Period pain is not normal, and you don't have to put up with it!

Period pain and cramping are often written off as a ‘normal’ part of being a woman - something you might come to expect after years of watching your mum or older sisters pop Panadol or Ibruprofen each time “that time” of the month rolls around. But did you know severe pain and cramping associated with your menstrual cycle is NOT normal? It’s a sign that something is not quite right and a suggestion there may be a hormonal imbalance, nutritional issue or underlying health condition that needs to be addressed. Ideally, your cycle should come and go with minimal disruption to your daily life, and minimal discomfort. The odd cramp or spasm here and there is usually nothing to worry about (and is common on the first two days of your bleed), but severe pain, cramping, aching, throbbing or stabbing sensations (especially those that require pain killers) need to be investigated!

Types of Period Pain

The official term for period pain is ‘dysmenorrhoea’. There are many causes of dysmenorrhoea, and we’ll explore some of them below, but firstly, it’s important to recognise that period pain presents in many ways and is often as unique as the woman experiencing it. Some women experience waves of spasm, while others experience acute, sharp, stabbing or cramping pains. For some women, pain my refer down the legs or into the back, and for others, it might be localised to the lower abdomen. Some women experience pain before their bleed, while others experience it during their bleed, especially in those first few days. ‘Mittelschmerz’ is a German word for pain that occurs in the middle of the cycle, around ovulation.

For women who are fortunate enough to have never experienced severe period pain, it’s important to recognise that for some women, period pain can be severely debilitating, requiring hospitalisation and/or medical intervention. Some women have pain so severe it can cause nausea and vomiting, so it’s essential we never dismiss a woman’s pain or label her as ‘melodramatic’; instead, we should be supporting her and encouraging her to seek help by a qualified healthcare practitioner. Sadly, I’ve worked with many patients whose diagnosis and treatment has been delayed by family members, friends and doctors dismissing the severity of their pain and/or telling them to simply ‘take some Panadol’ - For women with conditions like endometriosis, Panadol just doesn’t cut it! If you suspect something is not quite right and are not getting adequate support from your healthcare team, I encourage you to seek a second opinion. Early investigations might include:

• Case taking and questioning (the more details you have about the timing, nature and type of pain, the better)

• Blood tests

• Imaging (such as an ultrasound)

In some cases (and depending on these initial findings), further investigation may be warranted, such as with a laparoscopy, MRI or pelvic exam. Once the cause has been identified, steps can then be taken to rectify or manage the issue!

Causes of Period Pain

As I mentioned above, there are many types of pain women may experience with their menstrual cycle, and each need to be considered in the context of other symptoms and any investigations that have been performed. Some of the more simple causes include:

• Magnesium deficiency (resulting in cramping of the uterine muscle)

• Oestrogen excess (resulting in heavy menstrual bleeding, meaning the uterine muscle needs to work harder to expel the blood)

• Inflammatory diets (due to increased production of inflammatory prostaglandins; hormone-like compounds that cause contractions and pain the uterus)

• Zinc deficiency (as zinc deficiency is associated with heightened sensitivity to pain and increased production of those inflammatory prostaglandins!).

If there is a nutritional issue underlying the cause of your period pain (such as a magnesium or zinc deficiency), then correcting this imbalance should help alleviate the issue. Increasing your intake of anti-inflammatory foods such as turmeric, ginger and omega 3 fatty acids (from oily fish, chia seeds, hemp seeds and flaxseeds) may help decrease production of those inflammatory prostaglandins, to lessen your pain and cramping.

In my clinical experience, many women also notice a reduction in period pain when they remove dairy from their diet. There are a number of possible reasons for this. One may be that dairy contains small amounts of hormones such as insulin-like growth factor 1 and oestrogen, however the extent to which these hormones affect our health is a matter of debate. Another reason may be that milk contains a protein called A1 casein, which is metabolised in the body to form an inflammatory compound called beta-casomorphin 7 (BCM7). Some people seem particularly sensitive to BCM7, possibly because they lack the enzyme needed to break it down, or because they experience higher uptake of the compound from the gut into the bloodstream. Whilst these effects are not fully understood, for some women, trialling a dairy free diet can result in a dramatic reduction in their period pain.

If oestrogen excess is causing heavy periods and subsequent pain, then we need to rectify this hormonal imbalance. Oestrogen excess may occur due to increased production of oestrogen, reduced clearance of oestrogen, or a combination of the two. If the issue is increased production, then we need to address modifiable factors such as diet, body fat levels and exposure to endocrine-disrupting chemicals. Some women genetically produce more oestrogen, so in these cases, we help support oestrogen breakdown and clearance. The liver and bowel are the two main mechanisms by which we clear oestrogen from the body, so supporting these organs and ensuring regular bowel motions can help rectify the issue.

Other Causes of Period Pain

Sometimes, period pain goes beyond a simple magnesium deficiency or dietary issue. For some women, period pain is caused by an underlying condition, such as endometriosis, fibroids, cervical stenosis or pelvic inflammatory disease (typically caused by a sexually transmitted infection).

In endometriosis, the uterine lining grows outside of the uterus, such as in the abdominal cavity or bowel. This can cause severe pain, heavy menstrual bleeding and widespread inflammation. Other symptoms that can be suggestive of endometriosis include pain during sex, bleeding between periods, infertility and/or pain with bowel motions or urination. If you have any of these symptoms, it is ESSENTIAL you have them properly investigated.

What Does NOT Cause Period Pain

PCOS is NOT a cause of period pain, so if you’ve been putting your period pain down to this, it’s important to realise something else might be going on! Lara Briden has a great article on the topic of PCOS and period pain here.

Peri-menopause is certainly a time in which women experience changes in their cycle; they might experience cycles of varying length, heavier bleeds, lighter bleeds and other symptoms like hot flushes, however pain is not inevitable. In early peri-menopause, many women experience a significant increase in oestrogen production, which can thicken the endometrial lining and contribute to pain, cramping and heavy bleeding, in part due to the imbalance that occurs between oestrogen and progesterone production at this time. It’s easy therefore to put period pain down to these hormonal fluctuations, but it is important to still investigate the pain as a potential separate entity, to ensure the true cause isn’t missed.

Monitoring Period Pain

The health of your reproductive organs can play a huge role in your overall health and wellbeing, so being informed and proactive when it comes to your menstrual cycle is essential! I encourage all my female patients to monitor their menstrual symptoms with a period tracking app or notepad and pen. These tools can give valuable information to your healthcare provider about when your symptoms occur, as well as the severity and nature of your pain. They can be used to monitor changes in symptoms or symptom severity over time, as well as to track other useful info such as the duration of your bleed, changes in your cervical mucus and the length of your cycle.

That said, whilst I encourage my patients to use period tracking apps to record valuable information about their cycle, I do not recommend using them to predict ovulation or guide contraception choices. These apps use algorithms to calculate when your fertile window MAY be, but they are particularly unreliable if you have an irregular cycle. Even for women with a regular cycle, they should not be used as a form of ‘contraception’, as there are many factors that can cause us to ovulate early or late, and such algorithms do not account for these possible disruptions. Predictions made about your ‘fertile window’ are simply that - predictions. Like the weather, they are not cast in stone, and they are certainly not always accurate. To avoid confusion, some apps allow you to turn off the ‘fertile window’ function, which can help you avoid the temptation of relying on these predictions. The topic of birth control however is a whole other article in and of itself, and one that I will definitely explore in future blog posts.

Yours in health,

Niki x