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Period Pain Is Common, but Not Normal

Period Pain Is Common, but Not Normal

Every day, more than 300 million people menstruate in the U.S., and every month, more than 1.8 billion people menstruate worldwide. The average female will menstruate once a month for roughly 35 to 40 years. That’s approximately 3,000 days—equating to more than 8 years’ worth—of periods during a lifetime. The population that menstruates can experience many unwanted symptoms each month, which can interfere with basic daily living and functioning.

Is Painful Menstrual Bleeding Disrupting Your Daily Life?
Dysmenorrhea, better known as painful menstrual bleeding, affects more than fifty percent of cycling females in their lifetime, with some estimates suggesting up to 84%. Days of missed school or work due to painful menstruation affects between 32–40% of cycling females. Decreased productivity for those going to work while experiencing pain is as much as 33%, resulting in a mean of 8.9 days of total lost productivity per year. The largest study of productivity and menstrual complaints that has been performed demonstrated that the stigma of missing work/school due to menstrual complaints led up to 79.9% of absent females to not disclose the true reason for missing school or work. Such common complaints in such a large population should be discussed openly and without shame.

Primary Dysmenorrhea Secondary Dysmenorrhea
Onset shortly after menarche
Onset any time after first menstrual bleed, typically after 25 years of age
Lower pelvic or abdominal pain, associated with onset of flow and last 8–72 hours
Complaints change in time of pain onset during menstrual cycle or in intensity of pain
Back and thigh pain, headache, diarrhea, nausea, vomiting may be present
Other gynecological symptoms, heavy flow, painful intercourse, may be present
No abnormal findings on examination
Pelvic abnormalities on examination
Prostaglandins most common cause
Common causes: Endometriosis, uterine fibroids, adenomyosis, endometrial polyps, pelvic inflammatory disease, cervical stenosis, use of intrauterine contraceptive devices (IUD)


There are two types of dysmenorrhea, primary and secondary.

In the average female, primary dysmenorrhea decreases in severity as the female becomes older and after childbirth, whereas in secondary dysmenorrhea the pain worsens as the female ages and often has anatomical abnormalities or changes to the reproductive organs.

What’s Causing Those Cramps?
Prostaglandins are the primary cause of pain or cramps experienced during the menstrual flow. Prostaglandins are hormone-like lipids present in the uterine cells that cause the uterus to contract to help shed the lining each month. The lining is the flow you experience and as you rid the uterus of the lining, you are decreasing your prostaglandin levels as well. This process thereby produces potential debilitating cramps at the onset of your flow that improve as the menses lessens in blood flow.

Prostaglandins are involved in inflammation and pain response starting at ovulation and as they increase, the force of the contractions increases on the uterine lining until the lining is shed. This explains why some menstruating people experience cramps and spotting from ovulation until seven days into the bleed. The more inflammatory prostaglandins you have, the worse your cramps can be felt. You need prostaglandins for proper functioning reproduction health—it is when and how much is produced that starts to cause problems.

Unfortunately, if you are shutting down the prostaglandin pathway with frequent or high-dose medications like NSAIDs due to unwanted symptoms after ovation, you may also be decreasing fertilization and implantation success rates. The correct balance of inflammatory (prostaglandin 2) and anti-inflammatory (prostaglandins 1 and 3) prostaglandins are needed for proper fertilization and implantation, and to prevent debilitating cramps and other unwanted symptoms.

Prostaglandins are so powerful that manufactured prostaglandins are used medically to induce labor at the end of pregnancy or an abortion. This emphasizes the importance of a balanced inflammatory process in the menstruating population.

Conventional Treatments Aren’t Always a Good Option
Today’s modern American living, with our diets of highly processed and low-nutrient foods, high stress with little sleep, and unavoidable exposure to toxic environmental chemicals, such as endocrine disruptors, all play a role in increasing your inflammation. Preventing an uncontrolled inflammatory process is the best way to alleviate pain and cramps during menstruation, allowing for fewer missed school/work days and improved productivity when work is required during the monthly time of blood loss.

As previously noted, an inflammatory process is necessary for proper functioning reproductive health. Keep that in mind when considering treatment for younger menstruating people. From a clinical perspective, we are seeing more and worsening complaints in long term NSAID, oral contraception, and IUD users who are now trying to conceive in adulthood.

The success of conventional medicine practice comes from halting the inflammatory process in its tracks to help stop negative symptoms from being experienced. This works great for some, and may cause detrimental concerns such as stomach ulcers or ovulatory issues in others. Examples of conventional treatment include:

  • Paracetamol, aspirin, NSAIDs to reduce cyclo-oxgenase (COX2) pathway thus inhibiting prostaglandin production. Short-term NSAID use, 5–14 days, have been shown to cause fertility problems, gastric bleeding, and heart attack in women.
  • Oral contraceptives to inhibit ovulation.
  • Levonorgestrel IUD to prevent uterine lining thickening. Note that non-hormonal IUDs may result in cramps/pain and may need to be removed to resolve symptoms.

Healthy Alternatives for Menstrual Pain Relief
Holistic medicine success comes from correcting the cause of high prostaglandins, potential nutrient deficiencies, and hormone imbalances, not just stopping the process from happening. Consider starting with the following suggestions if you are not interested in the possible detriment that conventional treatments may create.

  • Diet: High-fiber, plant-based, Mediterranean style eating. Minimally processed foods. Avoid fatty foods, carbonated beverages, salty or sugary foods, alcohol, and caffeine altogether or as you near your bleed time to reduce excessive prostaglandin production. Caffeine increases vasoconstriction in the blood vessels of the uterus, creating more pain.
  • Lifestyle: Reduce exposure to endocrine disrupting chemicals by removing harsh feminine products, household cleaners, paints, herbicides, pesticides, antibiotics, plastics in form of phthalates and other toxins that leach into our foods from packaging and plastics, and personal care products. Do not microwave in plastic—a study has shown significant reduction in pain for college-aged females when they stopped microwaving with plastic.
  • Exercise: Release of endorphins and increased blood flow to the reproductive organs during moderate exercise naturally reduces pain signals such that medication was reduced or eliminated, according to a recent study.
  • Omega-3: Balances the production of anti-inflammatory prostaglandin 1 and 3 with the inflammatory prostaglandin 2. Eat more deep- and cold-water fish, flaxseeds, nuts, and seeds, and less processed omega-6 foods, including sunflower, corn, soybean, and cottonseed oils.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) can be an at-home therapy to reduce pain signals from being sent to the brain while improving blood flow.
  • Acupuncture: Shown to reduce inflammatory markers and improve blood flow to uterus, helping to alleviate menstrual pain.
  • Yoga: Cat-Cow, Child’s, Plank, Cobra poses help relieve cramps.
  • Sacral chakra balancing.
  • Stress reduction with proper sleep habits.
  • Heat: Using a heating pad on your abdomen or lower back helps relieve pain from menstrual cramps.
  • Topical magnesium gel or castor oil packs on the abdomen help relieve cramping.
  • Nutrients: Vitamin E, magnesium, calcium, manganese, boron, zinc, phosphorus, vitamins B1, B6, and D have all been associated with reduced menstrual pain.
  • Herbals: Curcumin, chamomile tea, fennel seeds, cinnamon, ginger (as effective as ibuprofen), pycnogenol, dill (as effective as mefenamic acid), green papaya, cramp bark, motherwort, valerian, dong quai.
  • Essential oils with massage: Lavender, peppermint, rose, and fennel can reduce pain, especially if massaged into the abdomen.

This is not an exhaustive list of options, and you should always seek the guidance of a medical professional before starting anything new.

Experiencing menstrual cramps should not reduce your ability to attend work or school or make you ashamed to say why you missed these activities. Addressing cramps holistically, before disrupting the delicate reproductive system with aggressive synthetic chemicals, can greatly improve your symptoms. Future generations deserve better guidance in preventing and treating menstrual complaints, especially when considering overall long-term reproductive health.

Dr. Nicole Kerr, ND, LAc, operates Fertility Oasis, an all-natural fertility clinic in Wallingford, CT. At Fertility Oasis, Dr. Kerr teaches her patients the importance of preconception care and about all treatment options available to couples struggling to conceive. Male and female infertility factors are addressed by Dr. Kerr to offer comprehensive fertility care to her patients.

Fertility Oasis, 857 N Main St Ext Suite 1, Wallingford CT, 203.265.0459.