Period pain
More than half of all women have experienced dysmenorrhoea, or period pain, which is abdominal pain stemming from uterine cramping during a menstrual period. Period pain can range from mild discomfort to severely debilitating, and for some women the pain experienced during menstruation may be more painful than labour pains.
Period pain and associated symptoms
Abdominal pain may be accompanied by pain in the low back and inner thighs. Associated symptoms include lethargy, fatigue, nausea, vomiting, diarrhoea or constipation, feeling dizzy or light-headed, fainting or headaches.
Period pain in your teens
If period pain begins within about three years of the first period (menarche), it is known as primary dysmenorrhoea, and is thought to be a result of normal hormonal changes with no specific problem or abnormality. Primary dysmenorrhoea is a very common condition and may cause severe period pain in a small percentage of women, but this type of period pain tends to become less severe with age and after pregnancy.
Period pain in older women
Period pain that begins to occur in women who have been menstruating for more than three years, is called secondary dysmenorrhoea. This is a less common type of period pain than primary dysmenorrhoea. Various reproductive system conditions may be the cause of this type of period pain. Reproductive conditions to be considered would include endometriosis, pelvic inflammatory disease, pelvic adhesions, ovarian cysts, fibroids, cervical stenosis or use of IUD (intrauterine device) for birth control.
Types of period pain
Period pain may be either a dull and constant ache in the abdomen or back, or it may be caused by cramp like contractions that come and go, that may be severe and accompanied by nausea or vomiting.
The period pain of primary dysmenorrhoea is thought to occur only in menstrual cycles in which an egg is released. The associated hormonal changes promotes secretion of prostaglandins by the endometrium (uterine lining). Prostaglandins are hormone like chemicals which increase contractions of smooth muscle such as uterine muscle. Excess prostaglandins can cause stronger contractions and uterine cramping. The high levels of prostaglandins can also cause contraction of other smooth muscle such as the muscle in the bowel, this can lead to increased peristalsis resulting in diarrhoea. The prostaglandins produced are believed to temporarily inhibit the blood flow to the uterine tissue resulting in oxygen deprivation of the cells, causing cramping and pain.
Although the uterus will normally contract and relax regularly and unnoticed throughout the month, during a menstrual period the contractions will become stronger, and in some women prostaglandin secretion may produce very strong uterine contractions, much stronger than necessary for the expulsion of menstrual material. These uterine contractions may themselves cause impaired blood flow to the uterine tissue causing colicky intermittent period pain.
Period pain generally starts shortly before or early in the menstrual period in time with increases in prostaglandin production and peaks after about 24 hours, diminishing after two or three days. Clots or pieces of tissue may be expelled with the menstrual fluid, and may produce additional period pain.
Heavier periods tend to be connected with cramping period pain. The greater volume of menstrual fluid to expel means stronger contractions of the uterus. Sometimes the uterus may not relax sufficiently between contractions which can cause period pain.
Dietary changes to reduce period pain
Many women consider period pain to be a fact of life. However, if you feel the level of your period pain is unacceptable and affects the quality of your life then dietary changes can help you do something about it. It has been discovered that women who suffer with period pain generally have high levels of prostaglandins in their bodies, but modifications to your daily diet can dramatically alter the amount and type of prostaglandins produced, reducing your period pain.
To improve the balance of prostaglandins increase dietary sources of omega-3 fatty acids such as nuts, especially walnuts, walnut oil, flaxseeds and flaxseed oil, and fish, especially oily fish such as salmon, herrings, sardines, trout, tuna and mackerel. Cut down on saturated animal fats and trans fats.
It has also been suggested the low calcium and magnesium levels can promote cramping associated with menstruation. Try increasing dietary sources of these minerals or take a supplement. Good sources include dark green leafy vegetables and sesame seeds.
To enable enymatic conversion to the facoured 'good' prostaglandins ensure an adequate intake through dietary or supplementary means of magnesium, zinc and vitamin B6, if taken as a supplement it is preferable to take a vitamin B complex.
Other self-help measures for period pain
Research suggests that some of the following may not be as effective as other treatments but some women may prefer to try something else before resorting to some form of medication.
If you smoke try and quit.
Rhythmic exercise like walking or swimming can help to reduce period pain.
Using a hot water bottle, a heat pad or heated patches on the abdomen can help to reduce the pain.
Acupuncture has been found to help reduce period pain.
Transcutaneous electrical nerve stimulation (TENS) is a useful method of pain relief for many conditions. The electrical current from the TENS machine stimulates release of chemicals that block or reduce painful nerve impulses.
Stress management techniques may help. Stress can inhibit the metabolic pathways that favour production of the 'good' prostaglandins. When we cannot relax, blood flow tends to become restricted, causing tension and pain. This is one way that practicing yoga may help reduce period pain because it can help people to relax. If you think that stress may be contributing your period pain, see the page on stress, or seek the help of a local qualified herbalist.
Herbal remedies for period pain
Although nonsteroidal anti-inflammatory medications may help reduce period pain, for some women they are not effective. But, even in those women who find their discomfort relieved, painkillers such as ibuprofen only suppress the pain temporarily, they do not prevent its monthly recurrence.
In addition to the dietary changes and self-help measures, herbal remedies can provide an effective alternative treatment, with an excellent success rate. For mild discomfort try a soothing herbal infusion of relaxing chamomile or antispasmodic peppermint or peppermint and ginger. Research has shown that ginger is as effective as painkillers such as ibuprofen for the relief of period pain.
There are many herbal medicines that have traditionally been used to reduce period pain and cramping, even the severe cramping such as caused by endometriosis. For period pain, herbalists might particularly choose the antispasmodic herbs such as Valerian and the Viburnum species, Cramp bark and Black Haw. Their strong antispasmodic effects work well for uterine cramping, and have been confirmed by research. In my experience Black Haw is superior to Cramp bark for uterine cramping, though many herbalists use them interchangeably.
Herbs can also help by reducing the level of inflammatory prostaglandins. A wealth of clinical research supports the use of pycnogenol, French maritime pine bark, for the treatment of period pain. The research shows that pycnogenol is a safe and effective treatment for period pain, including the pain of endometriosis, and that its effect last even after treatment with pycnogenol has stopped. Pycnogenol is a natural anti-inflammatory believed to lower production of prostglandins. Its anti-inflammatory effects are being researched for use in other conditions.
If your period pain is severe, seek the help of a local qualified herbalist.
Research related to period pain
Sedative and spasmolytic effects of Viburnum tinus L. and its major pure compounds; abstract
Relaxing effects of Valeriana officinalis extracts on isolated human non-pregnant uterine muscle; abstract
Nonsteroidal anti-inflammatory drugs for dysmenorrhoea; abstract
Herbal and dietary therapies for primary and secondary dysmenorrhoea; abstract
Therapeutic uses of magnesium; abstract
French maritime pine bark extract significantly lowers the requirement for analgesic medication in dysmenorrhea: a multicenter, randomized, double-blind, placebo-controlled study; abstract
Menstrual-related pain conditions: dysmenorrhea and migraine; abstract
Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate; abstract
Analgesic efficacy of French maritime pine bark extract in dysmenorrhea: an open clinical trial; abstract
[Randomized controlled clinical study on ginger-partitioned moxibustion for patients with cold-damp stagnation type primary dysmenorrhea]; abstract
Comparison of Effects of Ginger, Mefenamic Acid, and Ibuprofen on Pain in Women with Primary Dysmenorrhea; abstract
More information on period pain
BBC Health - Conditions - Menstrual problems?
The Merch Manual online medical library - Dysmenorrhoea
NHS choices - periods, painful - causes of painful periods
Patient UK - dysmenorrhoea