Menstrual Cramps (Dysmenorrhea)
It's menstrual cramp Monday! Join us for this week's episode of Health is PowHer podcast because we know pretty much every woman can relate to this topic. Menstrual cramps! Dr. Anna is going to share the science behind this not-so-lovely monthly occurrence and what you can do about them naturally and effectively! Listen in on iTunes, Spotify, Stitcher or right here on our website.
Let’s talk about something that almost every woman deals with at some point...menstrual cramps.
Menstrual cramps (or dysmenorrhea) is extremely prevalent. An estimated 45-95% of women deal with this issue.
Symptoms can include:
Low pelvic discomfort
Low back pain
Radiation of pain to thighs, knees, legs and feet
Insomnia or fatigue
Nausea, vomiting, bloating, diarrhea
Headache or migraine
You are more likely to develop menstrual cramps aka dysmenorrhea if...
Start your period (menarche) at a younger age
You smoke
Have a longer or heavier menstrual flow
Have a higher BMI (body mass index)
Regular alcohol consumption
Family history of dysmenorrhea
Age
Nulliparity (never having given birth)
Menstrual cramps can be related to menstrual cycle alone or to endometriosis or invasion of the tissue lining outside of the uterus. Want to make sure there’s no sexually transmitted disease or other causes of pelvic pain
Physiology of menstrual cramps
When your body is getting ready for your period, inflammatory substances are released called prostaglandins. These cause vessels to constrict and tighten up, thereby decreasing oxygen supply to uterine tissue. This creates a cascade of inflammatory substances to be released and cause contractions. Furthermore, the nerves surrounding the uterine tissue become more sensitive to pain.
Eventually, this entire process can lead to amplified pain, also known as central sensitization syndrome. This is when someone experiences pain abnormally, usually much more heightened and potentially with other physical symptoms.
First line treatment for menstrual cramps is NSAIDs aka non-steroidal anti-inflammatory drugs given 1-3 days prior to menses. Typically the medication of choice is naproxen twice daily. Unfortunately there is not enough evidence to truly recommend this as the standard of care according to the Cochrane review.
Second line treatment is use of contraceptives which suppress ovulation and reduce inflammatory substance production. Like NSAIDs, they also do not hold proven efficacy in research per Cochrane.
Let’s get to the integrative approach to menstrual cramps…
In order to truly help menstrual cramps, a well-rounded approach is key. This includes:
1. Moving towards an anti-inflammatory diet
2. Reducing environmental exposures to toxins that alter hormones including make-up, pesticides, etc.
3. Supplements like ginger, valerian, fish oil, thiamine and zinc
4. Essential oils such as rose, lavender, clary sage, peppermint, and rosemary
So let’s delve deeper into diet. Making some small but powerful changes can help healing from menstrual cramps. What you eat affects several substances in the body such as CRP, cytokines, white blood cells and platelets, all of which regulate inflammation and your immune system (aka what ultimately leads to that pain response in menstrual cramps).
Diet take-aways for menstrual cramp prevention
1. Increase green veggies and fruit
2. Decrease processed meats (aka deli meat, sausage, pepperoni, etc)
3. Consider going gluten free
4. Add Omega-3’s fats from dietary sources such as fish, walnuts, flax or a supplement
A few herbs and supplements for cramps:
Ginger
Ginger in doses of 750-2000 mg for first days of menses can reduce pain by up to 85% compared to placebo pills - these can be found in tea, capsules, or whole food ginger if you like to make brewed chai tea with fresh ginger.
Ginger shouldn’t be given in combination with anticoagulants or any blood thinners, or with a calcium channel blocker known as nifedipine.
Side effects include belching, sore throat, heartburn, diarrhea, increased menstrual bleeding or bleeding in general due to the anti-inflammatory pathways it works on.
Valerian
Valerian is a botanical and when given in doses of 255 mg 2-3 times daily for 2-3 menses can have antispasmodic and sedative effects, reducing duration of severe pain.
It smells a little bit like dirty socks. It shouldn’t be given with other central nervous system depressants that can potentially worsen drowsiness.
Side effects may include headache, gut discomfort, drowsiness, vivid dreams, urinary retention and some people have a paradoxical effect of anxiety or excitation.
Thiamine (Vitamin B1):
Vitamin B1 deficiency manifests as decreased pain tolerance, muscle cramps, and fatigue. It is thought to be involved in neuromuscular transmission
Supplements at 100mg per day for at least 3 months has shown to reduce intensity and severity of pain
Side effects may include dermatitis or allergic reaction but it is usually well tolerated. It may cause false positive elevations for uric acid and urobilinogen lab tests.
Vitamin E:
150-500 units for several days prior, during and after menses demonstrated a significant decrease in severity and duration of pain with Vitamin E compared with placebo
It is believed to have anti-inflammatory/antioxidant activity and increase in beta-endorphin levels
It is usually well-tolerated, however possible side effects include nausea, diarrhea, intestinal cramps, fatigue, weakness, headache, blurred vision, rash, gonadal dysfunction and creatinuria. There is a possible effect on platelet function.
There must be cautious use with anticoagulants and chemotherapy
Zinc:
15 mg to 100 mg daily for 3-12 months depending on serum levels may decrease cramps. Zinc is thought to have epigenetic regulation of hormones.
Possible side effects are nausea/vomiting, abdominal pain, diarrhea, metallic taste in mouth, copper deficiency
Zinc may interact by reduce levels of copper, beta-carotene, iron, and certain antibiotics such as quinolones and tetracycline
Magnesium:
50-600 mg daily of magnesium may help with cramps. Magnesium acts by reducing prostaglandin synthesis, regulating intracellular calcium concentration, and relaxing muscle
Possible side effects are GI upset: diarrhea, nausea, vomiting, abdominal pain/intestinal cramps; drowsiness, hypotension, confusion, loss of tendon reflexes, muscle weakness, respiratory depression, cardiac arrhythmias, coma, cardiac arrest, death
Cautious use with aminoglycosides, calcium-channel blockers, diuretics. Avoid taking with certain antibiotics due to decreased absorption.
Titrate doses accordingly to avoid diarrhea
Vitamin B6:
Vitamin B6 may increase influx of magnesium into the muscle cell
It is involved as a cofactor in methylation cycle, this is important because endometrial cells are hypomethylated in endometriosis
Blocks prostaglandins
Vitamin D:
Vitamin D has both autocrine and paracrine role in endometriosis lesions
Active form of vitamin D reduces inflammatory cytokines (IL-6, TNF20) and prostaglandins by suppressing COX-2
Single dose of 300,000 IU vit D reduced pain along with use of NSAID’s in a group of women
Iranian Herbs:
Saffron, native to Iran, has been used in treatment of many menstrual disorders. It Improves blood circulation and has antispasmodic effects.
Celery seed is used in Ayurvedic medicine for cramps
Fennel seeds have a possible antispasmodic effect
Other integrative therapies for menstrual cramps…
Acupuncture/Acupressure has a limited amount of supporting evidence according to the Cochrane database 2016. However meta-analysis showed that acupressure significantly reduced dysmennorrhea, acupuncture improved both physical and mental components of quality of life. The “Chongmai” acupuncture meridian seems to be effective in improving dysmenorrhea.
Massage, isometric exercises, reflexology, yoga, TENS unit usage and manipulation have reported benefits for dysmenorrhea as well.
Essential Oils that have shown benefit for cramps include
Rose
Lavender
Clary sage
Marjoram
*Insider tip from Dr. Anna: Blend 2:1:1 ratio of lavender, clary sage and marjoram essential oils with a carrier oil such as jojoba and rub onto the lower abdomen surrounding menstruation.
In summary, there are countless things you can try for menstrual cramps that are safe, natural and effective! We hope you enjoyed this episode of Health is PowHer and make sure to subscribe for future women’s wellness topics!