. It doesn’t require any medication, crazy diet regimen, or intense exercise routine. I always recommend starting simple by decreasing the amount of processed foods that you eat. If you’re used to eating a lot of processed foods, it can be hard to cut them out immediately. Start by incorporating more fresh foods and less frozen foods and work your way up from there. Food can be medicine. Not to be dramatic, but it can also be poison. An article from Harvard Health Publishing states “one of the most powerful tools to combat inflammation comes not from the pharmacy, but from the grocery store. "Many experimental studies have shown that components of foods or beverages may have anti-inflammatory effects," says Dr. Frank Hu, professor of nutrition and epidemiology in the Department of Nutrition at the Harvard School of Public Health.” (Harvard Health Publishing, 2024).
“one of the most powerful tools to combat inflammation comes not from the pharmacy, but from the grocery store.”
Your diet doesn’t have to be extreme, it just needs to be low-inflammatory. Omega 3 non-inflammatory fatty acids help to decrease inflammation. These are absolutely essential to your survival because they are part of the membranes that surround every cell in your body. Here’s the kicker: your body doesn’t make them. We can only get omega 3’s (specifically ALA, alpha-linolenic acid) from our food. Some foods that are high in omega 3’s are fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines), nuts and seeds (flaxseed, chia seeds, and walnuts), and fortified foods (certain brands of eggs, yogurt, juices, and milk).
Other anti-inflammatory foods are certain fruits (berries, apples, stone fruits, citrus, pomegranates, grapes), beverages (water, herbal and green teas), cruciferous vegetables (broccoli, cauliflower, cabbage, kohlrabi, turnips and radishes), deep orange, yellow, red and dark green foods (pumpkin, sweet bell peppers, tomatoes, carrots, kale, spinach, Swiss chard, arugula and endive), nuts (walnuts, almonds, and seeds like chia, flax, and hemp), onions, plant based proteins ( dried beans, lentils, lentil pasta and soy), spices and herbs (ginger, garlic, turmeric, cardamom, black pepper, cinnamon and rosemary), and whole grains (wheat, oats, rye, buckwheat, millet, quinoa and brown rice).
Changing your diet can seem a bit overwhelming, so take it in strides. Move cycle by cycle and see how your pain improves. Notice what foods cause irritation in your gut and try decreasing your consumption of them. Gut irritation leads to inflammation and, therefore, more prostaglandins. For example, certain types of dairy can irritate the gut. I love dairy and I don’t have an allergy or sensitivity to it, so I didn’t want to cut it out completely (I don’t recommend cutting out whole food groups unless there is an allergy or sensitivity). Instead, I found ways to incorporate more natural, less processed, healthy dairy into my diet. I switched from drinking whole, highly processed milk to low pasteurized natural milk from a local dairy farm. I’ve also tried goat milk which is a comparable price to cows milk, although definitely is an acquired taste. I also began incorporating flaxseed and fresh berries into my breakfast routine. It became fun for me. I hope it can be for you, too.
“Changing your diet can seem a bit overwhelming, so take it in strides. Move cycle by cycle and see how your pain improves.”
In addition to food, there are some supplements that can help ease period pain. Magnesium is a mineral that the body needs to help regulate blood pressure, blood sugar, nerve function, and muscle function. Magnesium has also been found to inhibit the synthesis of prostaglandins. One study published by the International Journal of Women’s Health and Reproduction Sciences found that the magnesium level in women with period pain was low. Therefore, magnesium deficiency could be linked to period pain. The study directly states, “it is possible that magnesium can reduce the severity of menstrual pain and its associated symptoms by decreasing the level of prostaglandins” (ijwhr, 2023). This study found that a dose of 300mg of magnesium significantly reduced period pain. It was also found that this dose could significantly decrease headache, depression, irritability, and abdominal pain. It is important to note that some herbal remedies and supplements can interact with certain medications. Therefore, if you are taking prescription medications and/or have a health condition, it is important to talk to your doctor prior to initiating a different supplement regimen.
“This study found that a dose of 300mg of magnesium significantly reduced period pain. It was also found that this dose could significantly decrease headache, depression, irritability, and abdominal pain.”
Similar to magnesium, ginger has also been found to inhibit the synthesis of prostaglandins. One study published by the National Library of Medicine found that a dose of 500mg of ginger is just as effective as a dose of 400mg of ibuprofen. Once again, if you are taking prescription medications or have an underlying medical condition, it is important to consult your doctor prior to taking herbal remedies and/or supplements.
“One study published by the National Library of Medicine found that a dose of 500mg of ginger is just as effective as a dose of 400mg of ibuprofen.”
If none of these modalities assist with your period pain, it is possible that you have a condition called endometriosis. Endometriosis affects 10% of reproductive age women and 80% of women with dysmenorrhea (NIH, 2023). Endometriosis is a condition where endometrial tissue implants outside of the uterus, typically in the pelvic region, causing an inflammatory reaction. This leads to chronic pelvic pain, pain with intercourse and menses, and infertility. Endometriosis is suspected to be under-diagnosed due to the prescription of hormonal birth control that covers up symptoms and the need for surgical evaluation for diagnosis. Treatment is possible through surgical removal of the endometrial implants. Incorporating anti-inflammatory foods into the diet and eliminating synthetic skincare and cleaning products containing xenoestrogens (a chemical compound that imitates estrogen and increases inflammation) can help decrease inflammation and lead to better outcomes. If you suspect you may be suffering from endometriosis, reach out to me. I am happy to talk you through your symptoms, teach you about your body, help you find ways to heal, and refer you to trusted medical providers in your area who specialize in NaPro Technology (Natural Procreative Technology) and restorative reproductive medicine.
“If none of these modalities assist with your period pain, it is possible that you have a condition called endometriosis. Endometriosis affects 10% of reproductive age women and 80% of women with dysmenorrhea.”
As always, never hesitate to reach out to me with questions. I’m always here as your RN.
Peace,
Emily
Refrences:
Choksey, R., Mangal, R. K., Stead, T. S., Jones, T., Flores, R., & Ganti, L. (2023, May 24). Quantifying the impact of dysmenorrhea symptoms on quality-of-life and access to oral contraceptives by income. Health psychology research. https://pmc.ncbi.nlm.nih.gov/articles/PMC10317510/
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