By Dr. Alexsia Priolo

It’s a misconception that period pain is normal. Period pain is the most common symptom experienced by almost 45 to 95% of people during their cycle but it isn’t normal.

Dysmenorrhea, the official name of period pain, can have significant effects on the lives of menstruators. It may negatively impact their daily activities and relationships, not to mention negatively affect school or work performance. Sleep is also commonly affected, and may lead to daytime fatigue. Unsurprisingly, mental health is affected, as period pain is associated with depression and anxiety.

Types of dysmenorrhea

There are two types of dysmenorrhea:

Primary Dysmenorrhea

This is period pain without an underlying condition. It may occur due to diet and lifestyle, nutritional deficiencies and/or prostaglandin production. In teens, painful cycles may begin after they start to experience ovulatory cycles (ex. progesterone is starting to be produced halfway through the cycle). Typically, it might start at the beginning of the period and improves over time.

Secondary Dysmenorrhea

This is period pain due to an underlying condition, that may occur before, during and/or after the period. These conditions include: endometriosis, adenomyosis, fibroids and cysts, infection, or can be a side effect from IUDs. This pain usually occurs in menstruators between 20 to 40 years old (likely because of a diagnostic delay), and may worsen over time.

In this blog post, I’ll be discussing primary dysmenorrhea.

Why Does Period Pain Happen?

Normally towards the end of your period, your uterine lining releases prostaglandins, chemicals that cause your uterine muscles to contract. It’s been accepted that people with dysmenorrhea produce an abundance of prostaglandins which cause contractions – thereby reducing blood flow and causing oxygen deprivation in the uterus. This usually leads to that cramping sensation around the pubic bone.

Pain typically occurs before or when your period begins, and can last between 8 to 72 hours. It’s usually at its worst during the heaviest day, and may radiate to your back or thighs. It’s also associated with fatigue, headaches, light-headedness, nausea and vomiting.

Period Pain Risk Factors

• Age

• Smoking

• Menarche

• Heavy and long flow

• Higher BMI

• Alcohol intake

• Family history

Is PMS the same thing?

Not quite! Although PMS (premenstrual syndrome) may begin before your period and continue for a few days, it’s a mix of physical and psychological symptoms. These include: breast tenderness, bloating, cramping, anxiety, depression and irritation.

Managing Period Pain

Conventional Treatment

The first-line treatment is NSAIDs (Nonsteroidal anti-inflammatory drugs). But if they don’t alleviate your period pain, your doctor may recommend combined oral contraceptives (COCs) like the birth control pill, as a second-line treatment.

Alternative Treatment

While NSAIDs and COCs may be helpful, they’re ineffective for about 25% of women. Moreover, for people wanting to achieve pregnancy in the near future, being on hormonal birth control isn’t a viable option.

This means that natural remedies are often taken to decrease pain and improve quality of life.

The following are some natural remedies that have been studied to decrease period pain:

Acupuncture

Acupuncture promotes the smooth movement of blood and energy (otherwise known as qi). Thin needles are inserted into specific areas of the body to promote these effects. Acupuncture also stimulates the nervous system causing the release of natural opioids and serotonin.

Many studies demonstrate acupuncture’s effectiveness at reducing pain when compared to NSAIDs or no treatment. Furthermore, it can be quite effective after a short time period.

Although acupuncture isn’t a treatment that you can do yourself, Naturopathic Doctors and Registered Acupuncturists can provide this treatment before or during your period.

Ginger

Ginger is a warming herb that improves circulation and decreases inflammation. As a bonus, it also reduces the sensation of nausea if you experience that symptom along with pain. Studies show that using ginger a few days before your cycle and a couple of days into it, can decrease pain when compared to NSAIDs.

Lavender

Studies show that lavender essential oil stimulates the part of the brain responsible for smell, and may release chemicals like endorphins and serotonin, leading to relaxation and a reduction in stress.

Studies show that inhaling lavender during your period, may decrease pain when compared to NSAIDs and placebo.

Fish Oil and Vitamin E

Fish oil and Vitamin E have been shown to quell prostaglandin production. Both of these treatments can decrease pain intensity when taken together at the beginning of your period. Studies show that fish oil (by itself) is more effective at reducing period pain than NSAIDs.

Exercise

Exercise reduces pain and prostaglandin synthesis. Many studies have determined that low intensity exercise such as yoga and stretching demonstrated the greatest and most consistent benefit at lowering pain compared to no treatment, and a moderate reduction compared to NSAIDs. This might be because exercise decreases cortisol levels, thereby reducing prostaglandin synthesis. Unfortunately, little research done examining the effect of high intensity exercise.

Quite a few studies have looked at yoga in particular, and have found that three specific poses – practiced on their own or with others, demonstrated an improvement in pain duration, pain intensity, and quality of life.

Final Thoughts

Recurrent life changes, less social supports, and stressful relationships are also connected to period pain. Therefore, speaking to a health professional or close confidant may be helpful.

When using natural remedies like herbs or minerals, it’s essential that you speak with a trusted health care provider like a Naturopathic Doctor to determine if any of these remedies are right for you – especially when to choose a safe dose and product.

While period pain might be common, it doesn’t need to be part of your normal. Naturopathic Doctors to help you experience a better flow.

References:

Adib Rad, H., Basirat, Z., Bakouei, F., Moghadamnia, A., Khafri, S., & Farhadi Kotenaei, Z. et al. (2018). Effect of Ginger and Novafen on menstrual pain: A cross-over trial. Taiwanese Journal Of Obstetrics And Gynecology, 57(6), 806-809. doi: 10.1016/j.tjog.2018.10.006

Armour, M., Smith, C., Steel, K., & Macmillan, F. (2019). The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complementary And Alternative Medicine, 19(1). doi: 10.1186/s12906-019-2433-8

Burnett, M., & Lemyre, M. (2017). No. 345-Primary Dysmenorrhea Consensus Guideline. Journal Of Obstetrics And Gynaecology Canada, 39(7), 585-595. doi: 10.1016/j.jogc.2016.12.023

Iacovides, S., Avidon, I., & Baker, F. (2015). What we know about primary dysmenorrhea today: a critical review. Human Reproduction Update, 21(6), 762-778. doi: 10.1093/humupd/dmv039

Matthewman, G., Lee, A., Kaur, J., & Daley, A. (2018). Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. American Journal Of Obstetrics And Gynecology, 219(3), 255.e1-255.e20. doi: 10.1016/j.ajog.2018.04.001

Woo, H., Ji, H., Pak, Y., Lee, H., Heo, S., Lee, J., & Park, K. (2018). The efficacy and safety of acupuncture in women with primary dysmenorrhea. Medicine, 97(23), e11007. doi: 10.1097/md.0000000000011007