The majority of women will experience cramping and pain with their periods at some point in their lives – reviews have found this to be up to 91%! Severe period pain is less common though, and requires investigation to check for more serious conditions like endometriosis.
The mechanics of the period: when the progesterone level drops it is a signal that there is no fertilised ovum, and the body starts to shed the lining of the uterus. In order to do this the uterus contracts rhythmically to support the removal of this unneeded lining. The decrease in progesterone leads to an increase in prostaglandins, and it is this muscular contraction of the uterus along with increased sensitivity to pain caused by the prostaglandins that causes dysmenorrhea.
Endometriosis, which I’m not going to go into more here and now, has a different cause of pain. The endometrial lining is found to be growing outside there uterus, so the shedding causes extreme pain. For this reason severe pain should be investigated.
Age is a factor for dysmenorrhea, it is more common in teenage girls and reduces with age. Pregnancy often makes a difference with women finding when their periods return after birth they are less painful than before pregnancy. High stress has also been shown to increase period pain.
Firstly let us look at diet and lifestyle.
Exercise is important. Multiple studies have shown exercise to reduce symptoms of dysmenorrhea, and this varies from Isometric exercises, which are specific contractions and holding of different muscle groups, through to aerobic exercise. Time is also important- some studies showed aerobic exercise was not particularly helpful after 4 weeks, but showed benefit after 8 weeks. Exercise will help in many ways- firstly, it will increase blood flow around the body, as well as to the pelvic area. This will mean there is better removal of waste including those prostaglandins that cause pain. Exercise also helps with stress which is one of the contributing factors to dysmenorrhea. There can also be a decrease in steroid hormones and an increase in progesterone and estrogen through the menstrual cycle which reduces the physical symptoms.
Diet is also important. Refined grains, sugar, and saturated and trans fats can all be pro-inflammatory. Instead, eat a diet of whole foods, fresh fruit and vegetables so you are getting a higher amount of antioxidants, vitamins and minerals.
Supplements to consider include:
Magnesium- this is important for the contraction and relaxation of our muscles, not enough causes cramping sensations. Particularly if you have a craving for chocolate (which has high levels of magnesium) before or during your period you may be deficient and a supplement could help.
Omega 3 (fish or krill oil) may help. Our typical western diet is grain heavy and therefore has many more Omega 6s than there should be in comparison to Omega 3s. Omega 6s are precursors of prostaglandins, while omega 3s decrease the production of those prostaglandins and instead produce a less inflammatory type.
Homeopathy can also support the body. I highly recommend a consultation for constitutional treatment. While you can use the below remedies for the symptoms, the best treatment is to deal with the underlying cause. There are over 400 remedies with dysmenorrhea as a symptom, which means these are just a few well indicated remedies and professional help to find the best one for you might be needed.
Magnesium phosphoricum- this can be used as a tissue salt (6x) or in homeopathic potency (30c). Pains are cramping, relieved by warmth and made worse by motion.
Belladonna – pain before the flow starts, and a feeling of heaviness or impending prolapse- must sit good straight. Pains come and go suddenly and flow may be clotted. Pains are cutting through the pelvis horizontally.
Viburnum Opulus – sudden pains in the uterus before the period and backache during the period. Pains are spasmodic, bearing down, aching in sacral and pubic region, excruciating cramping in the abdomen and occasional shooting pains in the ovaries.
Xanthoxylum – agonising, burning pains, extending down thighs with a feeling that the limbs were paralysed. Period is heavy and comes with bearings down pains. May also have a headache over the left eye the day before the period.
Cimicifuga- pains fly from one side to the other, sharp pains and need to bend over, flow may be light and pains are not as severe as other remedies. May have a headache before the period arrives.
Pulsatilla – griping pains that make them bend in half. The more severe the pains the more chilly they get. The flow (and the pains) can come and go and may be dark in colour. They may also be weepy and/or need company.
Cocculus – pain feels as if sharp stones were rubbing against each other in the abdomen, and can feel bloated. Pains are worse at night and they can be irritable. Flow may be dark in colour and clotted, and sometimes they can be nauseous.
Other things you can do-
Heat will often help relieve the cramping pain. Hold a hot water bottle or wheat bag to the area for as long as needed.
Some form of body work- whether this is osteopathy, chiropractic or Bowen therapy, they work in different ways but all can be helpful.
Acupuncture and Traditional Chinese Medicine can also be helpful, and
a Naturopath will be able to advise you on supplements and lifestyle interventions.
If you are looking at medicines, pick a NSAID (non steroidal anti inflammatory drug) over paracetamol. Nurofen is commonly used but Naproxen has a stronger anti inflammatory effect and is more effective. It does need to be taken with food, and take the recommended dose for the shortest possible length of time, but don’t chase the pain- it’s better to take regularly for the length of time you are in pain rather than take one dose then wait until you’re in agony before taking a second and waiting for it to kick in again. If you are on any medication, have a history of stomach or gastro intestinal problems, asthma or any medical conditions check with your Pharmacist first.
Low progesterone levels may sometimes be a contributing factor to dysmenorrhea. Progesterone will lower the pro inflammatory prostaglandins. Speak to your doctor about hormone testing and/or ask about bio identical progesterone cream; it is usually applied after ovulation to mimic the natural rise of progesterone and stopped when the period is due. It is not funded and has to be ordered for you so allow a few days to get it and ask how much it costs when going to your Pharmacy (the Doctor is unlikely to know).
Sometimes the combined oral contraceptive pill is recommended for severe period pain. I really feel this should be an absolute last resort after looking at everything else, especially for teenage girls. While it can give relief it is not solving the underlying problem, and it does have a range of systemic effects.
Send me a message if you would like to discuss how I can help with period pain.