I am here to tell you that this, in fact, is not normal! It is not normal to experience pain before or during your period. It is, indeed, very common, but not a normal physiological response.

Pain is simply a symptom that something is not quite right.

Types of period pain

The technical name for period pain is “dysmenorrhoea” and is commonly “treated” with a range of medications including anti-inflammatories and pain medications. Typical period pain, which will be the topic of this blog, occurs in otherwise well and healthy women and is called primary dysmenorrhoea. Secondary dysmenorrhoea arises due to an underlying condition, such as fibroids or endometriosis.

The uterus is a muscle which should gently contract and relax during menstruation while the endometrial lining sheds. This should be largely unnoticeable from a sensation point of view. When a women experiences period cramps/pain there is disordered contraction and relaxation of the uterus, resulting in pain. Alongside this disordered contraction is usually an inflammatory component contributing to the pain which is caused by prostaglandins.

This type of period pain is often described by women as cramps that come and go in waves and is also known as spasmodic dysmenorrhea ⁽¹⁾. Alternative to this, is congestive dysmenorrhoea which is better described by aches or heaviness before or during menstruation, possibly also including a backache, heaviness in the legs and a feeling as if “everything is going to fall out ⁽¹⁾.”

When to have your pain investigated

Any pain which is worrying or interfering with day-to-day activity, such as stabbing pains or debilitating pain, warrants investigation and treatment.

If you experience this severe pain, then it is important to consult with your doctor to discuss the potential causes and potentially have a pelvic ultrasound and examination done.

In the more severe cases that are resistant to natural treatment, it might be necessary to have a laparoscopy if your doctor thinks you might have endometriosis. In my experience, most women tend to experience dramatic improvements when given the right prescription, but of course, in some cases, the pain needs to be investigated further by your doctor.

Natural ways to reduce period pain

Dietary modification

The first step to addressing primary dysmenorrhoea is making sustainable dietary changes to reduce inflammation in the body. By reducing systemic inflammation, we can reduce the inflammatory compounds that are associated with period pain. These changes include:

• Ensuring each meal contains a serve of protein (animal or plant proteins), some healthy fats (avo, nuts, seeds, olive oil, fatty fish) and predominantly vegetables (aiming for 50-75% of your plate/bowl to be veggies)
• Removing or reducing inflammatory foods such as processed/junk foods, fried foods, alcohol, high sugar foods, artificial ingredients, gluten* and dairy*
• Incorporate anti-inflammatory foods such as a wide variety of vegetables and fruit, culinary spices (especially turmeric), oily fish, nuts & seeds, olive oil, green tea and cacao

*Gluten is certainly not an issue for everyone but it can be quite inflammatory for many women and many report feeling more energetic, less bloated, more mentally clear when they avoid it.

*Dairy removal is also not always necessary but usually when reduced women also experience improvements in other menstrual-related complaints such as PMS, acne, bloating and constipation. If you choose to have dairy, try to buy organic or goats dairy where possible as better alternatives.

Herbal medicine

Luckily, natural medicine has lots of tools to help manage period pain. Herbal medicine is incredible at reducing these prostaglandins and helping to regulate the contraction and relaxation of the uterus muscle.

The following herbal actions and herbal examples can be useful to consider, depending on the type of period pain ⁽¹⁾ ⁽²⁾ :

• Uterine tonic herbs: Raspberry leaf, Dong quai, Blue cohosh and Beth root
• Anti-spasmodic herbs: Cramp bark, Peony, Wild yam, Black and Blue cohosh
• Circulatory stimulating herbs (warming herbs): Cinnamon, Ginger, Ginkgo and Tienchi ginseng
• Anti-inflammatory herbs: Turmeric and Ginger
• Analgesics: Corydalis, Jamaican dogwood and Willow bark

Ginger

In a randomised placebo-controlled trial looking at the use of ginger for dysmenorrhoea, researchers used 500mg of ginger capsules, three times a day in their intervention group compared to a placebo. They found significant reduction in severity and duration of period pain in the ginger group ⁽³⁾. Ginger is available as a tea but for something a bit stronger, I use a ginger liquid extract in individualised period pain herbals.

Nutritional supplementation

• Magnesium: This is one of my first prescriptions for period pain. In most cases, the results within even just one cycle, are mind blowing. This is because magnesium helps to regulate muscle contraction and relaxation- including that of the uterus. It is well documented in the research for being a useful nutrient to consider(4).
• Fish oils: The omega-3 fatty acids in fish oils (or a vegan alternative) work by reducing inflammatory prostaglandins associated with period pain. So much so that studies have found that the efficacy of fish oil is better than ibuprofen in treatment of severe pain in primary dysmenorrhoea ⁽⁵⁾.
• Zinc: Studies show that adequate zinc levels prevent period pain by way of regulating inflammatory and pain mediators in the body ⁽⁶⁾. Zinc is also incredible for multiple other areas of hormone health!

Exercise

Exercise produces endorphins and these are natural pain killers – like the body’s own opioids. Exercise also helps improve blood flow to the uterus which aids congestive dysmenorrhoea. The best forms are both stretching exercises and aerobic exercise which gets your heart rate up such as brisk walking, swimming, jogging or biking ⁽⁷⁾. Mentally, exercise can be the last thing you want to do when you are experiencing period pain but is really does help in most cases.

Heat application

Many women find relief with using a hot water bottle or having a warm shower or bath. This helps because it aids blood flow to the uterus which helps to relax the muscles and reduce congestion in the area.

The great thing is that with many of these tools is that they will not only help with period pain but you will also find that when you address diet, correct deficiencies and implement professionally prescribed herbal medicine, other aspects of your menstrual cycle will improve as well.

Remember, you should not be putting up with anything other than a pain-free and symptom-free period! Even if you have been experiencing pain or other symptoms related to your cycle for your whole menstrual life, it is never too late to change this.

References

1. Trickey, R. (2011). Women, Hormones & The Menstrual Cycle (3rd ed.). Fairfield: Trickey Enterprises Pty Limited.
2. Bone, K. (2007). The Ultimate Herbal Compendium. Warick: Phytotherapy Press.
3. Rahnama, P., Montazeri, A., Huseini, H. F., Kianbakht, S., & Naseri, M. (2012). Effect of Zingiber officinale R. Rhizomes (ginger) on pain relief in primary dysmenorrhea: A placebo randomized trial. BMC Complementary and Alternative Medicine, 12. https://doi.org/10.1186/1472-6882-12-92
4. Parazzini, F., Di Martino, M., & Pellegrino, P. (2017, January 1). Magnesium in the gynaecological practice: A literature review. Magnesium Research. John Libbey Eurotext. https://doi.org/10.1684/mrh.2017.0419
5. Zafari, M., Behmanesh, F., & Mohammadi, A. A. (2011). Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian Journal of Internal Medicine, 2(3), 279–282.
6. Eby, G. A. (2007). Zinc treatment prevents dysmenorrhea. Medical Hypotheses, 69(2), 297–301. https://doi.org/10.1016/j.mehy.2006.12.009
7. Vaziri, F., Hoseini, A., Kamali, F., Abdali, K., Hadianfard, M., & Sayadi, M. (2015). Comparing the effects of aerobic and stretching exercises on the intensity of primary dysmenorrhea in the students of universities of bushehr. Journal of Family & Reproductive Health, 9(1), 23–28. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25904964