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A Naturopath's Take on Period Pain

Updated: Jan 27


Period pain Naturopath

For many women, getting their period is already an unwelcome visitor. But when that time of the month brings along debilitating pain, it can feel like an all-out war on your body. Dysmenorrhea, or period pain, affects a staggering number of women worldwide. While primary dysmenorrhea is the most common form, secondary dysmenorrhea can be caused by serious underlying medical conditions such as endometriosis, ovarian cysts, and tumours. If you're one of the millions of women who suffer from period pain, you know that it can be challenging to find relief without turning to anti-inflammatory drugs, which can come with unwanted side effects. But don't despair - there are alternative treatments available, including herbal remedies, that can help alleviate the cramps and discomfort. Let’s understand period pain a little more. 


Types of Dysmenorrhoea (Period Pain)

Primary dysmenorrhoea 

Primary dysmenorrhea affects over 50% of menstruating women presents itself with painful cramps starting just before or on the onset on menstruation. It mainly begins in adolescence from 6-24 months from the onset of the first period. The causes are not fully understood however the initial trigger can be associated with changes to a hormone called prostaglandin around the time of the period in response to a drop in a hormone called progesterone. Prostaglandins cause muscle contractions and narrow blood vessels in the uterus, which can cause a lack of oxygen and increased production of waste products. This leads to increased sensitivity of pain receptors, resulting in pelvic pain.


Primary dysmenorrhoea will response to to anti-inflammatory drugs as they impart the action of something called cyclooxyrgenase-2 (COX-2), which in turn, inhibits the production of prostaglandins reducing pain, this can be a way to differentiate between primary and secondary dysmenorrhoea. These anti-inflammatory agents can be not tolerated well for some women with gastrointestinal issues however. 


Secondary dysmenorrhoea

Secondary dysmenorrhoea is when the cause is shown to be a pathological or anatomical problem within the pelvic organs. The more common and known causes being a condition called endometriosis and pelvic inflammatory disease. 


Endometriosis and adenomyosis 

Endometriosis is a condition where endometrial like cells grow on the ovaries, tubes, pelvic ligaments, bladder or bowels. As these cells are still sensitive to the hormonal waves of the menstrual cycle, they still bleed at menstruation and cause pain and heavy periods. The pain can be throughout the cycle, at ovulation, before and through the period, it often feels congestive, heavy and dragging. During the period the pain can be so severe it causes fainting and vomiting. Adenomyosis is very similar to endometriosis however the endometrial like cells grow in the wall of the muscular layer of the uterus, this can drive pain down the upper back and legs. 


Pelvic inflammatory disease (PID)

This is caused by an infection which is often sexually transmitted. Most women with an infection will develop a fever, fatigue and pelvic pain. Women with PID may also experience abnormal vaginal discharge, painful urination, painful sexual intercourse, and irregular menstrual bleeding. Some women with PID may also experience symptoms of lower back pain, nausea, and vomiting. It is important to note that untreated PID can lead to serious complications, such as infertility, chronic pelvic pain, and an increased risk of ectopic pregnancy. Therefore, it is important for women experiencing any symptoms of PID to seek medical attention as soon as possible to receive appropriate treatment and prevent long-term complications.


Ovarian cysts, tumours & Fibroids 

Both benign and malignant ovarian cysts can cause pain but not normally until they are quite large or if they burst. Bursting pain will come on suddenly and last less than 24 hours. For ovarian cysts, the pain may be related to the size of the cyst, with larger cysts causing more discomfort. The pain may be a dull ache or sharp twinge, and may be felt in the lower abdomen or back. If the cyst ruptures during or near the time of menstruation, the pain may be sudden and severe. Additionally, ovarian cysts can cause irregular menstrual cycles, heavy bleeding, and other symptoms that can be confused with menstrual cramps.


Fibroids, on the other hand, can cause heavy bleeding during menstruation, which can lead to more severe cramps. If the fibroids are large, they may cause pressure on the bladder or rectum, leading to pain or discomfort. Fibroids can also cause irregular cycles, and can even interfere with fertility in some cases.


Intrauterine device

iuds can cause heavier and more painful periods in some women. Severe pain may indicate that the iud has dislodged causing an infection, if you suspect this is the case, you should get to a health provided urgently. The Mirena will generally reduce pain but can increase the risk of ovarian cysts. 


Congenital malformations 

Some rare development anomalies can cause anatomical malformation that cause pain. 


Investigations 

Pathology tests

Although a lab test cannot be used to diagnosis primary dysmenorrhea it can be used to rule out secondary causes. A vaginal swap can rule out sexual transmitted infections. A blood test Human chorionic gonadotropin (hCG) can rule ectopic pregnancy which can also be a secondary cause of pain. 


Pelvic Ultrasound 

A pelvic ultrasound is the next line of investigation to identify any abnormalities in the anatomy of the uterus and ovaries such as cysts, fibroids, or other pelvic masses. A specialised sonographer can give an indications that endometriosis is present by looking mobility of pelvic organs, or any deep endometriosis nodules on the bowel, vagina, uterosacral ligaments and other surrounding pelvic organs, however a laparoscopy is the most definitive. 


Laparoscopy 

A laparoscopy may be recommended for women with severe period pain that does not respond to typical pain medication or for those who experience additional symptoms such as heavy bleeding or painful intercourse. In some cases, the cause of the pain may be due to underlying medical conditions such as endometriosis, pelvic inflammatory disease, ovarian cysts, tumors, and fibroids. A laparoscopy can help diagnose these conditions by allowing doctors to directly visualize and biopsy any suspicious areas or growths within the pelvic cavity.


During the procedure, a thin, lighted tube with a camera is inserted through a small incision in the abdomen. This allows the surgeon to view the organs and tissues within the pelvis and abdomen on a monitor. If any abnormalities are identified, the surgeon may take biopsies or remove them during the same procedure. Laparoscopy is typically performed under general anesthesia and is considered a safe and minimally invasive surgical procedure.


Herbal Medicine 

The potential side effects of NSAIDs can be a problem for some people when managing period pain, which is why you might consider herbal medicine instead. Herbal remedies are generally considered to have fewer side effects than pharmaceutical drugs, and are often gentler on the body. Unlike NSAIDs, which can irritate the stomach lining and increase the risk of gastrointestinal bleeding, herbal remedies may be less likely to cause digestive issues. Additionally, certain herbs have been shown to have anti-inflammatory properties, which may help alleviate period pain without the side effects of NSAIDs. Herbal medicine can be customised to suit an individual's specific needs. 


Traditionally these herbs can be helpful in managing period pain:


Antispasmodic herbs:

Cramp bark: This herb is known for its ability to relax uterine muscles, which can help ease cramps during menstruation.

Black cohosh: This herb has traditionally been used to help manage menstrual cramps, as it contains antispasmodic compounds that can help relax muscles.


Analgesic herbs:

California poppy: This herb contains alkaloids that have a mild sedative effect, which can help reduce pain and promote relaxation. It has been traditionally used to manage menstrual cramps and other types of pain.

Ginger: This herb has anti-inflammatory and analgesic properties, and has been shown to help reduce menstrual pain and other types of pain.


Anti-inflammatory herbs:

Turmeric: This herb contains a compound called curcumin, which has powerful anti-inflammatory properties. It may be effective in managing menstrual pain and other types of pain associated with inflammation.

Chamomile: This herb has anti-inflammatory properties and is known for its ability to help calm the nervous system. It may be effective in managing menstrual cramps and other types of pain associated with inflammation.


Diet & Nutritional supplementation

Nutritional supplementation and dietary changes can play a role in managing menstrual pain. Here are some options to consider:

 

Essential fatty acids: A review of several studies found that omega-3 fatty acid supplementation may help reduce menstrual pain, particularly in women with dysmenorrhea (painful menstruation). The anti-inflammatory properties of omega-3 fatty acids may be responsible for this effect.


Magnesium: A study found that magnesium supplementation reduced menstrual pain and other premenstrual symptoms, such as mood changes, in women with dysmenorrhea. The authors suggest that magnesium may work by reducing the release of prostaglandins, which are involved in menstrual pain.


Vitamin B1 & B6: A randomized controlled trial found that vitamin B6 supplementation reduced menstrual pain in women with dysmenorrhea. The authors suggest that vitamin B6 may work by modulating levels of prostaglandins and other hormones involved in menstrual pain.


Anti-inflammatory diet: A study found that women who followed an anti-inflammatory diet had lower levels of menstrual pain compared to those who followed a standard diet. The anti-inflammatory diet consisted of whole grains, fruits, vegetables, lean protein, and healthy fats, while the standard diet consisted of more processed foods and sugar.


PEA (Palmitoylethanolamide): Several studies have found that PEA supplementation may help reduce chronic pain, including menstrual pain. A review of the scientific literature suggests that PEA works by reducing inflammation and nerve pain. 


t's important to remember that everyone's body is unique, and what works for one person may not work for another when it comes to managing period pain. It's always a good idea to speak with your healthcare professional about your individual needs and concerns. They can help you come up with a plan that's tailored to your specific situation and help ensure that you're getting the best possible care.


References

Artukoglu, B. B., Beyer, C., Zuloff-Shani, A., & Brener, E. (2019). Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy. British Journal of Clinical Pharmacology, 85(12), 2838-2850. doi: 10.1111/bcp.14105.


De Souza, M. C., Walker, A. F., Robinson, P. A., & Bolland, K. (2000). A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. Journal of Women's Health & Gender-Based Medicine, 9(2), 131-139. doi: 10.1089/152460900318623.


Farid, R., Rezaei, S., Einollahi, B., et al. (2017). Comparison of Anti-inflammatory and Analgesic Effects of Ginger Powder and Ibuprofen in Postsurgical Pain Model: A Randomized, Double-Blind, Case-Control Clinical Trial. Dental Research Journal (Isfahan), 14(1), 1-7. doi: 10.4103/1735-3327.199098.


Jafarirad, S., Aghamohammadi, V., & Asghari Jafarabadi, M. (2021). The Effect of Anti-Inflammatory Diet on Menstrual Pain and Bleeding in Young Women: A Randomized Controlled Trial. Journal of Pediatric and Adolescent Gynecology, 34(2), 168-174. doi: 10.1016/j.jpag.2020.07.013.


Khayat, S., Fanaei, H., Kheirkhah, M., et al. (2015). The effect of omega-3 fatty acids on depressive symptoms and inflammatory markers in maintenance hemodialysis patients: a randomized, placebo-controlled clinical trial. European Journal of Clinical Pharmacology, 71(3), 329-335. doi: 10.1007/s00228-014-1792-8.


Kho, K. A., & Shields, W. C. (2018). Dysmenorrhea and Endometriosis in the Adolescent. Journal of Pediatric and Adolescent Gynecology, 31(5), 477-482. https://www.jpagonline.org/article/S1083-3188(17)30504-2/fulltext


Lefler, L. L., & Li, G. R. (2012). Dysmenorrhea: Diagnosis and management. American Family Physician, 85(3), 285-291.


Proctor, M., Farquhar, C., & Stones, W. (2014). Diagnosis and treatment of primary dysmenorrhea. American Family Physician, 89(5), 341-346. https://www.aafp.org/afp/2014/0301/p341.html


Rosenfeld, J. A. (2016). Primary dysmenorrhea: diagnosis and management. American Family Physician, 93(8), 659-665. https://www.aafp.org/afp/2016/0415/p659.html


Trickey, R. (2019). Women's hormones and the menstrual cycle: Herbal and medical solutions from adolescence to menopause. New York, NY: Skyhorse Publishing.

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