Periodical cramping

Ever missed school, work or a party because of a period? If you have like me, you have probably experience period cramps at the start of your period. For most of us, these cramps can be pretty severe.

Dysmenorrhea is severe menstrual cramping pain that occurs before and during a period, and includes symptoms like nausea, vomiting, diarrhoea and headache. People with dysmenorrhea often miss school or work, can’t participate in their normal daily activities and might experience poor mood and sleep during their period.

Dysmenorrhea usually starts at the beginning of a period, or right before a period, in the late luteal phase, and can last for the first few days of a period. It is reported by up to 90% of people with periods (1, 2), and is particularly high in adolescents (3, 4). It doesn’t usually appear until at least 6 months after menarche (1, 2). There are two types of dysmenorrhea – primary and secondary. Primary Dysmenorrhea has no secondary underlying condition whereas secondary dysmenorrhea has an underlying condition, such as endometriosis or adenomyosis.

The pain is usually described as fist opening and closing, in the lower back and lower stomach (2).

The main cause of Primary Dysmenorrhea is an increased amount of prostaglandins, a group of hormones, that are secreted from the endometrium during menstruation (1, 2, 4). Prostaglandins cause the uterus to contract, which also can limit blood flow in the uterus, causing pain in the lower back and lower stomach (1). For people with dysmenorrhea, the uterus contracts more severely and for longer periods than for those who don’t experience it (2). Prostaglandins can also cause the gastrointestinal tract to contract, causing the nausea, vomiting and diarrhea (1, 2, 5).

Diagnosis of dysmenorrhea is usually based on someone’s history of period pain (2), so it can be helpful to track your period pain, as well as what helps you to manage the pain. For this you can use a period-tracking app like Clue, or keep a journal, noting your period days, cramping, any medications as well as what helps and what doesn’t.

Dysmenorrhea can vary between people, and it doesn’t always prevent someone from going about their normal life. If you’re in severe pain that anti-inflammatories doesn’t relieve, your cramping lasts more than a few days, you’re bleeding more than what’s normal for you, or something feels wrong, please see a doctor.

Current treatment options are non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and aspirin, since these types of drugs prevent the production of prostaglandins in the uterus and can help reduce menstrual blood flow (1, 2). If this is an option for you, it’s recommended to use anti-inflammatories with food 1-2 days before menstruation begins to help tackle pain (1). Anti-inflammatory drugs don’t always work in people with dysmenorrhea, with one in four people experiencing little to no relief (4). They also can have severe side effects when used long term (6, 7), and might not be preferred by all people.

If you’re not currently trying to get pregnant, hormonal contraceptives are another option for treatment. Some oral contraceptives prevent ovulation, and so also prevent prostaglandins from being produced in the uterus (1, 8). These also have benefits if you also experience heavy menstrual bleeding (2). Hormone releasing IUDs like the Mirena have been shown to help relieve primary and some instances secondary dysmenorrhea (1, 9). If you’re wanting to use hormonal contraceptives to help with dysmenorrhea, it’s best to see a healthcare professional to help you select the right option for you.

Heat therapy, including hot water bottles, heat packs, wraps or patches placed on the lower stomach or back can help with period pain relief (2, 10). When applied, heat helps by increasing blood flow and this encourages the muscle to relax. Heat patches are a more portable option, and may help to support participation in normal life (11). Heat can be used with other treatment options, or by itself.

The addition of cinnamon, fennel and ginger to a diet has also been shown to reduce painful cramping (4).

Cinnamon has anti-inflammatory properties, limiting the production of prostaglandins (4, 12). It’s shown to have effects about 8 hours after consumption of 0.4-6g (6, 7, 13). Cinnamon has also been shown to reduce the duration of cramps (7). I’d recommend incorporating it into drinks like smoothies, on stewed fruit or baking it into cookies.

Fennel, more specifically fennel seed oil has also shown benefits by lessening uterus contractions (15). Some studies have shown similar relief of menstrual cramps from fennel seed oil to ibuprofen (15, 16). It does, however, have a strong taste (16), so I’d recommend taking it in a capsule.

Ginger has been shown to suppress the production of prostaglandins, and has pain relieving properties, showing similar effectiveness to ibuprofen for some people (4, 17). If you experience nausea, vomiting or bloating with your cramps, ginger can also help to relieve these symptoms (16).

Several studies have looked at the benefits of yoga for both primary and secondary dysmenorrhea, and as well the benefits of ginger for general health, stress, flexibility and muscle strength (9, 18, 19). Yoga combines breathing techniques, meditation and physical exercise. It’s thought that the benefits of yoga on stress and anxiety help alleviate the intensity of cramps, as well as play a role in activating the body’s natural painkiller, endorphins (9, 19). Some of my personal favourites for cramps include extended child’s pose (Utthita Balasana) and the cat/cow pose (Bidalasana).

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References

1. Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. Lippincott Williams & Wilkins; 2012.
2. Smith RP. Dysmenorrhea and Menorrhagia. Springer International Publishing; 2018.
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4. Xu Y, Yang Q, Wang X. Efficacy of herbal medicine (cinnamon/fennel/ginger) for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Journal of International Medical Research. 2020 Jun;48(6):0300060520936179.
5. Jaafarpour M, Hatefi M, Najafi F, Khajavikhan J, Khani A. The effect of cinnamon on menstrual bleeding and systemic symptoms with primary dysmenorrhea. Iranian Red Crescent Medical Journal. 2015 Apr;17(4).
6. Jahangirifar M, Taebi M, Dolatian M. The effect of Cinnamon on primary dysmenorrhea: a randomized, double-blind clinical trial. Complementary therapies in clinical practice. 2018 Nov 1;33:56-60. https://doi.org/10.1016/j.ctcp.2018.08.001
7. Mirabia, P. Effect of Medicinal Herbs on Primary Dysmenorrhoea – A Systematic review. Iranian Journal of Pharmaceutical research

8. Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception. 2010 Mar 1;81(3):185-96.
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10. Jo J, Lee SH. Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific reports. 2018 Nov 2;8(1):1-8.
11. Potur DC, Kömürcü N. The effects of local low-dose heat application on dysmenorrhea. Journal of pediatric and adolescent gynecology. 2014 Aug 1;27(4):216-21. https://doi.org/10.1016/j.jpag.2013.11.003
12. Rao PV, Gan SH. Cinnamon: a multifaceted medicinal plant. Evidence-Based Complementary and Alternative Medicine. 2014 Jan 1;2014.
13. Tung YT, Chua MT, Wang SY, Chang ST. Anti-inflammation activities of essential oil and its constituents from indigenous cinnamon (Cinnamomum osmophloeum) twigs. Bioresource technology. 2008 Jun 1;99(9):3908-13.
14. Jaafarpour, M, Comparative Effect of Cinnamon and Ibruprofen for Treatment of Primary Dysmenorrhea: A Randomised Double Blind Clinical Trial
15. Omidvar S, Esmailzadeh S, Baradaran M, Basirat Z. Effect of fennel on pain intensity in dysmenorrhoea: A placebo-controlled trial. Ayu. 2012 Apr;33(2):311. DOI: 10.4103/0974-8520.105259
16. Bokaie M, Farajkhoda T, Enjezab B, Khoshbin A, Mojgan KZ. Oral fennel (Foeniculum vulgare) drop effect on primary dysmenorrhea: effectiveness of herbal drug. Iranian journal of nursing and midwifery research. 2013 Mar;18(2):128.
17. Ozgoli G, Goli M, Moattar F. Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. The journal of alternative and complementary medicine. 2009 Feb 1;15(2):129-32.
18. Sutar R, Yadav S, Desai G. Yoga intervention and functional pain syndromes: a selective review. International Review of psychiatry. 2016 May 3;28(3):316-22.
19. Rakhshaee Z. Effect of three yoga poses (cobra, cat and fish poses) in women with primary dysmenorrhea: a randomized clinical trial. Journal of pediatric and adolescent gynecology. 2011 Aug 1;24(4):192-6.
20. Raine-Fenning N (2005) Dysmenorrhea. Current Obstetrics & Gynaecology 15: 394-401