Periods Shouldn’t Be Painful

“Dys” (bad). “Menorrhea” (menstruation). Dysmenorrhea literally means “bad menstruation.” The name fits, considering that it brings abdominal cramping, nausea, vomiting, fatigue, headache, and gastrointestinal troubles. And it affects a LOT of women. One review study examined 15 research papers and found the prevalence between 16% to 91% of women in reproductive age (Ju, 2013). In a large study of Spanish university students, 75% of women reported dysmenorrhea (Fernández-Martínez, 2018). Many factors influence these wide-ranging numbers, including cultural background. Painful periods are not normal.


Primary dysmenorrhea refers to menstrual pain without an identified problem in the reproductive organs, like the uterus, ovaries, and fallopian tubes. The uterine lining releases inflammatory chemicals called prostaglandins, which contract the uterine muscles and vessels. This leads to crampy pain. Primary dysmenorrhea typically begins in younger women once they start to release eggs during ovulation.


Secondary dysmenorrhea stems from problems in the sex organs, such as endometriosis, fibroids, or anatomic differences.  Usually, but not always, secondary dysmenorrhea begins during a woman’s 30s to 40s. Conditions like endometriosis or fibroids are often caused by a combination of factors, including high estrogen levels, vitamin or mineral deficiencies, liver or gut problems, and psychological stress. You might talk to your doctor about checking certain labs or radiographic studies to gain a better understanding of what is going on internally.


Herbalists further categorize dysmenorrhea into congestive and spasmodic types. Does the uterus feel heavy with a lot of pressure (congestive)? Or are there sharp cramps that come and go (spasmodic)? Maybe both? Based on a woman’s symptoms, the practitioner combines herbs for a botanical tincture, suppository, or tea in a very personalized approach each woman.


Traditional Chinese Medicine (TCM) views dysmenorrhea as stemming from liver qi stagnation, cold accumulation, and/or blood deficiency. TCM is an ancient system of health based on the balance of life energy called qi. Disease results from excess, deficient, or stagnant qi. A TCM doctor uses acupuncture and herbals to treat imbalances. Both the World Health Organization and the National Institutes of Health recognize acupuncture as an effective treatment for dysmenorrhea. I can tell you from experience, it works!


Many women who struggle with dysmenorrhea have heard about conventional treatments. Oral contraceptives and hormonal IUDs may prevent pain, but they do not address the root cause and they often come with undesirable side effects. Over the counter pain medications like NSAIDS effectively abort pain, but this too is a bandage, not a long-term solution.


Anti-inflammation is the name of the game for treating dysmenorrhea with an integrative approach, whether it is primary or secondary. Anti-inflammation starts with the diet: food is medicine. In a nut-shell…

  • Foods to limit or eliminate: processed sugars, alcohol, dairy, gluten, processed or non-organic meats (especially red meat)
  • Foods to increase: fruits, green leafy veggies, plant protein like legumes, cold water fish, fiber from complex carbohydrates or seeds like ground flaxseed


Cruciferous vegetables like broccoli, cauliflower, cabbage, and brussel sprouts detoxify the liver. A healthy liver metabolizes and eliminates excess sex hormones. Extra fiber aids elimination.


Cold water fish like salmon and mackerel have high levels of omega-3 fatty acids, which decrease inflammation in the body. Two to three servings of salmon will give you all   the omega-3s you need for the week. For vegetarians or folks who don’t love fish, an omega-3 supplement also works great.


Several other supplements have been found to be effective in dysmenorrhea. Magnesium decreases prostaglandin release and calms uterine contractions. Vitamin B6, or pyridoxine, helps get magnesium into the cells to do its thing. It can be helpful to take a B-complex vitamin to receive the benefits of the other B vitamins. (Proctor, 2001).


Botanical treatment of dysmenorrhea uses combinations of herbs that function as uterine antispasmodics, anti-inflammatories, uterotonics, blood circulation stimulants, liver supporters, and laxatives. There is a long list of botanical treatment strategies for dysmenorrhea, which goes beyond the scope of this article. It is worth discussing with an experienced herbalist if botanicals are in line with your treatment goals.


Moderate cardiovascular exercise prevents pain by producing endorphins. Activities like yoga help increase pelvic circulation for relief. During painful episodes, you might try a soothing, warm bath with Epsom salts. Heating pads or hot water bottles placed over your abdomen also help relax those uterine muscles.


Quality sleep allows the body to recover and recharge while you menstruate. This means at least 7-9 hours nightly. Melatonin is a non-addictive supplement to aid sleep, that also functions as a powerful antioxidant to calm brewing inflammation.


We cannot separate any part of the body from the mind. Taking care of your emotional health with love is another important piece of the puzzle. The emotional centers of the brain sit next to the hormone-secreting hypothalamus and pituitary, so it makes sense that our emotional health affects our hormones. Self-expression through journaling, making art, therapy can all help tend to your spirit.


Periods should not be so painful that you cannot work, attend school, or generally enjoy your day.  A holistic approach to dysmenorrhea helps us get in tune with our bodies’ cycles. When we intuitively listen to what the body needs, the road to feeling better starts to go more smoothly.

 


References

Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 2014;36:104-13. doi: 10.1093/epirev/mxt009. Epub 2013 Nov 26. PMID: 24284871.

Fernández-Martínez E, Onieva-Zafra MD, Parra-Fernández ML. Lifestyle and prevalence of dysmenorrhea among Spanish female university students. PLoS One. 2018 Aug 10;13(8):e0201894.

Proctor M, Murphy P. Herbal and dietary therapies for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2001(2) CD002124.

Rakel D. Integrative Medicine – E-Book. Chapter 57 Dysmenorrhea. 2018. Elsevier Health Sciences. Kindle Edition.

Romm A. Botanical Medicine for Women’s Health. 2nd Edition. Chapter 9 Menstrual Wellness and Menstrual Problems. 2018. Elsevier Health Sciences.

Xu L, Xie T, Shen T, Zhang T. Effect of Chinese herbal medicine on primary dysmenorrhea: A protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2019 Sep;98(38):e17191. 

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Dr. Stephanie Colantonio, MD

Dr. Stephanie Colantonio, MD

I am a board certified physician providing integrative, mindful health care to young adults and teens in Los Angeles. My journey to integrative medicine started with my own struggle with migraines and high stress. A combination of acupuncture, herbals, dietary changes, and mind-body medicine brought me powerful relief. So, I committed to offering my patients more holistic care as well. I practice my belief that conventional science in partnership with traditional healing can help us connect to our bodies and feel better everyday. So many of our illnesses today can improve with slowing down and learning to treat ourselves with more love and kindness.

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