Menstrual Pain is the regular discharge of blood and mucosal tissue (known as menses) from the inner lining of the uterus through the vagina. The first period usually begins between twelve and fifteen years of age, a point in time known as menarche. However, periods may occasionally start as young as eight years old and still be considered normal. The average age of the first period is generally later in the developing world, and earlier in the developed world. The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women, and 21 to 31 days in adults (an average of 28 days). Bleeding usually lasts around 2 to 7 days. Menstruation stops occurring after menopause, which usually occurs between 45 and 55 years of age. Periods also stop during pregnancy and typically do not resume during the initial months of breastfeeding.
How Can I Relief From Menstrual Pain/ Period Pain
Non-Steroidal Anti-Inflammatory Drugs
- The different formulations of NSAIDs have similar efficacy for dysmenorrhoea, and pain relief is achieved in most women. Between 17% and 95% (mean 67%) of women achieve pain relief with an NSAID.[rx]Compared with placebo treatment, the number needed to treat is 2.1 for at least moderate pain relief over three to five days.[rx]
- Gastrointestinal effects (nausea, vomiting, and/or diarrhea) are of particular concern with NSAIDs. Effects are generally tolerable, but when treating women with risk factors for NSAID induced ulceration, the potential risks and benefits of using an NSAID should be considered.
- If an NSAID is offered in this situation, a gastroprotective agent may be useful. Women with a history of gastroduodenal ulcer, gastrointestinal bleeding, or gastroduodenal perforation should probably seek alternatives.
COX 2 Specific Inhibitors
- A review of the newest generation of anti-inflammatories has shown that COX 2 (cyclooxygenase-2) specific inhibitors are effective for dysmenorrhoea.w9 Questions about the cardiovascular and cardioprotective safety of COX 2 inhibitorsw10 remain unresolved, however, and these drugs have been withdrawn from use in many countries.
- Good quality clinical trials of oral contraceptives for dysmenorrhoea are lacking.[rx] One recent RCT found that low dose (or combined) oral contraceptives significantly reduced pain compared with placebo. Another recent trial found, however, that although a reduction in dysmenorrhoea was reported in the group who received the oral contraceptive, a similar reduction occurred in the group who took a placebo, with no significant differences between the two groups.
- In an open clinical trial of a combined oral contraceptive involving 100 000 women, 65% (23 500 women) of those who had dysmenorrhoea as a pre-existing condition felt relief from dysmenorrhoea as a result of treatment. Therefore, despite a lack of many high-quality RCTs in this area, there is some evidence in general populations that combined oral contraceptives can effectively treat dysmenorrhoea.
Levonorgestrel-Releasing Intrauterine System
- The levonorgestrel-releasing intrauterine system releases levonorgestrel (20 μ/day) into the uterine cavity for at least five years, thus preventing the thickening of the lining of the uterus. Up to 50% of women using it become amenorrhoeic after 12 months and reduction in dysmenorrhoea was spontaneously reported by women in non-randomised studies.[rx]
- The levonorgestrel-releasing intrauterine system has also been shown to be effective in reducing dysmenorrhoea in an RCT of women with endometriosis after one year.[rx] It should be noted that non-hormone intrauterine devices may result in dysmenorrhoea and may require removal if adequate pain relief is not provided with analgesics.
Combined Drug Treatments and Less Common Drug Treatments
- A combination of analgesics and the oral contraceptive or the Mirena intrauterine device is also an option in cases that do not respond to a single treatment. For the small percentage of patients who do not respond to these treatments or to combination treatment, other options exist.
Herbal products or medicines, and dietary supplements the evidence[rx] [rx]
- One study has shown that 100 mg of thiamine (vitamin B-1) taken daily may be an effective cure for dysmenorrhoea: 87% of patients were cured up to two months after treatment.
Pyridoxine and magnesium
- Some evidence also exists that pyridoxine (vitamin B-6) supplements, taken alone or with magnesium, can reduce pain, but more research is needed to confirm this. Magnesium may also be an effective treatment. Women in some trials of magnesium experienced a reduction in period pain and a lowering of prostaglandins in their blood.
- The therapeutic dose is unclear, however, as magnesium supplements were used several ways (daily or during pain). In addition, some women stopped taking magnesium during the trials, possibly owing to lack of benefit or due to adverse effects such as constipation.
- The use of fish oil capsules (omega 3 fatty acids) may also reduce pain, although more research is needed; adverse effects associated with fish oil treatment were mild and included nausea and worsening of acne.
Progestogens and Antiprogestogens
Gonadotrophin Releasing Hormones and Danazol
- Gonadotrophin releasing hormones and danazol confer the same degree of pain relief.[rx] The side effect profiles of these treatments are different, however, with danazol having more androgenic side effects, while gonadotrophin releasing hormones tend to produce more hypo-oestrogenic symptoms. Further studies are also required to establish the optimal supplementation or “add back” regimen of oestrogen for limiting adverse effects.[rx]
Calcium Channel Blockers
- Calcium antagonists can reduce myometrial activity and relieve dysmenorrhoea by controlling the cytoplasmic concentration of free calcium and thereby the contractions of the uterine muscle. None, however, are licensed for this indication.[rx]
- In all, 10-20% of women with primary dysmenorrhoea do not respond to treatment with NSAIDs or oral contraceptives. In addition, some women have contraindications to these treatments. Consequently, researchers have investigated many alternatives to drug treatments.
Herbal Products or Medicines, and Dietary Supplements
- Herbal and dietary therapies are popular as they can be self administered and are available from health shops, chemists, and supermarkets. This availability, although helpful, can create problems with the control of dosage, quality, and drug interactions.
- Systematic reviews and RCTs of herbal and dietary supplements have shown that thiamine, pyridoxine, magnesium, and fish oil may be effective in relieving pain, although some of these may be associated with adverse effects (see box).[rx],[rx] A Bandolier review found evidence from three small RCTs that vitamin E was effective in treating dysmenorrhoea, but it advises caution in use owing to potential adverse effects when used in high doses.[rx]
- One RCT has shown a significant association between a low-fat vegetarian diet and a reduction in symptoms (perhaps by influencing prostaglandin metabolism), but the trial was too small (33 women) to give conclusive results.[rx]
- Physical exercise may reduce dysmenorrhoea. Current studies have too many methodological flaws, however, to be able to confirm results. It is hypothesised that exercise works by improving blood flow at the pelvic level as well as stimulating the release of β endorphins, which act as non-specific analgesics.
Transcutaneous Electrical Nerve Stimulation
- Transcutaneous electrical nerve stimulation (TENS) involves stimulation of the skin using current at various pulse rates (frequencies) and intensities to provide pain relief.
- A Cochrane systematic review found limited evidence from small trials that high frequency transcutaneous electrical nerve stimulation reduces pain[rx]; 42-60% of patients had at least moderate relief, and less use of additional analgesics was needed in one RCT.
- Acupuncture excites receptors or nerve fibres, which, through a complicated interaction with serotonin and endorphins, block pain impulses. A Cochrane systematic review found one RCT showing that acupuncture significantly reduces pain, but more research is needed to confirm this finding.[rx]
- Heat therapy has been a traditional home remedy for dysmenorrhoea. One RCT has compared its use with the NSAID ibuprofen.[rx] The heat patch (39°C) used for 12 hours a day was found to be as effective as ibuprofen (400 mg three times a day) and more effective than placebo in reducing pain.
- Women using both the heat patch and ibuprofen experience the most pain relief. Another RCT found a heat wrap was better than paracetamol for pain relief over an eight hour period.[rx]
- A Cochrane systematic review of five RCTs found no significant difference between spinal manipulation and placebo manipulation.[rx]
- Many women experience some levels of discomforts during periods. Fortunately, the symptoms can be prevented or reduced by taking the right foods.
- Many factors are said to contribute to the discomforts during your period which manifests as inflammation (pain), bloating, fatigue, mood swings, cramps, headaches, and digestive issues.
Proteins and Fats
- When you consume healthy carbs with plenty of good proteins, the pancreas responds by secreting a measured amount of insulin and fats which in turn causes the glucose from the meal enters your blood slowly.
- Therefore, taking proteins foods such as eggs along with pure butter for your breakfast can help stabilize blood sugar as well as make you feel less hungry throughout the morning. Take more protein foods for lunch and dinner too and don’t forget to consume lots of veggies for every major meal.
- Unstable blood glucose causes you to experience mood swings during your period. High glucose levels promote inflammation. Taking 1 tablespoon coconut oil, 3 X per day can help stabilize your blood sugar.
- Green vegetables offer antioxidants phytonutrients, including carotenoids, bioflavonoids, lignins, and stilbenes, all of which also help reduce inflammation. Magnesium that’s located at the center of chlorophyll also acts as an anti-inflammatory.
Studies have shown that dietary magnesium insufficiency is more common in adolescent girls and women, and worsens with age.
- Cramps, headache, pain in certain parts of the body or the whole body is a sign of inflammation – C – reactive protein (CRP) levels are always high. CRP is a protein, also called a marker of inflammation, produced by the liver when there is inflammation in the body. All phytonutrients, magnesium (balanced by calcium), and potassium are thought to increase nitric oxide levels, a vital compound for relaxing your muscle and dilate your blood vessel. Magnesium and potassium also help relax the muscle and via their parasympathetic pathways.
- The point I would like to make here is that taking green veggies while on period may help prevent or reduce headaches and cramps. Dark green vegetables are loaded with vitamin K, which coagulates blood and prevents excess bleeding.
Colorful Vegetables and Fruits
- Colorful fruits and veggies are loaded with significant amounts of antioxidant and anti-inflammatory phytonutrients that include carotenoids, polyphenols, bioflavonoids. Lignins, and stilbenes. Vitamin C in and citric acid also contribute to antioxidant properties in fruit. Many veggies are also loaded with vitamin C. All these antioxidant and anti-inflammatory phytonutrients and organic acids can reduce menstrual cramps and headaches. Fruits and vegetables also provide fiber and water, which can help reduce bloating and reduce pain.
Omega-3 Fatty Acids
- Prostaglandins, a group of hormone-like substances in the body, are responsible for muscle contractions and menstrual pain, hence inflammation. One way to calm down their effects is by taking foods high in anti-inflammatory omega-3 fatty acids that include salmon, walnuts, and flaxseed.
- Alternatively, if you think you are lacking omega-3 via food intakes you may consume it in the form of dietary supplements. Krill oil, fish oil, mussel oil, and cod liver oil are good sources of omega-3. They are also loaded with vitamin A and D, both of which are potent antioxidants and involve in many vital physiological processes.
- At any point in their life, women may experience dysmenorrhea that’s characterized by painful cramps that may occur immediately before or during the menstrual period. One of the ways to relieve the painful period pain is by consuming pineapple.
- A painful period is sometimes thought to be a result of scanty menstrual flow with bright red or dark red blood. Consuming pineapple is said to help ease this condition. Pineapple increases your blood flow and reduces the pain.
Moderation is the key to wise eating habits.
- Eat pineapple moderately while menstruating, unless you want to induce your period.
- Tips: Most pineapple sold in grocery stores or organic outlets taste sour. One of the reasons behind the sour taste is because the pineapple is harvested in its unripe form. It ripens a little bit while shipped and in storage that can take several weeks before you buying it.
- Sprinkling a little salt (preferably Himalayan salt) on sliced pineapples not only help reduce the sourness but increase sweetness.
- Water retention during periods is experienced by many women and it is usually not a pleasant one. The most common cause of water retention is hormonal changes and imbalance which due to the increase of estrogen that starts slowly in the premenstrual stage and is excessive in the follicular stage.
- Another possible reason why many women experience water retention during periods is because they don’t drink enough water. Therefore, a simple remedy by drinking enough water throughout the day can help decrease water retention.
- Taking diuretic foods is another way of reducing water retention. There are many diuretic foods you can consume, including cranberries, grapes, watermelon, cucumber, celery, parsley, lemon, lime, tomatoes, pumpkin, asparagus, onion, Brussel sprouts, beets, artichoke, lettuce, cabbage, and watercress.
Herbal teas such as corn silk, dandelion leaves, and juniper berries tea can also help reduce water retention.
- Herbs like chamomile, lemon grass, sensitive plant, and chrysanthemum are natural relaxants. These herbs help relax your muscle and nervous system as well as promoting better digestions.
- A beverage made of fresh cacao powder which offers high antioxidant and anti-inflammatory phytonutrient contents is not categorized as a tea. However, this beverage can help many issues associated with painful periods, including inflammation, fatigue, indigestion, mood swings, and headaches.
- An herbal tea made by combining ginger, clove and a little turmeric can help reduce your painful period as it is high in antioxidants and anti-inflammatory phytonutrient contents.
Herbs you can add to your diet for Period Pain / Menstrual Pain
These herbal remedies contain anti-inflammatory and antispasmodic compounds that experts believe can reduce the muscle contractions and swelling associated with menstrual pain.
|Herb or supplement||Dosage||Does it work?|
||Sip two cups of tea per day a week before your period. You may benefit more if you drink it every month.||Drinking chamomile tea increases urinary levels of glycine, which helps relieve muscle spasms. Glycine also acts as a nerve relaxant.|
||When your period starts, take 30 mgs of fennel extract four times a day for three days.||One study looked at girls 15 to 24 years old. The group that took the extract reported feeling relief. The placebo group reported none.|
||Take 420 mg of cinnamon capsules twice a day during the first three days of your period.||In 2015, women who took cinnamon capsules in a study reported less bleeding, pain, nausea, and vomiting compared to the placebo group.|
||Try grating a small piece of ginger into hot water for a warm cramp-relieving drink.||One study found that 250 mg of ginger powder four times a day for three days helped with pain relief. It also concluded ginger was as effective as ibuprofen.|
||Take 60 mg of pycenogenol per day during your cycle. This can help with more moderate menstrual pain.||One study found that women who took 60 mg of pycenogenol per day during their cycle reported less pain. According to the study, the benefits increase as you take the pill and continue even after you stop.|
||Try 1,000 mg of dill for five days, two days before your cycle.||A study concluded 1,000 mg dill was as effective for easing menstrual cramps as mefenamic acid, an over-the-counter drug for menstrual pain.|
How diet and exercise can help in the long run for Period Pain
- Maintaining a healthy diet and keeping up a regular exercise regime can go a long way to preventing menstrual pain. One study found significant differences between period pain in women who maintained a healthy lifestyle and those who didn’t. Read on for specific diet and exercise tips.
Generally, a diet geared toward decreasing menstrual pain should be high in minimally processed foods, fiber, and plants.
Give these foods a try
- papaya (rich in vitamins)
- brown rice (contains vitamin B-6, which may reduce bloating)
- walnuts, almonds, and pumpkin seeds (rich in manganese, which eases cramps)
- olive oil and broccoli (contain vitamin E)
- chicken, fish, and leafy green vegetables (contain iron, which is lost during menstruation)
- flaxseed (contains omega-3s with antioxidant properties, which reduce swelling and inflammation)
This mineral helps your body absorb calcium and phosphorus. It also reduces menstrual cramps: A study that looked at 113 university students found that boron reduced the intensity and length of menstrual pain. Foods with high concentration of boron include:
- peanut butter
You can also take boron supplements, if your diet doesn’t provide enough. However, you should consult your doctor before taking boron supplements.
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