Why Period Pain is Not Normal, and What You Can Do About It

Period pain, known as dysmenorrhoea, is one of the most common symptoms women consult with a Naturopath for. I call it a symptom very deliberately, as it is a symptom (or we a strong, loving message!) from your body that something underlying is going on.

Period pain has been normalised to the point where advertising campaigns make a great deal of financial gain from showing us how effective their pain killers are for your once a month pain. Common descriptions I hear regarding period pain include women being unable to go to work for 1 to 3 days each cycle, feeling ‘hit by a bus’ when their period arrives, fainting, extreme exhaustion, vomiting, uncontrollable shaking on the shower floor, stabbing pains that feel as if they have been poisoned… The list goes on.

From an evolutionary perspective, it does not make sense for women to have crippling, debilitating period pain for 1 – 4 days every single month. What purpose would this serve to successfully carry on the human race?

No matter the severity of your period pain, my goal is to prevent the pain from occurring in the first place, and not only treat the pain once it has occurred. This is the foundation of Naturopathy – preventative medicine, as opposed to symptomatic medicine. Assisting the symptoms while the underlying cause is being tackled is what I strive to do.

Ruth Trickey phrases the issue of period pain well in her book Women, Hormones, and the Menstrual Cycle:

The two questions to ask about period pain are:

1. ‘Does it bother you enough to want/need to do something about it?’ and if so,

2. ‘Are you happy with the treatments you are using?’

After all, on average, a woman will have twelve or thirteen periods annually and if she has pain on two or three days of these, she will experience about a month of pain every year.

If you suffer from debilitating period pain, please see a health professional to further investigate the possibility of conditions such as endometriosis, adenomyosis, or pelvic inflammatory disease (PID). Endometriosis affects 1 in 10 women, and this is thought to be a conservative estimate.

Because period pain is a symptom and not a disease— in order to successfully treat the pain, you must determine exactly what is causing it in the first place. I discuss this concept in detail in my acne blog, finding the underlying driver for your symptoms will direct and refine your treatment. This is why the one size fits all approach does not work, particularly not for your health.

Let’s look at some of the most common causes of period pain.

1. Oestrogen excess or hypersensitivity

Excess circulating oestrogen levels can be the cause of many pre-menstrual symptoms (PMS), including period pain. Other symptoms include:

- Mood swings

- Irritability, anxiety

- Low moods, depression

- Heavy periods

- Clots in the period

- Bloating

- Water retention

- Breast tenderness

- Migraines

Excess oestrogen can occur with or without low progesterone, but symptoms are often more intense if progesterone levels are low, which I will cover in the point 2.

Oestrogen excess can happen when the oestrogen detoxification pathways are comprised or over-burdened. Oestrogen is cleared out both through the liver and the bowels. If either or both of these detoxification systems are not working efficiently, oestrogen will continue to be recycled by the body. The body does not see our own hormones as an urgent priority versus a substance like alcohol which becomes toxic in high amounts. Additionally, there are nutrients and co-factors required by both the liver and the bowel in order for their processes to run smoothly. These include B-vitamins, specific amino acids, selenium, a healthy functioning digestive system, and microbiome diversity.

Insulin resistance is a condition that can promote excess oestrogen, which is why some women with Polycystic Ovary Syndrome (PCOS) have high circulating oestrogen and insulin resistance.

How do you know if you have excess oestrogen?

If you identify with the above symptoms, excess oestrogen may be relevant to you. I recommend testing serum oestradiol on day two of your cycle.

What to do if this is you:

- Support optimal liver function to clear through any excess oestrogen. This can be done by through food, nutrients, herbs and supplementation. Some options include:

o Calcium-d-glucarate

o St Marys Thistle

o Broccoli sprout powder

o Curcumin

- Increase plant foods and fibre-rich foods, which assist with the excretion of oestrogen

o Psyllium husk

o Wholegrains

o Fruits and vegetables!

- Reduce sugar

- Reduce exposure to exogenous oestrogens

o Xenoestrogens – BPA and phthalates in plastics, pesticides, heavy metals in fertilisers

o Phytoestrogens – Soy products

o Medications – Oral contraceptive pill (OCP), hormone replacement therapy (HRT)

- Reduce or eliminate alcohol and caffeine, as both substances promote enterohepatic recycling of oestrogen

o Your liver will prioritise detoxifying and clearing alcohol and caffeine out of your body before your own oestrogen

Both alcohol and caffeine have been shown to increase period pain, so although they are not the underlying cause of your pain, they will be exacerbating it. Take a break from these substances at least two days either side of your period.

2. Low progesterone

The hormone progesterone is only created once ovulation has occurred. A small amount is created by our adrenal glands (mostly post-menopause), and the placenta in pregnancy, but as we are discussing period pain here, we will focus on optimal progesterone levels throughout the menstruating years.

Progesterone has anti-inflammatory effect, and during the luteal phase of the cycle it affects the regulation and synthesis of prostaglandins, that in turn will directly affect levels of period pain experienced.

If your progesterone levels do not peak in the luteal phase of your cycle, this indicates an anovulatory cycle – meaning ovulation has not occurred, or corpus luteum inadequacy. If your progesterone levels rise in the luteal phase but only slightly, you will most likely experience symptoms of low progesterone. These include:

- Mood changes, low mood

- Feelings of anxiety or irritability

- Disturbed sleep

- Decreased libido

- Bloating

- Fluid retention

- Short luteal phase

When a woman has low progesterone, the ratio of progesterone to oestrogen will also be unbalanced, which unfortunately can lead to both low progesterone and oestrogen excess symptoms. If this is the case, you must support your adrenal, ovarian, nervous system, and liver health. Focus on both of the treatment options in both points 1 and 2 of this blog.

How do you know if you have low progesterone?

If you identify with the above symptoms, low progesterone is worth investigating. I recommend testing serum progesterone 7 days before your period. Classically, people recommend testing on day 21 of your cycle, but this is only relevant if you have a 28 day cycle. For different cycle lengths, you need to calculate by subtracting 7 days from your period.

For example:

- For a 35 day cycle, test progesterone on day 28

- For a 21 day cycle, test on day 14

- For an irregular cycle, I recommend basing the day of testing on your previous 3 cycles, estimating what 7 days before your period might look like. Your practitioner will be able to interpret your progesterone results once they know when your period arrived, after you completed the test

What to do if this is you:

- Take the progesterone stimulating herb Vitex:

o Vitex not only modulates progesterone, but it may also indirectly lead to an elevation in mood as progesterone is our natural ‘anti-depressant’ hormone

- Consider herbal hormonal modulators:

o Peony

o Wild yam

o Black cohosh

o Tribulus terrestris to stimulate ovulation

- Increase your consumption of zinc as it is critical for hormone production:

o Top food sources are oysters, seafood, red meat, liver, eggs, pumpkin seeds

o Supplement with 30 - 50mg daily after food

- Supplement with B6 to support healthy ovulation

- Test prolactin:

o Prolactin and progesterone have a antagonist relationship

o I recommend testing on day 2 of your cycle

- Stress reduction is a key part of treatment – it must be prioritised daily. Read my blog for more information on stress

3. Prostaglandin imbalances

Prostaglandins are a family of complex ‘hormone-like’ substances found in the body that are involved in the regulation of inflammatory processes in our bodies. There are many different types of prostaglandins, some are anti-inflammatory whilst others are pro-inflammatory. Therefore it is imbalances in the families of prostaglandins that contribute to period pain, and not simply the existence of the prostaglandins themselves.

Prostaglandins cause narrowing of the blood vessels that supply blood to our uterus and abnormal contractile activity of the uterus wall. Both of these events lead to decreased blood flow and oxygen to our reproductive organs, as well as increased sensitivity of the nerve endings. This is why higher levels of prostaglandins are associated with more severe menstrual cramps, and why anti-inflammatory medications such as Nurofen or Naprogesic works so well as they inhibit prostaglandin synthetase enzymes necessary for prostaglandin synthesis.

Factors such as stress, infection, inflammation, disease, allergies, hormone variations and quality of diet cause the production of the pro-inflammatory prostaglandins over the anti-inflammatory types. Prostaglandin imbalances may be temporary or long-term, which is why period pain can change cycle to cycle.

What to do if this is you:

- Follow an anti-inflammatory way of eating

o The Mediterranean diet is a nice template to start with

o Read my blog on inflammation here

- Supplement with Essentially Fatty Acids (EFAS). EFAS provide the substrate for the anti-inflammatory group of prostaglandins

o Omega 3 fatty acids from fish oil (EPA/DHA)

o Evening primrose oil (EPO)

- Take anti-inflammatory herbal medicines

o Ginger

o Curcumin

o Boswellia

o Feverfew

- Consider B6

o B6 is a cofactor in many cellular processes of the female reproductive system including hormone synthesis, prostaglandin biosynthesis, and maintenance of normal intracellular magnesium concentration

- Supplement with magnesium to symptomatically assist with the spasmodic pain and cramping

4. Magnesium deficiency

Magnesium is the second most abundant intracellular cation, fourth most abundant mineral in our bodies, and is a co-factor in over 300 enzymatic reactions.

Magnesium deficiency statistics vary greatly, however one study found that 10 out of 11 apparently healthy women are magnesium-deficient based on the oral magnesium load test. Another found that 38% of patients with type 2 diabetes have low plasma magnesium levels (which is why I give magnesium to all of my diabetic and insulin resistance clients).

Magnesium is essential for nerve and muscle function, contributes to bone health, is key for energy production, blood sugar regulation, and the metabolism of carbohydrates. Common symptoms of magnesium deficiency include:

- Muscle cramps (aka period pain!)

- Fatigue

- Headaches and migraines

- Mood disturbances

- Anxiety

- Difficulty sleeping

Why can’t we get our magnesium from food alone? Unfortunately it is nearly impossible to get the levels of magnesium we need daily. There are many factors to this, but the biggest one is how we are living. Low intake of magnesium rich foods is an obvious contributor, however, high stress levels, medication use, alcohol intake, poor digestive function, loose bowels, and magnesium-poor soils all contribute to sub-par magnesium intake.

The Recommended Dietary Intake (RDI) for magnesium is 400 – 425mg/day for adult men, 310 – 320mg/day for adult women, with these amounts increasing during pregnancy and lactation.

What to do if this is you:

- Increase magnesium rich foods:

o Leafy green vegetables

o Wholegrains – particularly oats and barley

o Legumes – navy, pinto, kidney, and chickpeas

o Nuts and seeds - peanut butter, sunflower seeds

o Seafood, meat

o Dairy products

- Supplement with magnesium, I recommend between 300 – 600mg daily in split doses:

o Citrate and bisglycinate are well absorbed forms

o Chelate, oxide and sulfate are not

I hope you have learnt a thing (or two!) about the different causes and treatment options for your period pain, and feel like you have a place to start on the path to reaching pain-free, enjoyable periods.

If you have been struggling with your period pain or cycle symptoms and are looking for individualised support, please get in touch by booking a session here.

Jaclyn is a qualified Naturopath with a focus on hormonal complaints, cycle health, reproductive and fertility care, skin issues, and adrenal health.

Author
Jaclyn Cave
BHSc (Nat), BComm (Soc)
Masters Womens Health Med (UNSW - completing)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/

https://www.ncbi.nlm.nih.gov/pubmed/11059833

https://www.ncbi.nlm.nih.gov/pubmed/6790261

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068519/

https://www.ncbi.nlm.nih.gov/pubmed/32069859

https://www.ncbi.nlm.nih.gov/pubmed/19647143

https://www.ncbi.nlm.nih.gov/pubmed/28178022

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786912/#R49

Gropper, S., & Smith, J. (2013). Advanced Nutrition and Human Metabolism. 6th Ed, Cengage.

Hechtman, L. (2018). Clinical Naturopathic Medicine. 2nd Ed, Elsevier.

Trickey, R. (2003). Women, Hormones and the Menstrual Cycle. 2nd Ed, Allen & Unwin.