A Holistic Approach to Painful Menstrual Cycles

August 17, 2018 0 Comments

“Can you help me with my unbearable period cramps?”

As a nurse practitioner, I get this question all the time from young women.  It’s a common problem.  But the common “solution” of automatically putting girls on the pill isn’t always best for them.  I have had great success with several healthy and holistic options to make those few uncomfortable days much more comfortable.

I first help these women understand what is causing such bad cramping. During a woman’s period, the body is essentially shedding off the inner lining of the uterus, to start the cycle over. The lining would have been what nourished the baby, had a pregnancy resulted that cycle.  But since it did not, the body is having menses in order to start the cycle over.  This process can only happen by the production of inflammatory chemicals called prostaglandins. Prostaglandins are hormone-like chemicals that cause mini-uterine contractions that expel the tissue from the uterus.  Ideally the contractions are small enough that the process isn’t very painful.  But for some women it becomes extremely unpleasant due to increased amounts of prostaglandins or increased sensitivity to them.[1]  This results in painful menstrual cycles, a condition clinically called dysmenorrhea.  Dysmenorrhea can effect anywhere from 20-90% of women of reproductive age; 20% having symptoms on such a severe level that they significantly impact their quality of life.[2]

Dysmenorrhea not only causes cramping, it can lead to other unpleasant symptoms like low back pain, bloating, nausea, leg pain, diarrhea and fatigue. When severe, these symptoms certainly make a woman want to crawl back into bed with a heating pad instead of jumping into a productive day at work, school, or home.

One of the most common conventional treatments offered to women for painful periods is birth control pills. Birth control helps with painful periods only through a mechanism of action that is actually shutting down the primary function of our reproductive system.  The synthetic hormones in birth control suppress the normal menstrual cycle and overlay it with a pseudo-cycle created by the artificial hormones being ingested in the body.  Although this is considered an effective way to manage pain with the menstrual flow, it is also ridden with side effects, including nausea, weight gain, abnormal bleeding, irritability and breast tenderness.  Even if one is willing to overlook these nuisance side effects, artificial hormones in birth control also lead to increased risk of blood clots, stroke, and heart attack, as well as increased breast and cervical cancer.[3] For these reasons, many women do not want to use this treatment to treat their painful periods.

Instead of suppressing a normally functioning system of the body, treatment for menstrual cramps should focus on the actual cause of the cramps, which is inflammation. The goal of treatment should be to tame or quiet the inflammatory response caused by the inflammatory prostaglandins being produced by the body.

IBUPROFEN

The easiest and sometimes most effective conventional treatment is using non-steroid anti-inflammatory medicines. I like ibuprofen since it is readily available over the counter and works very well. In order to really get on top of the pain, women need to understand how to take ibuprofen effectively to reduce pain and bleeding.  Indeed, not only can ibuprofen decrease cramps, but, if taken correctly, can reduce the heaviness of her menstrual flow by 20-30%,[4] which women are also very grateful for. But women must take ibuprofen at a higher dose, more frequently, and more consistently to receive these benefits. I tell my patients to take either 600 (3 tablets) or 800 mg (4 tablets) every 6 to 8 hours around the clock as soon as their cramps start or when the flow starts to pick up, whichever comes first. If you take the ibuprofen, without missing doses, for that first day or two of the worst part of the period, you have essentially tamed the prostaglandins and decreased inflammation, making your period much happier to live with. Remember that you should check with your doctor if you have any concerns about taking ibuprofen, such as when you are a small-framed and maybe can’t handle that higher dosage.

SUPPLEMENTS

If you do not like the idea of using ibuprofen, or need additional support on top of the medicine, there are other more natural options to reduce inflammation. For example, in some studies, fish oil taken by women on their period had a powerful effect similar to ibuprofen. Fish oil is also an anti-inflammatory and is tolerated very well. You can take one 1000-1200 mg fish oil capsule three times a day starting right at the very beginning of the period all the way through the few days of full bleeding.[5]

I often use other supplements that are very beneficial to cramps, as well as those earlier PMS symptoms like fatigue, bloating, and headaches.  Magnesium glycinate at 400 mg if very helpful for all these symptoms and can be taken once to twice daily starting several days before the period starts all the way through the period. Vitamin E is also found to be effective for relieving breast tenderness and period discomfort.  I recommend 400 units two to three times a day starting a week before your period and continuing through the heavier days of your period can make a significant improvement.

Another supplement I recommend for both PMS and period pain is Iron. Studies show that getting at least 18-20 mg of Iron daily was found to lead to less PMS symptoms overall.[6]

This amount of iron is what is in prenatal vitamins, so taking a good quality prenatal vitamin, even if you are not trying to get pregnant, can help with period symptoms. As an additional option instead of a prenatal vitamin, I also like the multivitamin called optivite-PMT. It was formulated for PMS and it has healthy amounts of magnesium, vitamin A and B vitamins, and was found to decrease PMS up to 50% in clinical trials.[7]

DIET AND EXCERCISE

Another natural solution to reducing pain with menstrual cramps is to adopt an anti-inflammatory diet.  If a woman rids her diet of prostaglandin promoting foods, you can reduce inflammation and essentially have a pain-free period. This will also lesson PMS and help women feel great in so many other ways too!

There are different recommended diets which you can research online, but I tell my patients to reduce sugar, carbohydrates from foods like bread and pasta, dairy products, and processed foods. Eat lots of healthy fats such as olive oil, avocadoes, coconut oil, and grass-fed butter.  Try adding raw ground flax, walnuts, and pumpkin seeds to salads, snacks, or entrées. Eat more cold-water fish like wild-caught salmon.  Get anti-inflammatory nutrients from vegetables like carrots, sweet potatoes, and dark leafy greens and fruits such as apples, coconuts, citrus fruits, berries, beans, artichokes, asparagus, and broccoli.

Exercise can also be a beneficial way to reduce the discomfort with your period.  A recent study found that core strengthening exercises and stretching significantly reduced duration of pain and the intensity of pain with the period.[8]  We know that exercise not only increases blood flow throughout the body, but it also release endorphins, which are positive immune system chemicals, also called neurotransmitters.  Endorphins can affect the way the brain perceives pain by interacting with the brain’s opiate receptors. The higher the endorphins or “feel good hormones” the less pain we feel.

STRESS AND MORE

Stress can also cause inflammation.  Let’s not forget how important sleep is in keeping our stress levels in check. This can be difficult since for women, who are often busy caring for others and forget to take care of themselves. But if a woman is suffering from stress and the resulting inflammation and possible period pain, she needs a full night of sleep, meaning at least 7-8 hours, and she needs to spend intentional time each day relaxing and restoring her mental health. I recommend prayer as one great way to reconnect us with the spiritual aspects of our health. By adding just 10-15 minutes of daily prayer, you can significantly decrease stress and improve your overall health through the mind-body connection.[9]

Lastly, I want to mention acupuncture as an alternative therapy to improve menstrual cramping. Studies have shown a significant reduction in pain using acupuncture therapy.[10]  This treatment could be particularly beneficial for women who do not prefer the use of traditional medical treatments. This should only be utilized by a trained acupuncturist.

WHEN TO SEE A DOCTOR

There are several holistic and effective ways to make your cramps and the whole menstrual period experience much more comfortable, without resorting to birth control right away.  But remember that it is not normal to have very severe cramping.  Those who would describe their pain as severe or almost unbearable, want advice on these various options, or have tried these approaches without success, really need to be evaluated by a healthcare professional. Pro Women’s Healthcare Centers offer trained professionals to help you find answers about any serious underlying women’s healthcare issue that may be contributing to their problems, such as PCOS or Endometriosis. There are cures for these conditions and I urge women to take their health seriously and get the help they need.

 

[1] Jensen DV, Andersen KB, Wagner G. Prostaglandins in the menstrual cycle of women. A review. Dan Med Bull. 1987 Jun; 34 (3):178-82. Review. PubMed PMID: 3297513.

[2] Clinical Evidence Handbook; Dysmenorrhea PALLAVI LATTHE, B February 15, 2012 ◆ Volume 85, Number 4 www.aafp.org/afp American Family Physician

[3] Rebecca Peck & Charles Norris (2012) Significant Risks of Oral Contraceptives(OCPs): Why This Drug Class Should Not Be Included in a Preventive Care Mandate, The Linacre Quarterly, 79:1, 41-56

[4] Management of Abnormal Uterine Bleeding in Adolescents J Pediatr Adolesc Gynecol. 2010 Dec; 23 (6 Suppl):S22-30. doi: 10.1016/j.jpag.2010.08.007. Epub 2010 Sep 24.

[5] Zafari, M., Behmanesh, F., & Agha Mohammadi, A. (2011). Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian Journal of Internal Medicine, 2(3), 279–282.

[6] Smith et al, 2003. “Religiousness and depression: Evidence for a main effect and the moderating in Patricia O. Chocano-Bedoya, JoAnn E. Manson, Susan E. Hankinson, Susan R. Johnson, Lisa Chasan-Taber, Alayne G. Ronnenberg, Carol Bigelow, and Elizabeth R. Bertone-Johnson. Intake of Selected Minerals and Risk of Premenstrual Syndrome. American Journal of Epidemiology, 2013 DOI: 10.1093/aje/kws363 fluence of stressful life events”. http://psycnet.apa.org/journals/bul/129/4/614/.

[7] Goei GS, Abraham GE; J Reprod Med. 1983 Aug;28(8):527-31.  Effect of a nutritional supplement, optivite, on symptoms of premenstrual tension.

[8] Saleh HS, Mowafy HE, El Hameid AA (2016) Stretching or Core Strengthening Exercises for Managing Primary Dysmenorrhea. J Women’s Health Care 5:295.

[9] Smith et al, 2003. “Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events”. http://psycnet.apa.org/journals/bul/129/4/614/.

[10] Iorno V, Burani R, Bianchini B, Minelli E, Martinelli F, Ciatto S. Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment. Evidence-based Complementary and Alternative Medicine : eCAM. 2008; 5(2):227-230. doi:10.1093/ecam/nem020.

 

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