Ever experienced period pain? My hand is up over here! And if your hand is up too, we are certainly not alone. In fact, it would be unusual if we had not experienced any period pain, given 90% of Australian women aged 13- 25 years report experiencing menstrual and pelvic pain [1].
Read on to find out what causes period pain and discover effective strategies to help make your periods more manageable.
What is ‘Normal’ period pain?
Pain that lasts for only the first couple of days of your menstrual period without impacting your ability to do usual activities may be considered ‘normal’.
Pain that does not seem to dampen with pain medication, that last for many days and stops you from taking part in your usual activities is not normal. I repeat, pain that impacts upon your daily activities over many menstrual cycles is not normal.
If you are experiencing painful periods, it’s time to find a great women’s health medical professional to be part of your support team!
Primary and Secondary Dysmenorrhea
The medical term for pain associated with menstruation is ‘dysmenorrhea’.
When there is no identifiable medical reason for menstrual pain it is called primary dysmenorrhea. Primary dysmenorrhea is experienced mainly during the time of menstrual bleeding, and any abdominal and pelvic investigations are typically normal.
Secondary dysmenorrhea is when there is an underlying cause that can be identified for the pain. Other symptoms often accompany secondary dysmenorrhea and these can include menstrual cycle disturbances, painful intercourse, and gastrointestinal symptoms.
Secondary dysmenorrhea may be related to the presence of endometriosis, adenomyosis, uterine fibroids or pelvic inflammatory disease.
Could my Pain be Endometriosis?
One of the most common causes of painful periods is endometriosis. Endometriosis is where cells similar to those that grow in the uterus are located outside the uterus, usually on the pelvic organs. These cells form lesions and respond to hormonal stimulation across the menstrual cycle, just as your uterine tissue would. It is estimated that 10 -15% of women have this condition (and yes, my hand it up!).
How do I Know if I Have Endometriosis?
Currently, diagnosis of endometriosis requires keyhole surgery to take a look inside the pelvis and identify the presence of lesions. While pain is a common symptom of endometriosis though, it is possible to have endometriosis without pain. In most cases, this endometriosis is discovered during investigations for infertility. If you are trying to conceive, you can read more about getting pregnant with endometriosis here.
In an online survey of 1,354 Australia women aged 18-50 years, women with endometriosis had greater pain, bloating, nausea and widespread pain sites compared to women without endometriosis [2]. If you think you may have endometriosis, talk with your general practitioner who will be able to refer you to a specialist gynaecologist.
Why are My Periods Painful?
With or without endometriosis, the all too familiar uterine contractions that are the main cause of menstrual pain are often the result of an increase in prostaglandins.
Prostaglandins are part of the chemical chain of communication between inflammatory stimulus and menstrual symptoms such as pain and gastrointestinal disturbances.
Reducing inflammation and oxidative stress are therapeutic strategies to manage and reduce period pain, as this dampens the production of prostaglandins.
We know that increasing gut microbiota diversity reduces inflammation, and this is one of the paths to less painful periods and better reproductive health.
Can’t I just Take Nonsteroidal Anti-inflammatory Druges (NSAIDs)?
If you have been dealing with period pain it is likely that at some stage you have taken a Nonsteroidal Anti-inflammatory Drug (NSAID) like ibuprofen or aspirin. NSAIDs work by inhibiting cyclooxygenase, an enzyme required for the production of prostaglandins. When you inhibit cyxlooxygenase, prostaglandin production dramatically reduces.
This is a good thing, right?
Well, like most things- balance is important. While too many prostaglandins can lead to increased pain (and other impacts on our body), very low levels of prostaglandins can impact our fertility by inhibiting the process of ovulation.
During a typical menstrual cycle we will have a surge of luteinising hormone that stimulates the release of an egg from a follicle developing in our ovary. One important role of prostaglandins is to help release this egg from the developing follicle at the time of ovulation.
If prostaglandin production is too low or has been inhibited by taking NSAIDs, you may experience luteinised unruptured follicle syndrome. Luteinised unruptured follicle syndrome is where no egg is released, so ovulation does not occur and there is no chance of pregnancy during that menstrual cycle. This is a cause of unexplained infertility, and common in women with endometriosis.
High doses of NSAIDs like ibuprofen and aspirin, which may often be taken to manage period pain, have been associated with luteinised unruptured follicle syndrome. As NSAIDs inhibit the cyclooxygenase enzyme, prostaglandin production is dampened, and there are not enough prostaglandins to help rupture the follicle and release the egg inside.
NSAIDs also impact your gastrointestinal tract and can dampen the production of protective mucus production in the gut. There are risks with taking NSAIDs long term so do seek medical advice if you are managing pain routinely with these drugs.
How Do I Balance Prostaglandin Production?
Balancing prostaglandin production naturally is an effective way to manage menstrual symptoms, without impairing follicle growth and egg release.
There are steps you can take to dampen prostaglandin production to reduce pain. Try these proven strategies and let us know if you experience menstrual pain relief!
Get Some Sun
Women with low levels of Vitamin D experience a greater severity of menstrual pain [11] and increasing Vitamin D levels is a great way to dampen this.
80% of our Vitamin D comes for exposure to ultraviolet light, so pop outside with your arms and legs exposed on a sunny day for 10 to 30 min to soak up some sun. If your skin is darker you may need a little more exposure to get your vitamin D dose.
Vitamin D is essential for healthy functioning of our ovaries, endometrium and our gut!
This important Vitamin regulates tight junctions the gut, and we know that a strong gut barrier means less inflammation. Reducing inflammation lowers prostaglandins and improves regulation of ovulation and our menstrual cycle.
Move Your Body
Exercise really is medicine. We love talking about exercise for better gut and reproductive health. It is one of the best anti-inflammatories so there are no surprises that getting your body moving reduces prostaglandin production.
Exercise performed for 45 to 60 minutes a day, three times a week or more, regardless of intensity, significantly reduces menstrual pain [3].
Getting out for a walk while you are curled up on the bathroom floor is never going to be an option (I have been there!) but consistency when you can get out to move your body will upregulate those anti-inflammatory pathways to make periods more manageable.
Nature’s Goodness
A healthy diverse gut reduces inflammation to limit the production of prostaglandins. Optimal reproductive health starts in your gut and emerging research is showing that a healthy gut also helps reduce pain hypersensitivity (that’s a blog post for another day!).
The gut loving compounds Cynara scolymus [4], alpha linolenic acid [5], flavonoids [6], policosanols [7] and tricin [8] have all been scientifically proven to reduce prostaglandin production. As researchers it is fundamental that all of our selected ingredients are backed by the latest scientific research and these effective, prostaglandin reducing compounds are all naturally occurring in Fertile Gut!
Crafting Our Unique Prebiotic Blend
Did you know that it can take up to 17 years for research to be put into practice? [9] Fertile Gut was created to bring you the latest scientifically proven ingredients, faster. Our products are 100% natural and safe for conception, pregnancy, and breastfeeding to give you peace of mind, and optimal reproductive health!
In a world where 'gut health' is added as a tag line to products rushed to market, and there is often little or no scienfitic evidence for effectiveness, we are proud to be different.
We are working on some exciting new products for release this year that will uphold our mission of delivering natural, effective, bioactive ingredients for better reproductive health and fertility by creating a Fertile Gut!
References
- 1. Armour, M., et al., The Prevalence and Educational Impact of Pelvic and Menstrual Pain in Australia: A National Online Survey of 4202 Young Women Aged 13-25 Years. J Pediatr Adolesc Gynecol, 2020. 33(5): p. 511-518.
- 2. Evans, S., et al., Phenotypes of Women with and Without Endometriosis and Relationship with Functional Pain Disability. Pain Med, 2020.
- 3. Armour, M., et al., Exercise for dysmenorrhoea. Cochrane Database Syst Rev, 2019. 9: p. CD004142.
- 4. Ben Salem, M., et al., Chemicals Compositions, Antioxidant and Anti-Inflammatory Activity of Cynara scolymus Leaves Extracts, and Analysis of Major Bioactive Polyphenols by HPLC. Evid Based Complement Alternat Med, 2017. 2017: p. 4951937.
- 5. Adam, O., G. Wolfram, and N. Zollner, Effect of alpha-linolenic acid in the human diet on linoleic acid metabolism and prostaglandin biosynthesis. J Lipid Res, 1986. 27(4): p. 421-6.
- 6. Cui, J. and J. Jia, Natural COX-2 inhibitors as promising anti-inflammatory agents: an update. Curr Med Chem, 2020.
- 7. Carbajal, D., et al., Effect of policosanol on platelet aggregation and serum levels of arachidonic acid metabolites in healthy volunteers. Prostaglandins Leukot Essent Fatty Acids, 1998. 58(1): p. 61-4.
- 8. Al-Fayez, M., et al., Differential modulation of cyclooxygenase-mediated prostaglandin production by the putative cancer chemopreventive flavonoids tricin, apigenin and quercetin. Cancer Chemother Pharmacol, 2006. 58(6): p. 816-25.
- 9. Morris, Z.S., S. Wooding, and J. Grant, The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med, 2011. 104(12): p. 510-20.
- 10. Harada, T., Dysmenorrhea and endometriosis in young women. Yonago Acta Med, 2013. 56(4): p. 81-4.
- 11. Abdi, F., et al., A systematic review of the role of vitamin D and calcium in premenstrual syndrome, Obstet Gynecol Sci, 2019. 62(2):73-86.
