Painful Periods
It’s the middle of your long work day but your productivity is on point, and bam! It hits you like a tidal wave. Suddenly, your innards feel like they are being wrung out like a dirty dish rag and you’re overwhelmed by nausea. The pain and sickness stop you in your tracks and bring you to your knees, confused as to what’s happening.
Panic sets in momentarily but subsides as you quickly recognize this familiar pattern. You knew it was coming, but shark week intimately shows you no mercy. It’s your favorite time of the month!
Do you struggle with painful periods (medical term is dysmenorrhea)? If you do, I’d like to briefly discuss what it is and why it happens. Then, most importantly I’ll discuss techniques that you can use to help yourself and other women, so that you may find relief and be able to participate in life to your fullest extent.
What is dysmenorrhea?
Painful periods are very common for menstruating (bleeding) women. The medical term for painful periods is dysmenorrhea, and can be classified as either primary or secondary dysmenorrhea.
Primary dysmenorrhea is estimated to affect between 45-95% of menstruating women. It is defined as “painful, spasmodic cramping in the lower abdomen, just before and/or during menstruation, in the absence of any discernable macroscopic pelvic pathology.”[1]
In other words, this type of pain is present just before or at the start of a period, and is felt within the abdomen and/or radiates into the back and thighs.
This is in contrast to secondary dysmenorrhea, in which pain may be coming from “a number of identifiable pathological conditions, including endometriosis, adenomyosis, fibroids (myomas) and pelvic inflammatory disease.” [1] These conditions should be ruled out by your physician, if your pain does not respond to conventional treatment. For discussion sake today, we are discussing primary dysmenorrhea.
Are menstrual cramps normal?
So, is it common? Yes. Is it normal? No, it’s not a normal part of the menstrual cycle. Many females experience the initial onset of pain during their adolescent years, starting at or shortly after (6-24 months) menarche (her first period). [1] Therefore, it seems understandable that many women would assume it is normal because it is their usual experience. But this doesn’t have to be normal for you.
Ladies, we have options! And we can choose to take responsibility for the health of our bodies! Cliché, I know, the obvious must be stated: there are things in life we can control, and things we cannot. We have no control over our genetics, but we can influence how they are expressed by setting ourselves up for success where possible. I’m here to help you discover how!
What causes painful periods?
Before knowing how to help yourself, you need a basic understanding of what is happening in your body. By developing an understanding of your physiology, you develop a deeper connection between your body and mind.
Remember, your body loves you and does everything in its power to protect and heal you. Let’s discuss the physiology of those darn period cramps.
When a woman menstruates, the inner lining of the uterus sheds off because a month has passed without a baby being attached to the uterine wall. This shedding is known as endometrial sloughing, and this is accompanied by the release of innate chemicals known as prostaglandins.
The release of these prostaglandins are believed to cause increased uterine contractility and restriction of blood vessels, which results in decreased blood flow and decreased oxygen to the uterus, ultimately resulting in pain.
Some women just have genetically higher levels of prostaglandins, other pro-inflammatory cytokines (chemicals), and the hormone estrogen. Furthermore, these women are more prone to become highly sensitized to pain.
The reoccurrence of monthly pain can lead to the nervous system ramping up its response to each subsequent episode, which leads to an increased perception of the pain. This is known as central sensitization. [1] In other words, even when the physiological processes in the uterine tissue remain the same, the brain perceives it as more intense.
This does not mean that a woman’s pain is not valid. Each human experiences the world through her own unique journey, and we must respect that. But it’s important to not fall victim to our own negative emotions that we as individuals attach to that pain response.
What can I do to help remedy the pain?
The first line of treatment is usually NSAIDs (non-steroidal anti-inflammatory drugs), which are found to be 64-100% effective, and the second is oral contraceptives. [1] I’m a holistic healthcare provider, and as a physical therapist, I always try to help my patients find the most natural and healthy solutions. All medications have the risk of side effects, and I could write another blog post on this topic alone.
Here I’ll discuss holistic management:
1. Hydration
This is the low hanging fruit. Again, it sounds cliché, but drinking enough water and keeping your body tissue hydrated is important in helping reduce any types of cramps, whether it’s uterine or muscular. Tissue must be slick enough to physically glide, and at the cellular level requires enough water and electrolytes to maintain proper contractions. If your hydration and electrolytes are out of balance, your tissue will get “sticky” and not move properly with fluidity.
Ideally, an individual should drink half their body weight in ounces of water per day. For a woman who is 150 pounds, they should aim to drink 75 ounces of water per day. Some people do better by adding electrolytes to their water rather than drinking it plain. This salt could be in the form of sea salt, Himalayan pink salt, or even pre-packaged electrolytes. My favorites are LMNT and Trace Minerals.
Just make sure to avoid anything with additives, including sugar or artificial sweeteners. Check your food labels! I like to put 1/8 teaspoon of Celtic sea salt in a 40-ounce water bottle and shake it. Salt is not bad for you, unless it is iodized table salt (like Morton’s). Salt is a basic requirement for human physiological function. Your body actually integrates salt that is dissolved in water differently than salt that is in food.
Coffee and caffeinated teas are dehydrating; these do not count as sources of liquid, and you should actually drink extra water if you are consuming these.
Magnesium is a specific electrolyte that has actually been shown to help reduce muscular cramps and decrease the perception of pain. It has been found that women with dysmenorrhea have decreased magnesium levels [2]. Magnesium can be consumed orally as a powder or capsule supplement. There are many different forms of magnesium, so make sure to do your research and talk to your physician about supplementation and any possible interactions it may have with your current medications.
2. Nutrition
Eat an anti-inflammatory diet! This means a diet focused on decreasing your systemic (total body) inflammation. Many great books and so much cool research come out that look at different diets and foods. Check out my resource link, coming soon.
But the notion is simple: eat real foods. This includes grass-fed meats, pastured poultry and eggs, good fats (ex. ghee, tallow, lard, coconut oil, olive oil, avocados), vegetables, and moderate amounts of fruit. I’m a proponent of a paleo diet, so I believe that avoiding most grains and all sugar is best.
Turmeric is spice that has been shown to have anti-inflammatory effects, similar to NSAIDs when taken consistently. It can be used in cooking, added to drinks, or taken as a capsule. If you have gout or are sensitive to oxalates, here is a supplement brand that is low oxalate .
3. Sleep
Sleep is a highly underappreciated aspect of life and of the recovery process. Women with painful cramps may lose sleep secondary to the pain, and sleep deprivation has been shown to increase the pain response. This loss of sleep and increased pain becomes a vicious cycle that is difficult to break out of. So do yourself a favor, and make sure to get enough sleep when you’re not menstruating.
Set a regular sleep schedule to get an adequate amount of uninterrupted sleep daily. While on your period, take short mid-day naps (15-30 minutes), but no longer because this will disrupt your night. Check out my resources on sleep hygiene. Yes, SLEEP HYGIENE is a real term!
Try to get 1-3 hours of morning light between the hours of 7 am to 11 am. The sun should be on your bare eyeballs. Don’t look directly at the sun, but you should not be behind glass (such as a window or glasses) or contacts. Doing this morning light exposure daily will regulate your circadian rhythm and help you fall asleep at night with greater ease. The vitamin D you get from the sun is important as well for overall health.
4. Exercise
Engage in low- to moderate-intensity exercise while menstruating. Getting light exercise helps increase blood flow throughout the body and also releases endorphins, which help to reduce pain. Endorphins are your body’s natural pain relief hormones.
High-intensity exercise may be too strenuous when your body is menstruating, and this may overload your nervous system. Find a gentle activity to engage in, such as walking, biking, swimming, yoga, or light weight lifting.
In part 2 of this post, Painful Period Remedies, I discuss additional ways you can improve with management of painful periods, including practicing mindfulness and energy techniques, self-myofascial release techniques and stretches, breathing techniques, and other modalities.
Live in peace, Ali
Disclaimer: This blog is intended for informational and educational purposes only and is not considered medical advice.
References:
[1] Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Human Reproduction Update. 2015;21(6):762-778. doi:10.1093/humupd/dmv039
[2] Shin H-J, Na H-S, Do S-H. Magnesium and Pain. Nutrients. 2020; 12(8):2184. https://doi.org/10.3390/nu12082184
