Period pain occurs when the muscular wall of the womb tightens (contracts). Mild contractions continually pass through the womb, but they’re usually so mild that most people can’t feel them. During menstruation, the wall of the womb starts to contract more vigorously to encourage the womb lining to shed away as part of the reproductive ‘menstrual’ cycle [1].

When the muscular wall of the womb contracts, it compresses the blood vessels lining the womb. This temporarily cuts off the blood supply – and hence oxygen supply – to the womb. Without oxygen, the tissues in the womb release chemicals that trigger pain. While the body is releasing these pain-triggering chemicals, it’s also producing other chemicals called prostaglandins. These encourage the womb muscles to contract more, further increasing the level of pain [1].

Period pain is a common occurrence for people who have a menstrual cycle. However, severe period pain is NOT normal and can be a sign of other health issues, such as endometriosis, fibroids, polycystic ovary syndrome (PCOS), or pelvic inflammatory disease (PID) [1]. There are some simple dietary and lifestyle changes you can make to reduce even severe period pain (see tips and tricks below) so do not listen to anyone who may imply that serious period pain is an acceptable, or ‘normal’, part of the menstrual cycle, it is not, and it may even require medical intervention.

Period pain is usually felt as painful muscle cramps in the lower abdomen (just above the pubic area), which can spread to the back (around the kidneys, especially), and thighs. The pain sometimes comes in intense spasms, while at other times it may be dull but more constant. It may also vary with each monthly period. Some periods may cause little or no discomfort, while others may be more painful [1].

Sometimes you may experience pelvic pain even when you don’t have your period e.g. at ovulation. But if the pain continues throughout your cycle, please contact a medical professional [1].

Note: Medical conditions to rule out first;

• Endometriosis
• Fibroids
• Adenomyosis
• Pelvic Inflammatory Disease 

Managing period pain:

First of all, you may want to find out if your period pain is ‘normal’ or not… This blog may be able to help. The good news is that period pain responds particularly well to the four steps outlined on our ‘all symptoms‘ page.

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight additional advice for those suffering from period pain, below;

1. Eat lots of fresh fruit and vegetables
2. Eat lots of fibre (and drink water with it)
3. Eat oily foods (mainly unsaturated fats)- Fish oil (i.e. omega 3 fatty acids) (2000 mg per day) has been shown to reduce period pain [2] [3].
4. Reduce meat and dairy products
5. Avoid sugary foods and drinks
6. Avoid caffeine
7. Avoid alcohol
8. Take nutritional supplements e.g.  Magnesium (100-300 mg daily) [4], and Turmeric [5] (i.e. as a supplement- not just the spice!) are thought to reduce prostaglandins (the chemicals involved in triggering period pain). Zinc (23-30 mg per day with food) may also significantly reduce period pain: One study found that 30 mg of zinc per day in the four days leading up to menstruation eliminated period pain in the majority of participants [6].

TOP TIP 1! Stop smoking! It increases the risk of period pain [1].

TOP TIP 2! Taking 200-400mg of ibruprofen for 2-4 days before a period is due [and during it] can significantly reduce period pain and the amount of blood lost. Track your cycle to identify any ‘tell-tale’ signs of an impending period, and your average cycle length, to help you plan when to start taking the ibuprofen. [1]

Exercise– you may not feel like exercising during a painful period, but keeping active can reduce pain in some people (it certainly helps mine!- Ed.), although the clinical evidence is limited (i.e. more research is required to know for sure) [7].

Regular exercise, particularly aerobic exercise, may help you combat stress and release tension, this is important for the reasons outlined below…

Learn to relax– Pain causes both physical and mental stress [8]. In turn, prolonged stress can increase our perception of pain [9].

So, it is important to try to avoid any unnecessary stress, especially just before and during your period, when you are most likely to experience period pain.

You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or pilates to help you unwind.

If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing period pain- please let us know– we can share them with others!

Further information:

• NHS information on period pain; http://www.nhs.uk/Conditions/Periods-painful/Pages/Introduction.aspx

Page last reviewed and updated: June 2018

References:

1. NHS (2016) Period pain. [ONLINE] Available at: http://www.nhs.uk/Conditions/Periods-painful/Pages/Introduction.aspx#Treating. [Accessed 3 August 2017].

2. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL.(1996)  Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. Apr;174(4):1335-8. PubMed PMID: 8623866.

3. Hansen SO, Knudsen UB. (2013) Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol. Jul;169(2):162-71. doi: 10.1016/j.ejogrb.2013.03.028. Epub 2013 May 2. Review. PubMed PMID: 23642910.

4. Parazzini F, Di Martino M, Pellegrino P. (2017) Magnesium in gynecological practice: a literature review. Magnes Res. Feb 1;30(1):1-7. doi: 10.1684/mrh.2017.0419. Review. PubMed PMID: 28392498.

5. Itthipanichpong C, Ruangrungsi N, Kemsri W, Sawasdipanich A. (2003) Antispasmodic effects of curcuminoids on isolated guinea-pig ileum and rat uterus. J Med Assoc  Thai. Jun;86 Suppl 2:S299-309. PubMed PMID: 12930003.

6. Eby GA. (2007) Zinc treatment prevents dysmenorrhea. Med Hypotheses. 69(2):297-301. Epub 2007 Feb 7. PubMed PMID: 17289285.

7. Brown J, Brown S. (2017) WITHDRAWN: Exercise for dysmenorrhoea. Cochrane Database Syst Rev.  Feb 14;2:CD004142. doi: 10.1002/14651858.CD004142.pub3. Review. PubMed PMID: 28194755.

8. Slavich GM, Irwin MR. (2014) From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychol Bull. May;140(3):774-815. doi: 10.1037/a0035302.

9. Østerås B, Sigmundsson H, Haga M. (2015) Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study. BMC Public Health. Oct 23;15:1081. doi: 10.1186/s12889-015-2414-x. PubMed PMID: 26498498; PubMed Central PMCID:
PMC4619092.