Experiencing PAINFUL Periods? Understand WHY and what your treatment options are:
Period cramps just before or during your monthly bleed are something that most people who menstruate are familiar with. According to the WHO data, up to 94% of girls aged 10-20 and 8.8% of women aged 19-41 experience period cramps. (1)
Abdominal pain during or before your period is termed “dysmenorrhea” and dysmenorrhea can significantly reduce the quality of a person’s life. The pain is often cramping in quality and can radiate to the thighs or low back, depending on severity. In addition to abdominal pain during menses, some people also experience vomiting, headaches, back pain, diarrhea, and fatigue
Severe menstrual cramping or chronic pelvic pain can be a symptom of an underlying health condition that is best evaluated by speaking with your healthcare provider.
Why am I even getting period cramps?
There are two types of dysmenorrhea, primary and secondary. Primary dysmenorrhea refers to pain that is from the changes in the body from the period alone. Secondary dysmenorrhea refers to pain that stems from an underlying health condition.
The pathophysiology of primary dysmenorrhea is still not fully understood. However, a molecule called prostaglandins seem to play a large role in the production of pain related to periods. As our hormones fluctuate throughout our menstrual cycle, there are also cyclic changed in prostaglandin levels and uterine contractility. Prostaglandins have a strong positive association with inflammation, and it has been shown that there is an upregulation of production of these molecules during menstruation (1). Prostaglandins cause narrowing of blood vessels that supply the uterus, leading to lack of oxygen and increased sensitivity to the nerves around our pelvis. In addition, they stimulate smooth muscle contraction, which supports menstrual bleeding, but can also cause pain.
Other molecules with potential involvement in dysmenorrhea include vasopressin (ADH), TNFapha, IL6, VEGF, and CRP (1).
Common options for pain relief from primary dysmenorrhea:
Tracking your cycle with an app can provide useful information about your menstrual symptoms and allow for empowerment as you get to know your body better. With time, you can begin to see patterns and thus prepare yourself better for to ensure that your monthly menses does not detract from your quality of life!
Dietary (2, 3)
In general, consume a diet rich in omega-3 fatty acids, fruits and vegetables as they contain magnesium, Vitamin B, E, zinc, beta-carotene etc. All of these of dietary antioxidants that can help reduce the inflammatory aspect of dysmenorrhea.
Decrease consumption of omega-6 fatty acids
Found in vegetable oil, eggs, margarine etc
Omega-6 fatty acids play a role in the formation of prostaglandins and leukotrienes and both molecules are implicated in the pathophysiology of dysmenorrhea
Increase fibre intake
Dietary fibre intake plays a role in reducing blood estrogen levels and dietary fibre has been found to be inversely correlated with menstrual pain
Nutraceutical (2)
Vitamin D
Vitamin D receptors are located in various parts of the human body, including in the uterus. Vitamin D has been shown to inhibit the synthesis of prostaglandins and one study has shown an inverse correlation between Vitamin D levels with pain score.
Zinc
An antioxidant and anti-inflammatory agent that can improve circulation of endometrial tissue (recall prostaglandins decrease blood flow to endometrium)
Acupuncture (4, 5)
Acupuncture has been studied in comparison to both herbal treatment, sham treatment, and pharmacological treatment for the reduction of dysmenorrhea
Traditional acupuncture has been evidenced to show equal or greater efficacy than pharmacological, sham and herbal treatment for reducing menstrual pain
Exercise (6)
Exercise may be a useful therapeutic option as it has been evidenced to provide a decrease in pain intensity and pain duration. More importantly, exercise has the potential to improve quality of life.
Pharmaceutical (1)
NSAIDs
NSAIDs such as ibuprofen and naproxen function to decrease the production of prostaglandins, thus reducing uterine contractions and pain.
NSAIDS for dysmenorrhea are most effective if they are started 1-2 days before the start of menstruation
Birth control
Birth control functions to limit the growth of the endometrium during the menstrual cycle, as the endometrium is a source of prostaglandins and other inflammatory molecules.
In addition to limiting endometrial growth, birth control also inhibits ovulation and thus stops progesterone production. Stopping progesterone production also reduces the synthesis of prostaglandins and other inflammatory molecules contributing to dysmenorrhea.
This article is not intended as medical advice. Please speak to your health care practitioner before trialing solutions for your concerns.
1. Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K. Inflammatory Markers in Dysmenorrhea and Therapeutic Options. Int J Environ Res Public Health. 2020;17(4):1191. Published 2020 Feb 13. doi:10.3390/ijerph17041191
2. Ciebiera M, Esfandyari S, Siblini H, et al. Nutrition in Gynecological Diseases: Current Perspectives. Nutrients. 2021;13(4):1178. Published 2021 Apr 2. doi:10.3390/nu13041178
3. Bajalan Z, Alimoradi Z, Moafi F. Nutrition as a Potential Factor of Primary Dysmenorrhea: A Systematic Review of Observational Studies. Gynecol Obstet Invest. 2019;84(3):209-224. doi:10.1159/000495408
4. Yang J, Xiong J, Yuan T, Wang X, Jiang Y, Zhou X, Liao K, Xu L. Effectiveness and Safety of Acupuncture and Moxibustion for Primary Dysmenorrhea: An Overview of Systematic Reviews and Meta-Analyses. Evid Based Complement Alternat Med. 2020 Apr 29;2020:8306165. doi: 10.1155/2020/8306165. PMID: 32419829; PMCID: PMC7206866.
5. Cho S-H, Hwang E-W. Acupuncture for primary dysmenorrhoea: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2010;117(5):509-521. doi:10.1111/j.1471-0528.2010.02489.x
6. Carroquino-Garcia P, Jiménez-Rejano JJ, Medrano-Sanchez E, de la Casa-Almeida M, Diaz-Mohedo E, Suarez-Serrano C. Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Phys Ther. 2019;99(10):1371-1380. doi:10.1093/ptj/pzz101
