Menstrual Health

Aug 23, 2021

Period Cramps 101

Anywhere between 45% to 93% of reproductive-age women experience period cramps, which can be relieved via lifestyle changes or medication.

If you’re someone who menstruates, chances are you are no stranger to ‘dysmenorrhea’, AKA, painful period cramps of the uterine origin. You know -- the throbbing pelvic pain in your lower abdomen that feels like your uterus is being squeezed inside out on a cyclical basis. Well, aside from the many unpalatable descriptions we can all come up with, we have both good news and bad news to offer. 

The good news is that you’re not alone. Per a 2017 research paper “Dysmenorrhea and related disorders”, anywhere between 45% to 93% of reproductive-age women experience cramps prior to and during their periods , with the highest prevalence rates reported among adolescents. The bad news is that the “burden of period cramps” is said to be greater than that of any other gynecological complaint, leading to emotional turbulence and huge losses in productivity. In other words, cramps are the leading cause of “gynecological morbidity” in women of reproductive age, even after accounting for other confounding variables such as nationality, age and income disparity. In fact, the WHO also gauges period cramps to be the prime cause of chronic pelvic pain. [1]

Unfortunately, since dysmenorrhea is considered to be a “normal aspect of the menstrual cycle”, most people suffer through cramps without ever telling someone or seeking medical assistance. For some, the discomfort is merely annoying, while for others, (approximately 3 to 33%) the pain is so severe that they find themselves unable to function for ~1 - 3 days each menstrual cycle. Needless to say, cramps have a massive impact on quality of life, with negative externalities making their way to your mood, sleep and mental health.

So, what causes period cramps?

Broadly speaking, there are two main types of dysmenorrhea: primary and secondary. Each type has different causes.

Primary Dysmenorrhea  or “menstrual pain without organic disease” is the presence of cramps in the lower abdomen in the absence of other diseases such as endometriosis. [2] The cause of primary dysmenorrhea is yet to be well established, however, most data points towards the “hyper-production” of uterine prostaglandins, which are lipids compounds responsible for tightening and relaxing the muscles of the uterus. If the amount of prostaglandins increases beyond normal, they can induce pain by contracting the uterus too strongly, thereby reducing blood flow and oxygen supply to the myometrium. 

Primary dysmenorrhea usually begins 1-2 days prior to your period starting or when bleeding actually starts. The pain can range from mild to severe in the lower abdomen, back or thighs. Pain is typically the worst in the first 24 hours and subsides after 2-3 days. You may also experience other symptoms, including nausea, fatigue, and even diarrhea. [3] Menstrual Cramps in this category see the highest prevalence in the 20- to 24-year-old age group with incidence decreasing progressively thereafter. [2] It is also possible that the pain will entirely subside after one has given birth. It is also worth noting that primary dysmenorrhea has been linked to inflammation in research studies.

Secondary dysmenorrhea (“menstrual pain associated with underlying pelvic pathology”) is caused by conditions that affect your uterus or other reproductive organs, such as endometriosis, uterine fibroids and pelvic inflammatory disease . This kind of pain typically begins earlier in the cycle and lasts longer than primary dysmenorrhea cramps. Nausea, fatigue and diarrhea are also mostly absent. [3] Given that individuals with Endometriosis often don’t get the right diagnosis until much later, a significant amount of effort has been expended in recent years to find signs and symptoms that would allow for an earlier diagnosis. “An early age onset of dysmenorrhea is considered a risk factor for endometriosis; other menstrual characteristics such as cycle length and menstrual bleeding duration and quantity are not related to the development of endometriosis.” [1] If you suspect that you may have secondary dysmenorrhoea, we urge you to consult a doctor immediately.

How to reduce the intensity of period cramps

Now, getting to the meat and bones: strategies for reducing or relieving dysmenorrhea or period cramping, which is broadly broken down into medication and lifestyle changes.

Medication: Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are typically first line defense treatments against cramps. It is recommended to try them for a minimum of 3 menstrual periods for relieving pain as they block prostaglandin production.Take OTC pain relievers when you start to experience cramps for the greatest effect. If NSAIDs don’t work, other advanced medical alternatives include oral contraceptives and progestins. Oral contraceptives bring almost immediate relief from symptoms such as heavy periods, painful periods, and irregular bleeding. In addition, OCs often are used as therapeutic drugs for women with symptomatic menorrhagia or endometriosis. [1]

Lifestyle changes:

  1. Stay hydrated: Bloating can make menstrual cramps worse and cause pain. Drinking (hot) water during your period might help you feel less bloated and relieve some of the discomfort that comes with it. 
  2. Opt for exercise: If you’re in pain, exercise might be the last thing on your mind. But even gentle exercise releases endorphins that make you feel happy, reduce pain and relax your muscles. Fifteen minutes of yoga, light stretching or walking might be all you need to feel better. We have personally seen the difference in the intensity of our cramps with and without exercising.
  3. Eat anti-inflammatory foods: Some foods can provide natural cramp relief while also tasting delicious. Anti-inflammatory foods can aid in blood flow and uterine relaxation. Berries, tomatoes, pineapples, and spices like turmeric, ginger, and garlic are all good choices. Inflammation can also be reduced by eating leafy green vegetables, almonds, walnuts, and fatty seafood like salmon.
  4. Reduce stress: Stress can aggravate cramping. Lean upon meditation, deep breathing and yoga to get your emotions under check. Try guided visualisations if you're not sue how to de-stress. Simply close your eyes, take a deep breath, and visualise a peaceful, safe environment that is meaningful to you. Take calm, deep breaths while remaining concentrated on this place for at least a few minutes.r
  5. Skip the treats: While a brownie or french fries may seem appealing especially during your periods, meals rich in sugar, trans fat, and salt can promote bloating and inflammation, which can exacerbate muscular discomfort and cramping. To combat sugar cravings, grab a banana or another piece of fruit, or always go back to the trusted dark chocolate square. 
  6.  Consider dietary supplements: Vitamin D can aid calcium absorption and decrease inflammation. Omega-3, vitamin E, and magnesium, among other nutrients, can help decrease inflammation and may even make your periods less uncomfortable. Consult your HCP before beginning any new supplement regimen.
  7. Apply heat: You may already be familiar with this one. We’re talking hot water bottles, heating pads, a relaxing hot bath to help your muscles relax, improve blood flow and relieve tension. 
  8. Indulging in herbal teas: Herbal teas include anti-inflammatory and antispasmodic ingredients that can help relieve uterine muscle spasms that cause cramping. Menstrual cramps can be relieved naturally by drinking chamomile, fennel, or ginger tea. Herbal teas can offer other advantages, such as stress relaxation and insomnia alleviation.
  9. Try massage therapy: Massage treatment was found to considerably lessen menstrual discomfort in women with endometriosis in one research study. Massages can help to relax the uterus, which can help to decrease uterine spasms. Massage treatment should be focused on the abdomen area to properly control period cramps.
  10. Try alternative therapy: Alternative medical methods such as acupuncture and acupressure have helped some people suffering from cramps. These techniques can assist you in relaxing, releasing muscular tension, and increase blood flow throughout your body.
  11. Magnesium:  We highlight Magnesium again as a study discovered that taking 250 mg of magnesium and 40 mg of vitamin B6 per day reduced PMS symptoms the most. Certain medicines, such as antibiotics and proton pump inhibitors, might be affected by magnesium. Please consult your doctor to see whether magnesium is appropriate for you. 
  12. Other changes: Refrain from smoking as it is thought to increase the incidence of period pain by reducing the supply of oxygen to the pelvic area. It is also recommended to reduce alcohol and caffeine consumption, eat high fiber foods and reduce the amount of salt in your diet. 

If your cramps are severe enough that a conventional painkiller won't help, and they're interfering with your ability to work, study, or conduct other daily tasks, it's time to see a doctor. If your cramping comes on abruptly or is especially severe, or if it lasts longer than a few days, you should visit your doctor. Menstrual cramps that last for days or weeks or chronic pelvic discomfort might be signs of endometriosis or adenomyosis. Advocating for yourself in the face of suffering might be difficult, but it will help you feel heard and receive the treatment you require.

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