Skip to main content

Your Guide to Pain Free Periods

Painful periods and menstrual cramps

This is the one article series a lot of women have been asking for – what to do about painful periods and period cramps. Half of women experience pain during their menstrual cycles (and around 90% of teen girls) and 1 in 10 women have periods that are so painful they are unable to work or function for up to a week each month.

So what are we going to do about it ladies? I’m not one to just take things as they are – and I don’t want you to either! Let’s learn a bit more about why some of us get such significant pain during our periods, and then we’ll talk about what we can DO to lessen our pain, and live our amazing lives, every damn day of the month.

Dysmenorrhea

The medical term for painful periods is dysmenorrhea. And it encompasses anything from cramps in the lower abdomen to low back pain, pain/pulling sensation in the inner thighs, diarrhea, nausea, vomiting, dizziness, headache and fatigue. Dysmenorrhea is basically anything miserable during a period that interferes with our ability to function.

There are two different types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea – no underlying cause, just the result of our body’s natural physiology

Secondary dysmenorrhea – occurs as a result of something else – an underlying condition that can lead to pain during periods – endometriosis, ovarian cysts, pelvic inflammatory disease, uterine fibroids, a narrow cervical opening, etc.

Ultimately we need to understand if there is a secondary cause for the painful periods – and treat that. If your periods started being painful right from your first period in your teens, then it’s most likely primary dysmenorrhea. If you had years of pain-free periods, then a full workup for secondary dysmenorrhea is highly recommended. In either case read on and learn more about what you can do to help yourself manage your period pain.

Why Are My Periods Painful?

A couple of specific physiological changes occur at the start of our periods that contribute to pain during periods.

Just before the start of our period flow the blood supply, and thus oxygen delivery, to the uterus is significantly restricted. In order for the lining of the uterus to be shed there is also an increase in the production and release of inflammatory compounds (called prostaglandins) that stimulate uterine contractions. This combination of low oxygen delivery (called ischemia), inflammatory prostaglandins, and contractions causes the pain associated with our periods.

But Dr. Lisa, not every woman experiences painful periods (lucky b*tches)

Yes, dear reader, this is absolutely true! Some factors need to be considered in those of us who do have painful periods.

Women who have painful periods produce on average 8-13 times more prostaglandins than women who do not experience painful menstrual cramps (more on this in the treatment section). Women who do not ovulate during their menstrual cycle also do not have painful periods – the drop in progesterone is what triggers the inflammatory prostaglandin production and painful uterine contractions. As we get older and make less progesterone, we also can experience much less painful periods.

And lifestyle makes a difference for some women too. Women who already have poor oxygen delivery to the uterus – smokers, women who are overweight, women who are sedentary – they tend to have cramping that is either more intense, or lasts longer, or both.

Treatment of Painful Periods and Menstrual Cramps

There is a LOT that we can do to manage our menstrual cramps. Many of the lifestyle and natural treatments are very effective for reducing pain during our periods and can give women back their vitality every day of the month. Ultimately it can be a trial and error to determine what will be the most effective for you, and working with a Naturopathic Doctor can accelerate your progress.

Below I’ve given you my top ten lifestyle modifications for managing period cramps.  Once you’ve made those changes, check out my article on Natural Treatments for a Pain Free Period. And then when you’re empowered with all that knowledge, book an appointment so we can put together the very best plan for you.

Lifestyle for Pain Free Periods

Studies have found a number of factors that can contribute to painful periods – women who eat more sugar, junk food, fast food and saturated fats tend to have more painful periods. Women who exercise regularly (not just during their periods) tend to have less menstrual cramps. Using tampons can make menstrual cramps worse, as can constipation or food sensitivities.

Below you’ll find my top ten lifestyle tips for reducing period pain

  1. Cut the sugar

Not really a newsflash, but sugar makes just about everything worse – including period cramps. Sugar interferes with the body’s ability to absorb and use B vitamins and minerals, both of which can worsen muscle tension and increase the force of uterus cramps. So quit it – you already knew you should.

  1. Ditch dairy

Prostaglandins, those inflammatory molecules produced by our uterus that cause pain, are made in our body from arachidonic acid. Arachidonic acid comes mostly from our diet, in particular dairy products (although poultry is also a high source of arachidonic acid). Reducing or eliminating dairy is a great idea for women who get period pain – and it has been suggested that eliminating dairy may provide a significant benefit (with no other treatments) for up to one-third of women with painful periods!

  1. Avoid alcohol

Ladies, I get it. The urge to have a lovely glass of wine to dull the cramping and misery, and really, you just want it. But I’m a teller of truths – alcohol is a no-go for painful periods. Alcohol is well known to deplete B vitamins as well as muscle-relaxing minerals such as magnesium. Not only that – it interferes with the liver’s ability to metabolize hormones. All of these contribute to more cramping and heavier periods (which lead to more clots, which trigger more uterine spasms, which causes more pain…)

  1. Skip the salt

Salt is something many people think they are avoiding, but that stuff sneaks into everything. While I’m not opposed to a bit of sea salt on my edamame, the primary source of salt in the diet is processed or packaged foods. Salt can increase fluid retention, which can worsen bloating and discomfort as well as period pain. So skip the salt and season with spices instead.

  1. Load up on the legumes, nuts and seeds

Nuts and seeds are excellent sources of minerals like magnesium and calcium – both of which can lessen muscle tension and reduce the pain of menstrual cramps. Additionally, eating a diet higher in plant proteins and lower in animal proteins has been found to reduce the incidence of dysmenorrhea. So skip the chicken and have some chickpeas and cashews instead.

  1. Eat your veggies

Really, is there anything vegetables CAN’T do? They are the most important component of the human diet, and eating more of them cures just about everything – including period cramps. Women who eat more fruits and vegetables have the lowest rates of painful periods. Vegetables are excellent sources of minerals, like calcium and magnesium, as well as fiber to reduce bloating and discomfort.

  1. Understand your food sensitivities

Wait, what? Food sensitivities? What do those have to do with my period cramps?

It turns out, quite a lot!

Food sensitivities can damage the lining of the digestive tract, altering the absorption of B vitamins and minerals, resulting in more cramping. Additionally, food sensitivities can cause increased production of inflammatory molecules, leading to more inflammation (and more pain) when period time rolls around. Add to the mix the irregular bowel movements that can result from food sensitivities and you have the perfect storm for period pain. So if you’ve ever wondered if you have food sensitivities and you get painful periods, I’d considering having the food sensitivity test. It may be just what you need.

  1. Exercise regularly

Exercise improves blood flow to, and from, the uterus. Exercise also helps to alter the production of prostagandins, leading to less pain. And it’s not just exercise during your period that helps – most studies show that women who exercise regularly have less painful periods than those who don’t. There are also some specific exercises that have been found to help manage period pain – you can read more about those here.

  1. Toss the tampons

We are entering a new age of period empowerment. No longer are we having to choose between bulky pads and bleached cotton tampons. There are so many options now for women to comfortably accommodate their periods.

Pain free periods. Natural treatments for period cramps

From the Diva Cup to Thinx period panties, to all natural pads that are thin and comfortable. Women who use tampons have more painful periods than those who don’t, and most of those tampons are full of chemicals that can be absorbed across the mucosal barrier of the vaginal canal – not a good thing! So toss those tampons and join women in the age of period empowerment!

  1. Try a Natural Approach

While we may be tempted to manage our period pain with Midol and Advil and other pain killers, there are a number of natural supplements – nutrients and botanical (plant) medicines that can provide amazing relief. And without the side effects of those pain killers as well! Start by reading my article on Natural Treatments for Pain-Free Periods and then work with a Naturopathic Doctor to personalize a treatment plan that can give you relief from your menstrual cramps.

Natural Treatments for Pain-Free Periods

Natural treatment options for period cramps

Ok ladies. In the last article we talked about why your periods can be painful – conditions l

ike endometriosis, fibroids or pelvic inflammatory disease, and lifestyle factors. We also talked my top ten lifestyle tips for pain-free periods. (If you haven’t read that article, pop over and read it now, then come on back and join me here. I’ll wait.)

In this article we’re going to go deeper into the science on period pain and discuss ten of most promising natural treatments for managing period cramps and painful periods.

But remember, these won’t work if you don’t have a healthy foundation in place, so start with the lifestyle changes, and then work with your Naturopathic Doctor to layer in some of these treatments to help you achieve your pain-free period!

Nutrients for Menstrual Cramps

B1 – Thiamine

Ah, thiamine, vitamin B1 – named so because it was the first B vitamin discovered! I’ve got a weak spot for B vitamins (and all vitamins really) because they are literally how our bodies get sh*t done! Thiamine is needed for your body to make energy from food – especially the grains that it is abundant in.

The mechanism by which this B vitamin can help period cramping stems from it’s action on the central nervous system and neuromuscular system – all coming down to it being effective for reducing spasmodic uterine pain (i.e. cramping). One study (link: https://www.ncbi.nlm.nih.gov/pubmed/8935744) found that taking vitamin B1 daily for 3 months completely alleviated period pain in 87% of study participants – damn! Worth a shot I think!

B6 – Pyridoxine

Vitamin B6 has fast become one of my favourite B vitamins (sorry B12!) due to it’s profound actions on female hormone balance. In addition to supporting energy production (just like all the B vitamins), vitamin B6 is needed to make progesterone, serotonin, norepinephrine and melatonin.

When used with its BFF, magnesium, vitamin B6 may be helpful in decreasing period cramps. When used for 10 days prior to the period, women have reported less painful periods (and less premenstrual acne!) when using a combination of B6 and magnesium. While it may not be enough on its own, it can be an important part of a treatment plan for period cramps.

Magnesium

Magnesium, known primarily for its ability to relax muscle (making it incredibly useful for blood pressure, muscle cramps and asthma), is unfortunately one of the most common nutrient deficiencies in North America. Found mostly in unprocessed foods (like leafy greens, nuts and seeds), magnesium deficiency can cause:

  • fatigue
  • irritability
  • weakness
  • muscle spasms
  • menstrual cramps
  • poor nail growth (I get asked about this issue all the time!)
  • insomnia
  • sugar cravings
  • anxiety

It has been suggested that the majority of women with PMS have a deficiency of magnesium – unfortunately magnesium is not easily tested for in laboratory tests, so deficiency often goes undiagnosed.

But the benefits of magnesium are not going unnoticed! A Cochrane study found that using magnesium for period cramps was effective for pain relief and resulted in women using less pain medication during their periods. Win! Magnesium: 1, period pain: 0.

Omega 3s

The last of our nutrients for period cramps, are our omega 3 fatty acids. These amazing compounds decrease inflammation (by altering prostaglandin production – remember this from the last article?) and taking relatively high doses (around 2 grams per day) has been found to reduce pain scores in women with period pain. And with all the side effects of omega 3s (healthy skin, less inflammation, improved mood, better heart health), it sure won’t hurt to give these a try.

Botanicals for Menstrual Cramps

While nutrients help our body to function optimally (that’s what they do!), botanicals, or plant medicines, act more like medications – changing or encouraging our bodies to function in specific ways. Most often I have my patients on a combination of nutrients (Woot! Optimal health!) and plant medicines to get the best outcomes.

Valerian

Best known for it’s sleep supporting actions, valerian (Valerian officinalis) can be very supportive for managing painful periods. With the ability to bind to GABA receptors in our brain (the same ones Valium uses), valerian can reduce pain, anxiety and insomnia. It has also been found to reduce spasmodic contractions – those same ones that lead to all the pain of period cramps. Valerian doesn’t need to be taken all month – just during your period to manage the discomfort and misery of painful periods.

Crampbark

Well doesn’t the name just say it all?? Crampbark (Viburnum opulus) has been used for generations for period cramps. Acting as a uterine relaxer and antispasmodic, crampbark is your best friend if your period cramps are accompanied by low back pain or pain that radiates into your thighs.   Taken in a similar manner as ibuprofen, one capsule of crampbark every 3-4 hours can help to reduce cramping and pain.

Ginger

I hate to play favourites (no, that’s not true. I totally love my favourites), but ginger is the BOMB when it comes to managing period pain.

With antispasmodic effects as well as the ability to inhibit the production of inflammatory and spasmodic prostaglandins (again with the prostaglandins!), ginger is a powerhouse of period pain management.

There have been studies comparing ginger with ibuprofen and found no difference in the effectiveness of the two treatments for period pain – in fact, more women in the ginger group were completely pain free than in the ibuprofen group. BOOM!

Ginger is most effective starting a few days before your period, and continuing through the first days when cramping is most likely to occur.

Black Cohosh

One of the best researched botanical medicines in the world, black cohosh’s claim to fame is in managing symptoms of menopause. But that’s not all it is good for.

Black cohosh (Actaea racemosa) is another uterine relaxer that can be useful for period cramping. It’s best for women who also have significant water retention (think swollen ankles, bloating and tender breasts), irritability during PMS, and delayed or irregular menstrual periods.

Other Natural Supplements

A few other natural medicines can help you achieve your dream of a pain-free period. And I certainly couldn’t leave them out! These two treatments are best used under supervision or advisement of your Naturopathic Doctor – so have a talk with them about whether to include these in your plan for a Pain-Free Period!

Melatonin

Melatonin for period crampsMelatonin is most commonly thought of as our sleep hormone, produced by the pineal gland in our brain to support sleep-wake cycles. But it does so much more than that!

Melatonin levels are lower during the second half of our menstrual cycle (during our luteal phase), and this is thought to be a factor in the development of period pain.

When melatonin levels are high, it can decrease the contractile force of the uterus – decreasing painful cramps. As well melatonin is known to have analgesic properties – decreasing pain. Melatonin also inhibits the production of those pesky prostaglandins that lead to most period pain.

Safe for most women, melatonin should be used for a few days prior to the onset of the period and for the first few days of the period. Taken before bed, you’ll likely get some stellar sleep as well!

BHRT Progesterone

For women whose period pain does not improve, no matter how many things they try, bioidentical progesterone can be a game changer.

Progesterone is the hormone that dominates the second half of the menstrual cycle, and a drop in the level of progesterone leads to an increase in inflammatory arachidonic acid and prostaglandins from the uterus. Welcome to Pain City.

If we can lessen the severity of this drop, or delay it, then often we can reduce the pain and intensity of uterus contractions that come from a hard drop in progesterone.

Best indicated for women in their 30s and 40s, bioidentical progesterone should be prescribed by a knowledgeable practitioner. Used for somewhere between 3-12 days before the onset of the period, progesterone may be exactly what some women need.

Onwards in your Pain-Free Period Journey!

Ladies, you don’t have to suffer. There are SO many things you can do to manage your periods so that they do not negatively impact your life. If you want to learn more, browse through some of the other articles on this website, or book an appointment to get your periods back on track!

Problems with Pill: Nutrient Depletion

Oh the pill.  Many of the women in my practice have a love-hate relationship with this medication.  Some of the things I commonly hear:

  • My skin looks better on the pill
  • I’ve been on the pill since I was a teenager and am scared to go off
  • The pill is treating my PCOS
  • I don’t want to be taking synthetic hormones but I don’t know what else to do
  • The pill makes me crazy every month
  • I’ve never really thought about the pill…

The most common thing I see is that women take the pill without ever really questioning it.  No doubt it is an incredible medicine, that had a huge impact on women and feminism.  But it is not the cure-all for women’s troubles that we are told it is.

In the article Problems with the Pill, I share some of the concerns that I, as a naturopathic doctor and women’s health expert, have regarding the pill. The purpose is not to convince you to give up the pill, but to empower you with information.  This article starts the conversation by looking at the nutrient deficiencies resulting from the pill.

Nutrient Deficiencies and the Pill 

Folic acid (folate)

Foliage (leafy greens), are the best source of folate

Since the ‘60s it has been consistently found that women taking the pill have lower levels of folate in their blood streams. Due to changes in folate metabolism and absorption, folate levels drop in women on the pill, and are lowest in women with longer use. Folate is necessary for DNA synthesis and cell division, and is essential for healthy development of a fetus (low levels can lead to neural tube defects and cleft palate.)

Vitamin B2 (riboflavin)

Riboflavin is an essential B vitamin, necessary for the production of energy, and the metabolism of fats and carbohydrates. Vitamin B2 is not stored in the body, so deficiency is common, and is worsened by the use of the pill.

(An interesting aside, supplementing vitamin B2 can be incredibly effective in managing headaches and migraines, a common side effect of the birth control pill.)

Vitamin B6 (pyridoxine)

A superstar B vitamin, vitamin B6 is needed for protein, fat and carbohydrate metabolism (turning food into muscles and energy – yes please!), it is also necessary for the production of our feel good neurotransmitter, serotonin. The drop in vitamin B6 levels in women on the pill is especially troubling because low B6 is associated with an increased risk of blood clots (a common side effect of the pill.)

Vitamin B12 (cobalamin)

Eggs are a source of vitamin B12

The last of the B vitamins depleted by the pill, vitamin B12 is essential for the production of energy in our mitochondria, for burning fat and carbohydrates as energy, and for healthy red blood cell production. B12 deficiency is even more of an issue in vegans and vegetarians, as the only food sources are from animals, or supplements.

Vitamin C

One of the most important antioxidants in our bodies, vitamin C is also essential for immune function, and preventing heavy metal toxicity. The estrogen found in the pill changes the rate of metabolism of vitamin C, leading to increased loss in the urine. A low intake of vitamin C (not getting your 8-10 servings of fruit and vegetables daily!) can make this problem much more serious. Taking a vitamin C while using an oral contraceptive may also reduce some of the cardiovascular risks associated with the pill.

Vitamin E

Not just one single vitamin, but a group of vitamins (the tocopherols), vitamin E is an antioxidant, with the special ability to be recycled and reused multiple times. It is also a fat-soluble antioxidant, meaning it can get into our cell membranes and protect them from damage. Low vitamin E levels can promote platelet clotting, increasing the risk of blood clots – again, a major concern for women on the pill.

Magnesium

Over 300 different enzyme systems use magnesium, including all the enzymes for energy production. Many of my patients also recognize the possible side effects of low magnesium levels – headaches, muscle cramps, restless legs, migraines, anxiety, and constipation. The pill can seriously reduce magnesium levels in the body, leading to imbalances in calcium and magnesium ratios, increasing the risk of blood clots (again!)

Selenium

Seeds are excellent sources of selenium

One of the most important nutrients for the thyroid, and for every cell that uses thyroid hormone (listen up ladies, 1 in 6 of you also has a thyroid dysfunction.) Deficiencies of selenium have been implicated in Hashimoto’s thyroiditis, as well as heart disease and cancer. The pill reduces the ability of the body to absorb selenium, and combined with the low selenium content of food grown in Ontario soils, this can be a serious issue in women’s health.

Zinc

The last of our nutrient depletions associated with the pill (I think that’s enough already!), zinc is incredibly important to our brain function (“no zinc, no think”), learning and memory. It is also involved in immune function, DNA metabolism and apoptosis (programmed cell death that, when it goes awry, can lead to cancer.)   We don’t know if the zinc depletion seen in women using the pill is due to changes in absorption, excretion, or increased demand, but since the 1960s we’ve known women taking the pill have lower zinc levels.

Next Steps…

A high quality multivitamin and mineral supplement may be enough to provide you with the nutrients you need while taking the pill.  However, all supplements are not created equal.  Speak to your Naturopathic Doctor about the appropriate form of nutrients and dosage for you.  And if you’re interested in working with me, book a meet-and-greet or initial consultation to get started on achieving your vibrant, amazing health.

Selected References

Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences. 2013;17:1804-1813.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.