Dysmenorrhea is the medical term for the painful menstrual cramps that many women experience just before and during their period. And it is the most commonly reported menstrual disorder — over half of all women experience some level of abdominal cramping at some point during their lives. (1)
But for nearly 10 percent of women, the level of pain and discomfort during their menstrual cycle as well as co-occurring symptoms are temporarily disabling.
In fact, menstrual cramps are the leading cause of absenteeism in women under the age of 30. (2)
Because menstrual cramps impact school attendance and performance, as well as work attendance and productivity, significant research has been completed and is ongoing for dysmenorrhea symptoms, causes and treatments.
For most women, dysmenorrhea symptoms typically begin a couple of days before bleeding begins and continue for several days during the period. Pain and cramping in the lower abdomen can range from mild discomfort to debilitating pain. This cramping is a natural result of the menstrual cycle; the pain is caused as the uterus contracts to facilitate the expelling of the lining of the uterus.
Prostaglandins play a role in the severity of cramps. Research indicates that women with elevated levels of these hormone-like chemical messengers may experience more intense cramping and pain. Younger women and adolescent girls tend to have higher levels, and that’s why they may experience more intense pain than women in their 30s, 40s or 50s. (3)
While cramps can be painful, and even debilitating, physicians normally recommend over-the-counter (OTC) painkillers to treat the discomfort. However, there are many natural remedies that have been shown to reduce common PMS symptoms and cramps.
Dysmenorrhea is generally not a cause for alarm. However, seek emergency medical attention immediately if you experience:
- Cramping along with excessive bleeding
- If tissue passes in the menstrual flow
- If you have fever or chills
- If the pain suddenly appear or worsens
- If you faint or become dizzy
- If you might be pregnant
What Is Dysmenorrhea?
Dysmenorrhea is the term used to refer to the pain experienced during PMS cramps. The cramps typically start a couple of days before the period begins and continue for two to three days during the period. The painful sensation is caused when the uterus physically contracts to aid in the expelling of the uterine lining.
Pain varies widely from woman to woman, and can range from minor discomfort to temporarily debilitating. The severity of cramps tends to lessen as women age and the level of prostaglandins naturally decreases. This type of cramping during the menstrual cycle is called primary dysmenorrhea.
Primary dysmenorrhea occurs in healthy women as the uterus contracts. Pain is common in the lower abdomen or the back, and it can even radiate through the thighs and down the legs. Pain intensity can range from mild to severe and may be accompanied by nausea, vomiting, fatigue and diarrhea. Primary dysmenorrhea generally becomes less painful as women age, and it may stop entirely after giving birth.
When there is an underlying reproductive disorder or disease contributing to or causing the cramping during a menstrual cycle, it is called secondary dysmenorrhea. For women with secondary dysmenorrhea, the pain tends to arrive earlier in the cycle and last longer. However, unlike those with primary dysmenorrhea, the discomfort is typically not accompanied by nausea, vomiting, fatigue or diarrhea.
Signs and Symptoms
Common signs and symptoms of dysmenorrhea include: (2)
- Aching lower abdominal pain
- Uncomfortable pressure in the abdomen
- Pain in the back
- Pain in the hips
- Pain in the inner thighs
- Pain that travels down the thighs and calves
- Fainting Spells
Causes and Risk Factors
Primary dysmenorrhea is caused by uterine muscle contractions that occur in order to facilitate the expelling of the uterus lining. Severe contractions may constrict blood vessels feeding the uterus resulting in an intense pain similar to the chest pain felt when blocked blood vessels keep the heart from getting oxygen. (4)
- Uterine fibroids
- Pelvic inflammatory disease (PID)
- Cervical stenosis
- Ovarian cyst
- Ectopic pregnancy
Recognized risk factors include: (7)
- You are 30 or younger
- Menstruation started when you were 12 or younger
- Heavy bleeding during your period is common
- You have irregular menstrual bleeding or cycles
- Other women in your family have dysmenorrhea
- You’ve never been pregnant
- You’ve never given birth
- You smoke
- You are overweight or obese
- You drink alcohol
- You experience common PMS symptoms
- You have pelvic inflammatory disease (PID)
- You’ve been sterilized
- You have a low body mass index
- You are a victim of sexual abuse
When you initially experience cramping symptoms during your menstrual cycle, you should consult with your physician. For a proper diagnosis, and to rule out any underlying conditions, you doctor will do a full examination, including a pelvic exam. If there any abnormalities that cause concern, your doctor may order an ultrasound, CT scan, MRI or laparoscopy.
Traditional treatments for primary dysmenorrhea include: (8)
- Over-the-counter pain relievers
- Prescription strength NSAIDs
- Hormonal birth control including pills, injections, patches or IUDs that prevent ovulation and reduce pain severity
For secondary dysmenorrhea, treatment will address the underlying causes such as fibroids or endometriosis and may also include pain relievers. (9)
Long-heralded in the treatment of PMS symptoms including fatigue, moodiness and bloating, recent research indicates that 1,000 milligrams of calcium per day is effective for reducing menstrual pain intensity. In a small, randomized double-blind trial, participants given 1,000 milligrams of calcium from the 15th day of their cycle until pain disappeared, for three full menstrual cycles, reported a significant decrease in pain levels. (10)
During your period, increasing your intake of calcium-rich foods like whey protein, sardines, goat milk kefir, raw milk and white beans may help reduce symptoms in addition to supporting strong bones, healthy blood pressure levels and proper muscle and nerve function. (10, 11)
2. Vitamin D
With research indicating that perhaps as many as 90 percent of adults in the United States are vitamin D deficient, boosting levels through supplementation and diet changes is common. And, research now shows a weekly dose of 50,000 IU oral vitamin D significantly decreases the severity of pain for those with primary dysmenorrhea. (12)
The randomized double-blind placebo-controlled clinical trial published in the peer-reviewed journal Gynecological Endocrinology found that women with primary dysmenorrhea given the dosage weekly for eight weeks experienced less pain, and even one month after treatment had stopped, pain levels were better than before treatment.
In addition to supplementation, boost your vitamin D intake by spending more time in the sun without sunscreen. Sunshine is the No.1 way to easily and safely increase your vitamin D levels and just 10 to 20 minutes a day is all you need. For extra enhancement, add vitamin D-rich foods including wild-caught fish like halibut, mackerel, salmon and swordfish, as well as mushrooms exposed to ultraviolet light, to your diet.
3. Vitamin E
This fat-soluble vitamin is well-known for its power to balance cholesterol, promote healthy skin and hair, improve vision and even balance hormones. And now, research shows that 500 IU of vitamin E two days before your period starts, and continued for three days after your period begins, may reduce menstrual cramping. (13)
In this randomized, placebo-controlled trial of students with primary dysmenorrhea, half were given a placebo and the other half were given vitamin E for two consecutive menstrual cycles. While both groups showed improvement in symptoms, the group that received the vitamin E experienced greater effects and relief.
That said, vitamin E supplementation isn’t appropriate for everyone. If you are on blood thinners, have heart disease, diabetes, retinitis pigmentosa or cancer of the head, neck or prostate, you should avoid high doses of vitamin E. Instead, increase levels by including vitamin E-rich foods into your diet like almonds, spinach, sweet potatoes and avocado.
4. B Vitamins
While deficiency of vitamin B6 is rare in the United States, it can cause a worsening of PMS symptoms, depression, anxiety, irritability, confusion and muscle pains. According to Women’s Health, a part of the Office on Women’s Health of the U.S. Department of Health and Human Services, vitamin B6 may help with common PMS symptoms including moodiness, forgetfulness, bloating and anxiety. The RDA for vitamin B6 for women ages 19–50 is 1.3 milligrams daily. (14)
In addition, vitamin B1 shows promise for reducing pain in women with primary dysmenorrhea. In a review of clinical trials, researchers found in one large randomized controlled trial that women given 100 milligrams of vitamin B1 daily experienced less pain than women who were given a placebo. (15)
To support general wellness and to help alleviate a wide range of symptoms during your period, take a high-quality B vitamin complex supplement that gets its nutrients from real food sources.
5. Omega-3 Fatty Acids
Our bodies don’t produce omega-3 fatty acids, so we have to get it from foods and high-quality supplements. Known for supporting heart health, brain health, reducing inflammation and much more, a randomized double-blind, placebo-controlled study published in the journal Reproductive Health found 1 to 2 grams of fatty acids daily may help to reduce cramps and other PMS symptoms. (16, 17)
While a small trial, the findings were significant. One group received 1 gram of omega-3 fatty acids daily while another group received 2 grams of omega-3 fatty acids daily. Both groups reported a significant reduction in pain at three months, but the group that received the 2-gram dosage experienced even more significant results.
As a supplement, using just 1 tablespoon of a high-quality fish oil provides just over 4.5 grams of omega-3 fatty acids. In addition to a high-quality supplement, add wild mackerel, walnuts, chia seeds, Alaskan salmon and flaxseeds to your diet.
6. Yoga and Meditation
Known for reducing stress and anxiety as well as improving balance and coordination, research shows that practicing yoga daily along with meditating can relieve pain associated with the menstrual cycle.
In a study of 113 medical students diagnosed with primary dysmenorrhea, those that completed a three-month program of practicing yoga 40 minutes every day, along with pranayama and meditation for 10 minutes every day, experienced a significant decrease in pain. In fact, 83.33 percent of the study group reported complete pain relief. (18)
Used for a wide range of ailments including headaches, seasonal allergies, mood disorders, chronic pain and addiction, research now supports acupuncture for dysmenorrhea patients. In an analysis from a large randomized controlled trial published in the journal BMC Complementary and Alternative Medicine, acupuncture was given at points Spleen 6, GB39 or a non-acupoint. All three groups reported a significant decrease in pain. (19)
In a clinical trial conducted by the Osher Center for Integrative Medicine at the University of California, San Francisco acupuncture plus vitamin K injections were tested in women with primary dysmenorrhea. Those who received a vitamin K1 injection at Spleen 6 at the start of menstruation had a significant decrease in the intensity of pain and a decrease in duration of other menstrual symptoms. Of note, 80 percent of those in the trial reported wanting to continue monthly treatments. (20)
8. Water Aerobics/Aquatic Exercise
While exercise is generally recommended to reduce PMS symptoms, including cramping, vigorous exercise is often too much for those experiencing significant discomfort. However, a small study of nonathletic young women with primary dysmenorrhea found that the severity and the duration of the pain decreased significantly after 12 weeks of aquatic exercises. Researchers didn’t specify exercises conducted, but lap swimming and water aerobics may be beneficial in reducing pain. (21)
9. Topical Pain Relief
According to the University of Maryland Medical Center, a castor oil pack may relieve the pain associated with menstrual cramps. Apply castor oil directly to the skin, top with a soft flannel cloth and then cover in plastic wrap. Place a hot water bottle or heating pad over the pack and rest for an hour. Do this when the pain appears and continue each day for best results.
Feel free to add your favorite essential oil to the castor oil before applying to the skin. Lavender essential oil is a great choice as it is known to improve mood, relieve stress, improve sleep and relieve pain. (22, 23, 24)
Most women experience some level of menstrual cramping at some point during their lives. However, severe cramps may be a sign of an underlying serious medical condition like endometriosis, an infection, an ectopic pregnancy, pelvic inflammatory disease, adenmyosis or uterine fibroids.
Seek emergency medical attention immediately if the pain is sudden, worse than normal, or is accompanied by excessive bleeding, any signs of a fever, silvery or gray tissue is passed in the menstrual flow, or if you may be pregnant. (25)
A note about Endometriosis and Irritable Bowel Syndrome. As endometriosis and IBS share many of the same symptoms it is wise to discuss all of your symptoms with your doctor, including any family history of endometriosis or IBS. A retrospective analysis of women attending an IBS clinic in New Zealand found that patients with concurrent endometriosis and IBS benefited from a low FODMAP diet for four weeks. Study group members reported a 50 percent or greater improvement in symptoms. (26)
- Cramps are the leading cause of absenteeism in women under the age of 30.
- Dysmenorrhea is generally not a cause for concern, but if cramps occur with any sign of infection, pain is sudden or worsens, tissue is passed in the menstrual flow or you may be pregnant, seek emergency medical attention immediately.
- Primary dysmenorrhea is the most common cause and is the result of the physical contracting of the uterus.
- Secondary dysmenorrhea is caused by certain underlying medical conditions including uterine fibroids, adenomyosis, PID, cervical stenosis or endometriosis.
- Natural treatments may help to relieve the pain and discomfort of common PMS symptoms including cramping.
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