Have you ever missed school or work due to a heavy, painful period? Stayed home and canceled plans because of awful cramps, nausea, or headaches? Why does some period pain get worse with age? This is the reality many women (estimates range from 45% to 95%!) experience every month [1]. These symptoms may seem inevitable and difficult to understand, but there are a whole host of causes for period pain. By understanding your cycle and the reasons for painful menstruation, you can get to the bottom of why you’re experiencing these symptoms. Here I’ll share how heavy painful periods can be addressed in a way that hopefully heals them at their source.
What kind of period pain are you experiencing?
The first thing to figure out is whether you have primary or secondary dysmenorrhea. The terms primary and secondary do not refer to the types or severity of symptoms, necessarily. Instead, they refer to why the pain is occurring.
Primary dysmenorrhea
Primary dysmenorrhea is painful cramping or abdominal pain that can occur either before or during your period. This type of pain often starts during the first few periods a girl experiences as she goes through puberty. It often lessens as a woman ages. Primary dysmenorrhea is the most common type of period pain and isn’t associated with other disorders. It is caused by an excess of prostaglandins in the lining of the uterus. We will discuss how these chemicals interact with your body and how to potentially help decrease them below. For now, know that these usually decrease with age and possibly even after you have given birth.
Is primary dysmenorrhea normal?
As your uterine lining sheds during your period, chemicals called prostaglandins are released. These cause your uterus to contract (or ‘cramp’) to expel its lining. While prostaglandins are necessary in order for this process to take place, having too many of them can cause intense cramping. When people say that period pain is “normal,” they often mean that it’s caused by a chemical that is naturally found in every woman’s body as she menstruates (and at other times as well!). But having a very high amount of prostaglandins that causes intense pain (especially pain that causes you to miss school or work) is not normal [2].
Reducing primary dysmenorrhea by decreasing inflammation
Prostaglandins are released at an elevated rate when the body has excess inflammation. Unfortunately, many of us have inflammation due to dietary or environmental factors. To help decrease the amount of prostaglandins your body is producing, avoid inflammatory foods. These include refined vegetable oils, highly processed grains (think bleached flour) and sugar, conventional dairy products, low-quality processed meats. Also avoid excessive caffeine or alcohol. Instead, focus on a whole-foods diet that includes high quality proteins, healthy fats like olive oil or coconut oil, and seasonal fruits and vegetables.
While prostaglandins are not found in foods themselves, inflammation increases prostaglandin production. So, consuming a diet that helps lower inflammation will also help decrease your prostaglandin load and hopefully your period pain .
Secondary dysmenorrhea
Not all period pain is due to prostaglandins, however. Secondary dysmenorrhea is period pain associated with reproductive organ disorders like endometriosis, uterine fibroids, adenomyosis, or polycystic ovary syndrome (PCOS). Typically, this kind of period pain starts before your menstrual period and sometimes continues even after bleeding has stopped. It can be even more intense than primary dysmenorrhea because it’s often accompanied by other symptoms of the reproductive disorder you have, like headaches or nausea. The onset is typically later in life than primary dysmenorrhea [1]. More women in their 30s or 40s experience secondary dysmenorrhea than do teen girls or women in their early 20s. In fact, period pain from secondary dysmenorrhea may appear to get worse with age. But the developing or worsening reproductive disorder, not your age, is the real issue.
Why does secondary dysmenorrhea happen and can it harm my fertility?
Again, the distinction between primary and secondary dysmenorrhea exists because some women’s menstrual pain is caused by prostaglandins, and for others, it is caused by a reproductive disorder. This distinction matters because while primary dysmenorrhea may not have negative implications for one’s fertility, secondary dysmenorrhea almost certainly does.
According to the American College of Obstetrics and Gynecologists, endometriosis is the most common cause of secondary dysmenorrhea. Endometriosis, which occurs when endometrial-like cells grow outside the uterus and cause pain and inflammation, is typically diagnosed via laparoscopy. It is also sometimes accompanied by other symptoms such as chronic pelvic pain or pain with sex. While endometriosis does not have a definitive cure, there are ways to surgically address it.
Other reproductive disorders that cause dysmenorrhea include adenomyosis, which is when the tissue lining the uterus grows down into the muscular layer of the uterus, causing heavy, painful periods and other symptoms like painful sex or spotting in between periods. Uterine fibroids and Polycystic Ovary Syndrome (PCOS) are other causes of secondary dysmenorrhea, and are both types of unhealthy tissue growth. While PCOS creates fluid-filled cysts that form outside of the uterus (namely, in the ovaries), uterine fibroids are benign masses that can form either outside or within the uterus.
All four of the above disorders can, unfortunately, cause infertility. Endometriosis and PCOS are two of the leading causes of infertility in women, but both can be helped either naturally using lifestyle changes or surgically with NaProTechnology, FEMM, or other restorative reproductive medicine (RRM) approaches. There are many women who, with the help of a RRM provider, have been able to decrease or sometimes reverse the effects of their reproductive disorder, improving their fertility in the process.
Diagnosing dysmenorrhea
If you are experiencing period pain, be sure to tell your doctor about your symptoms, when and how long they typically occur each cycle, and when you first noticed the pain. If you’ve had painful heavy periods since you can remember, you’re more likely to have primary dysmenorrhea. 70-90% of women with primary dysmenorrhea are under the age of 24 [2]. However, a more formal diagnosis is required in order to determine what kind of dysmenorrhea you have [2].
Your doctor can help distinguish primary from secondary dysmenorrhea by asking the questions listed above and figuring out if your medical history corresponds with primary dysmenorrhea or suggests a reproductive disorder. He or she might then direct you to take NSAIDs such as Ibuprofen to see if they help diminish or end the pain. If they do help, the diagnostic process will often end there.
If your medical history does not correspond with primary dysmenorrhea—that is, you have other symptoms which align with disorders like endometriosis or PCOS, your periods are getting more painful with age, or your pain lasts for longer than, or outside of, menstruation—or you do not respond to treatment with NSAIDs, then you may receive further testing. This could include a pelvic exam, ultrasound, or pelvis magnetic resonance imaging (MRI). These tests can help determine whether you have a type of secondary dysmenorrhea instead.
What can I do about my period pain, and is birth control the answer?
For women with either primary or secondary dysmenorrhea, meeting with a RRM provider can help you address the underlying causes of your pain. If excess prostaglandins are your issue, your doctor will typically recommend that you take NSAIDs, as they are anti-inflammatory and block prostaglandin production [3]. Natural remedies for period pain also include consuming ginger, which studies suggest can be just as useful in decreasing or even taking away period cramps as NSAIDs [4]. You can also help ease the pain by using hot packs, doing gentle exercise like walking or stretching, and avoiding the inflammatory foods like sugar that many of us crave on our periods (pint of ice cream, anyone?).
If your dysmenorrhea is due to another reproductive disorder, your RRM provider may prescribe medication, surgery, or other interventions to treat the root cause of the problem. Hopefully, your period pain will decrease as a result.
Of course, OB/GYNs who lack training in restorative reproductive medicine often recommend birth control for period pain, and indeed women may experience symptom relief from these interventions. However, hormonal birth control causes many of its own serious and/or uncomfortable side effects. It is ultimately a “Band-Aid solution” that does not address the root cause of your symptoms. For this reason, they’ll likely return once you stop using birth control. Especially for women with diagnoses like endometriosis, there are a plethora of natural or surgical solutions that address why you’re having dysmenorrhea. These solutions heal your body and your fertility and don’t merely manage symptoms.
How Fertility awareness can help with heavy painful periods
Tracking and understanding your cycle is another key to figuring out what’s causing your painful periods and potentially finding relief. It may give you a clue as to whether you are experiencing primary or secondary dysmenorrhea, and a RRM-trained provider can take the data you’ve collected and help create a tailored plan that’s targeted to help you with your heavy painful periods. Understanding your cycle and the way your body works can be extremely useful in getting to the bottom of the causes of your period pain, and ultimately, fixing it.
References:
[1] Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13;332(7550):1134-8. doi: 10.1136/bmj.332.7550.1134. PMID: 16690671; PMCID: PMC1459624. [2] Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ. Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean J Fam Med. 2022 Mar;43(2):101-108. doi: 10.4082/kjfm.21.0103. Epub 2022 Mar 17. PMID: 35320895; PMCID: PMC8943241. [3] InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Period pains: Can anti-inflammatory drugs help? 2007 Nov 16 [Updated 2019 Aug 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279323/ [4] Ozgoli, Giti et al. “Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 15,2 (2009): 129-32. doi:10.1089/acm.2008.0311Additional Reading:
How I started healing my painful irregular periods with the switch to fertility awareness
How fertility awareness can help with severe menstrual cramps
Teens and irregular periods: What’s normal—and what’s not
Adenomyosis vs. Endometriosis: How they’re similar and how they differ
5 non-surgical, non-pharmaceutical approaches to treat pelvic pain
