How Much Period Pain Is Normal?
If you’re like most women, you’ve experienced period pain at some point in your life. A little bit of mild cramping is often considered “normal,” especially at the beginning of your period. But when a period is truly healthy, you won’t even feel it coming at all. If you’re consistently having to pop painkillers like candy, or you’re in too much pain to go to work or school, then something deeper is going on. That type of period pain is not normal. In medicine, painful periods are called dysmenorrhea. Your period is like a barometer of your overall health. It tells you how well your body is being nourished (or not), how much stress you’ve been under, and how much inflammation might be going on in your body. It’s important to uncover the root causes of why your hormones are in turmoil so that you can find the least invasive, safest and most effective solution. The great news is that women’s hormonal issues respond beautifully to natural medicine and, with a little detective work, you can troubleshoot your problems to get back on the road to wellness. First, let’s explore the causes of menstrual pain. I‘m going to get all ‘sciency’ because I want you to really understand what’s going on inside of your body. I even made a cute little drawing to help explain everything. Bear with me and keep reading. It’ll all make sense – I promise! 🙂What Causes Menstrual Pain?
Pain during menstruation is thought to be caused by prostaglandins and leukotrienes. Together, these compounds are known as eicosanoids. Prostaglandins are a group of hormone-like fats that are made by our cells at sites of tissue damage or infection in the body. Their job is to direct the healing process by coordinating blood vessel constriction and blood clotting. In this process, prostaglandins cause the pain, fever, redness and swelling that we experience with illness and injury. Prostaglandins also play a role in the female reproductive system by controlling ovulation, initiating labor (there’s a clue about pain, eh?) and regulating menstrual flow. In other words, prostaglandins cause the uterus to contract. Two specific prostaglandins have been linked to menstrual pain: PGE2 and PGF2-alpha. Now, normally, prostaglandins are very short-lived. Once their job is done, the body breaks them down quickly. But problems arise when inflammatory prostaglandins are produced in excess. Certain dietary and lifestyle factors will cause persistent tissue damage and load us with omega-6 fats, resulting in ’round the clock production of inflammatory prostaglandins. Below is an illustration of the process. As you can see, anything that promotes high levels of arachidonic acid, the precursor to prostaglandins, can lead to pain and inflammation.
Prostaglandin E2 (PGE2), an inflammatory compound, stimulates the aromatase enzyme, which raises estrogen levels. Estrogen then stimulates the COX-2 enzyme, which creates more PGE2, and thus more inflammation. It’s a vicious cycle!
Similar to prostaglandins, leukotrienes are inflammatory molecules that are released by our white blood cells. Leukotrienes are notorious for their role in allergies and asthma, but leukotriene E4 may play a specific role in menstrual pain. There are many things that lead to painful periods, but I’m going to focus on the most common reasons that I see in my practice. Keep in mind that the causes of your menstrual pain can be multifactorial, and often it is the total load of several imbalances that is responsible for causing symptoms.1. Your diet is not good.
We just talked about prostaglandins, leukotrienes, and their role in menstrual cramps. But what causes your body to produce them in large amounts? Much of it has to do with your diet.
A diet full of vegetable oils, refined grains, sugar, and alcohol is almost guaranteed to make your periods miserable. Because of the ways these foods damage your cells, disrupt your hormones, and interfere with cell communication, these foods will send your immune system into a firestorm. And that means prostaglandins and pain.
Alcohol is especially problematic for women with painful periods because it reduces the liver’s ability to detoxify estrogen and toxins. Did you know that having just 2 drinks per day can double the amount of estrogen in your body?! As shown in the diagram above, estrogen increases PGE2 (the pain molecule) by stimulating the COX-2 enzyme.
Having too much estrogen will also cause heavy periods, sore breasts, bloating, moodiness, and pretty much all of the things that we hate about periods in the first place! So nix the booze until you’ve made enough progress in your healing, okay?
Want to get real help now? Join our Body Bliss program and break free from period pain.
2. You have high insulin levels.
Insulin increases arachidonic acid, the precursor to the inflammatory prostaglandins that cause menstrual pain. Insulin also promotes clotting and can interfere with ovulation.
How do you know if your insulin levels are too high? Ask your doctor to order a fasting insulin test for you. Your fasting insulin level should be no higher than 8, but I really like to see it 6 or less.
If your insulin is too high, you need to start making changes like cutting sugar out of your diet and emphasizing vegetables, protein and healthy fats. Exercise, especially resistance exercise like weightlifting, is crucial for lowering your insulin levels. Also be sure to get 8 hours of sleep each night: Just one night of sleep deprivation can promote insulin resistance!
Signs and symptoms of imbalanced blood sugar and insulin resistance include:
- Sleep trouble
- Brain fog
- Darkened skin folds
- Belly fat
- Energy crashes or sleepiness after meals
- Sugar cravings
3. You’re not ovulating.
Ovulation is the release of an egg from the ovary. It typically happens on day 14 of the menstrual cycle. Ovulation is important when it comes to period pain because that is where you get your progesterone. Progesterone balances the stimulating effects of estrogen; it is a very calming hormone. When you don’t have enough progesterone, it leads to inflammation. It also works in reverse: inflammation impairs your body’s ability to make progesterone, so it becomes a vicious cycle. Having periods that are late, early, too heavy, too light or absent can all be symptoms of not ovulating (called “anovulation”). Common causes include nutrient deficiencies (especially magnesium, selenium and B6) polycystic ovary syndrome (PCOS) and stress. Stress is of particular importance because it reduces progesterone in two ways: 1). by “stealing” progesterone to make the stress hormone cortisol; and 2). by interfering with ovulation, your main source of progesterone. And while we’re talking about stress, it’s worth noting that chronic stress promotes insulin resistance (see point #2 above)! If you’re not ovulating, you need to figure out why you’re not ovulating. Are you deficient in important nutrients? Is it chronic stress? Are you eating inflammatory foods? Is it your thyroid?4. Your thyroid is out of whack.
Your thyroid is a small butterfly-shaped gland in the front of your neck. It makes thyroid hormone, which provides the “spark” for bodily functions like digestion, generation of body heat, detoxification and ovulation. Every single cell in your body needs thyroid hormone. The most common thyroid problem is when the gland is underactive, which is called hypothyroidism. Hypothyroidism interferes with ovulation, which means you’ll be making less progesterone. And remember that low progesterone promotes inflammation. Heavy menstrual bleeding can be a symptom of an underactive thyroid. Unfortunately many women with hypothyroidism never get diagnosed because the standard screening test (TSH or thyroid stimulating hormone) doesn’t show the whole picture. I always recommend a complete thyroid panel that includes TSH, free T3, free T4, reverse T3, and thyroid antibodies.5. You’re full of toxins.
Did you know that even low-level exposures to chemicals and environmental toxins can cause period problems, cancer and reproductive issues? It’s sad but true. Many of the chemicals in our environment act as “endocrine disruptors,” meaning they can mimic hormones and disrupt our hormonal (endocrine) system. These toxins include pesticides and herbicides, metals, solvents, flame retardants, plastics, food additives, and fragrances. These chemicals are everywhere, so there’s no foolproof way to avoid them entirely. The best thing to do is minimize your exposure (check your personal care products!), and it’s equally important to support your body’s ability to detoxify. This is one of the foundational strategies that we teach in our Body Bliss program.6. Your gut isn’t healthy.
Okay, this is a BIG one. The health of your GI tract is so intricately linked to the rest of your body (and mind). Practically every patient who comes to me with chronic health issues has some degree of imbalance in their digestive system. When our guts are healthy, good things happen for us. We absorb our nutrients. Our friendly gut bacteria help us detoxify estrogen and reduce inflammation. Our hormonal systems are balanced. All good things! But when our guts are not healthy, it sets the stage for all of the things that we don’t want. Our metabolism doesn’t work right. We become full of inflammation. Our immune system is imbalanced and we can develop autoimmunity. It can ruin our thyroid function. We can’t get rid of excess estrogen. We can’t absorb the nutrients we need. And the list goes on. More specifically, when the bacteria and other microbes in our gut are out of balance, there are some key factors that directly contribute to period pain. Unfriendly bacteria (referred to as “gram negative”) have something called lipopolysaccharide (LPS) on their outer surface. LPS is, by far, one of the most toxic and irritating substances known to the human body. And when the gut isn’t healthy, LPS can move across the gut barrier and get into the bloodstream. This creates a cascade of inflammation, revs up the immune system, blocks detoxification, and can specifically cause pelvic pain. In my practice, I’ve been able to link LPS with headaches, acne, and a host of other chronic conditions. One of the most common conditions that creates a large amount of gram negative bacteria and LPS in the gut is small intestinal bacterial overgrowth. This is a condition where the motility of the small intestine has been compromised, and bacteria proliferate in the gut. The classic symptom is bloating after meals, usually with a “pregnant belly” look. The other awful thing these critters do is produce an enzyme called beta-glucuronidase. This enzyme causes estrogen and toxins that would have otherwise been excreted to become freely circulating again. And remember that toxins and estrogen contribute to inflammation and pain. So what causes your gut to become so unhealthy in the first place? Hands down, the number one cause I’ve seen among my patients is antibiotic use. Whether it’s for recurrent sinus infections, UTI’s or acne, frequent antibiotic use can destroy your health. Don’t get me wrong! Antibiotics certainly have a time and a place. But the key is to support your immune system so that you’re not having to deal with to chronic infections in the first place. The bottom line: If you want healthy periods, you absolutely must fix your gut. There’s no way around it.7. You smoke.
It goes without saying that smoking is bad for you. Research shows that smoking even 1 cigarette per day is an important risk factor for painful periods. And the earlier you start smoking, the more likely you are to have painful periods. Quitting can be incredibly hard, but I’ve had more than one patient tell me that Allen Carr’s book worked like a charm for helping them quit for good!8. You have Celiac disease.
Celiac disease is an autoimmune disorder where eating gluten (a protein found in wheat, rye and barley) causes serious damage to the small intestine.
Many health care practitioners don’t realize that the symptoms of celiac disease can vary, so many people go undiagnosed. In fact, less than half of people with celiac disease have the classic symptoms of GI pain and diarrhea.
Skin rashes, neurological symptoms, fatigue, painful sex and menstrual pain can all be clues that you have celiac disease or gluten sensitivity. Remember, anything that causes inflammation in the gut will cause inflammation in the rest of your body!
9. You have growths.
Uterine fibroids are noncancerous tumors of the uterus. They are incredibly common, and a majority of women will develop at least 1 small fibroid at some point. Fibroids don’t usually cause pain, but they can when they obstruct blood flow or if they grow rapidly. If your periods are becoming heavy, that can be a symptom of fibroids. Adenomyosis is a condition where the inner lining of the uterus grows through the muscular uterine wall. This can cause heavy bleeding, cramps and bloating. Many women also have ovarian cysts, which are fluid-filled sacs that can cause painful cramps. Most of the time cysts clear on their own, but they can require treatment if they start to obstruct the fallopian tubes or they become very large. While these growths can be responsible for pain, keep in mind that they are symptoms of underlying inflammation and hormone imbalances. That’s why it’s so important to address things like gut health and nutrition.10. You have endometriosis.
It’s estimated that 1 in 10 women have a condition called endometriosis. In endometriosis, the tissue that lines the uterus (called the endometrium) becomes implanted outside of the uterus, around other locations in the body. This misplaced tissue behaves in the same way as it would inside the uterus and it grows and bleeds in response to estrogen. Eventually, adhesions form. Adhesions are bands of scar tissue that can “glue” organs and body structures together. They can cause strong, sharp or burning pain, and even gastrointestinal symptoms like heartburn and constipation if the scars are attached to the intestines. Endometrial tissue can even attach to the lungs in rare cases. The symptoms of endometriosis include:- SEVERE menstrual cramps (sometimes even painkillers won’t help)
- Abdominal or pelvic pain between periods – when you’re not even bleeding
- Pain with sex or vaginal penetration
- Urinary problems
- Long periods
- Heavy periods (which can lead to anemia)
- Bloating
- Constipation
- Pain with bowel movements
- Infertility
- Fatigue
How to Stop Period Pain Naturally
I admit that I am not a fan of using birth control pills or painkillers to treat painful periods. Why? Because birth control pills increase the risk of blood clots, they can cause permanent side effects (like loss of sex drive and vaginal dryness), and they do nothing to address the root causes of the pain in the first place. Period problems are a message from your body that something is out of balance. When we suppress those messages, we can create additional problems. Over-the-counter painkillers are effective for pain and can help to reduce heavy bleeding, but they can cause liver or kidney damage with long-term use. They can also damage the gut, which contributes to body-wide inflammation.Let me be clear: there is a time and a place for medication, and you have to do what is best for you. Right now, you might need big doses of painkillers just to get through your day. No judgment. I totally get that!
But my goal as a naturopathic doctor is for you to ultimately not need those medications because you’ve done such a great job getting your body back into balance.
Supplements
- Our favorite “all around” formula for healthy periods and balanced hormones is FemGlow. This is our exclusive product. Along with diet and lifestyle changes, the ingredients in this formula have produced amazing results for my patients. Whether you’re concerned about period pain, PMS, or even menopausal discomfort, FemGlow provides balanced support.
Lifestyle
- Find ways to manage stress.
- Sweating through exercise or sauna is a great way to support gentle detoxification.
- Eat an unprocessed, low-sugar, whole foods diet.
The naturopathic doctors (NDs) at Attune Functional Medicine proudly serve the Denver metro area including Broomfield, Boulder, Arvada, Louisville, Thornton, Lafayette, Westminster, and Erie. Telehealth is also available for long-distance care.
thank you i have this problem its been five months now.i m on medication.my problem is i went to gynaecologist,GP but i didnt find help the gynae said i hv a left swollen tube he gave me medication but still i m suffering.
A swollen fallopian tube could be many things. If a tube becomes blocked, it can become filled with fluid and look swollen upon imaging. This is called hydrosalpinx. Most often, hydrosalpinx is caused by a long-term infection or even endometrial deposits (adhesions). I hope you can find a doctor who can give you the right treatment. Don’t stop looking!
Thank you so much
Thank you so much for this!! I have been having issues since January 2012. My period has gotten heavier and heavier. I use a diva cup and now lose about a cup of blood per cycle. My bleeding lasts about 3-4 days and every month its a few days later than the month before. My blood loss contains clots that are the size of the palm of my hand causing me to be anemic. The pain in my left ovary makes me nauseous and on a scale of 1-10 it’s worse than child birth. About 6 months out of the year it effects my job and I can’t make it into work. I never had these problems growing up. I am now 42 and can only pray that menopause is around the corner! I have seen countless DRs and they either want me to take hormones (BCP/IUD) or have an ablation. I refuse. I don’t take meds at all. I do use crampbark but it doesn’t help much. The only thing that seems to offer any comfort is soaking in warm water. I eat about 75% clean and don’t use lotions or chemicals to clean my home. I feel so lost most days because the pain is so miserable.
I’m so sorry to hear this, DeAnna. Have you been evaluated for endometriosis? The intense pain and the large clots make me suspect that condition. It’s quite common among women in their 30s and 40s.
I have been in pain for more than a year now I had endometriosis, I did a labracacpy in March but the pain is still there it’s getting worse land worse every month I can’t Handel it anymore
Hi, Yasmeen-
I am so sorry to hear about your unbearable pain. Sometimes the endometrial adhesions need to be removed or broken apart before the pain will stop. In addition to the supportive therapies discussed in this article, many women find relief by working with a physical therapist who can perform the Wurn technique. This helps to manually break up the painful scarring: http://www.clearpassage.com/who-we-are/about-the-wurn-technique/
You might also find Dr. Egeland’s new video helpful: https://www.youtube.com/watch?v=cp7PqdR3Z2A&t=6s
Always remember that healing is possible, even when it doesn’t seem that way. I wish you all the best!
This is great info. I’ve had hormonal issues since I first got my period. At 15 My doctor diagnosed me with PCOS simple because of my hormone levels. I didn’t have the typical visual symptoms. I’m 37 now and I’ve gone through phases where the pain was bearable, meaning it would respond to a handful of Advil…eek. And other times, like now, where the pain is so out of control and overwhelming that it causes me to pass out, throw up and become a half conscious mess on the bathroom floor for HOURS. No amount of Advil helps at this point. It’s torture. I live a clean lifestyle, I’m 125 lbs, I teach several yoga classes a week. I eat organic also. I’m noticing pre-mature aging, gray hairs rapidly coming in, little black (hormonal) hairs sprouting on my chin and other places, body hair growth patterns changing (excess androgens??), vaginal dryness. I don’t understand !!!! Suggestions? I’ve been trying to figure this out for years and I just don’t know what to do?!?!
Hi, Kelly –
I’m really sorry to hear about the terrible pain you’re having! I’ve had a lot of patients describe their symptoms the same way you do.
It sounds like you’re doing the right things with diet and lifestyle, so there are likely some deeper issues going on. High stress (emotional stress or toxic exposures) can reduce your sex hormones, including the androgens like DHEA, estrogen and testosterone, because the body ‘steals’ pregnenolone to make cortisol. This can contribute to vaginal dryness. And to compensate for the low DHEA and testosterone, your body can convert the testosterone that you do have into 5-alpha DHT, which is the strongest (most androgenic) type of testosterone. So even though you may very well have low testosterone overall, you might be shunting much of it towards the 5-alpha DHT pathway, which can lead to excess hair. Also, at 37, you’re likely having more cycles where you don’t ovulate. The perimenopausal transition can start around this age, and less ovulation means less progesterone to balance the inflammatory effects of estrogen.
The early graying is also important clue, because that’s a sign of oxidative stress (free radical damage). When the body is stressed (again – emotionally or from chemicals, metals, or microbial toxins), it makes the stress neurotransmitters dopamine, epinephrine, norepinephrine, and serotonin. When these neurotransmitters eventually get broken down, they release toxic compounds including hydrogen peroxide (hence the hair lightening!). Since hydrogen peroxide is damaging to the body, you will use up a lot of your glutathione to neutralize it. The problem with this is that glutathione is your body’s main antioxidant defense, and if it gets depleted because you’re constantly having to break down the stress neurotransmitters, the free radicals in your body can get out of control and perpetuate the cycle of inflammation (pain and damage).
In my experience, when people are eating a clean diet and living a healthy lifestyle but are STILL struggling, there’s something else that needs to be removed. In naturopathic medicine, we call these “obstacles to cure.” I really encourage you to work with a practitioner who can asses you for toxic chemicals, metals, chronic infections, and other factors that could be disturbing your health.
I will also say that lately I’ve been seeing a strong correlation with food intolerance and painful periods. Some of my toughest cases have improved dramatically when they start avoiding foods to which they have immune reactions.
Best of luck, Kelly! I truly hope you find answers and relief. Thanks for reading and commenting!
Thank you so much for your thorough insight. This all makes sense to me. In fact just over this past weekend at a restorative yoga Workshop,I came to the conclusion that my nervous system has been chronically ‘jacked up’for years, and I didn’t even realize it! When that’s our chronic mode of opperating I guess we become accustomed to the level of emotional stress that we are actually experiencing…and numb to it. It wasn’t until I took my nervous system all the way into parasympathetic mode through restorative yoga over weekend, that I could see/feel the contrast! Wow! There is so much to be said about REAL self care. Thank you again. Your knowledge is a blessing ?
Thank you for your kind words, Kelly! I’m so glad that I’ve been able to help you. You are so right about REAL self care. I always tell myself and my patients that stress will sabotage all of our best wellness efforts. Keep taking good care of yourself! 🙂
Great post
Thank you so much for writing this article! It is brilliant, incorporates everything that i have instinctively felt and explains the science behind it as well as goes into detail on so many levels, covering so many issues in one place! It has made so much sense to me and will be extremely helpful in my future choices and decisions regarding my body! ❤️
Thank you for the kind words, Sirin! It makes me incredibly happy to know that you found my article helpful. Hugs and best of luck to you on your wellness journey!
My periods are very straight sometimes they go through my pad and the blood it self is so sticky and jelly
Yes, menstrual blood will be somewhat sticky because it contains tissue from the uterine lining. The thing to look out for is if you’re having a lot of large or very dark clots (anything larger than a dime concerns me). Clots can be a sign of endometriosis or inflammation in general. And if you’re bleeding a lot, it could be a sign of endometriosis, too much estrogen, or even a blood clotting disorder. Thanks for reading and commenting!
My period some times cause much pain and looks like jelly
Hii i have hypothyroidism as a kid of eleven and now as a teen and i really have the worse period cramps ever its like death experience And even if i eat healthy it doesn’t work.. may B can u sugest what kind of food i should have and how I can avoid the worst period cramps . And also not just stomach cramps i also have back nd leg pains and i cant eat food i feel to vomit it .. I would be grateful if u reply
Hi, Sophy –
Whenever diet changes alone don’t improve symptoms, it’s really important to look for other causes of inflammation. For example, the toxic chemicals found in cosmetics and personal care products can lead to hormone imbalance and inflammation. There is also a huge connection with gut health, hidden infections and menstrual health. We’ve learned that severe cramps accompanied by back pain, leg pain, and vomiting (as you describe) can be signs of endometriosis, so you should definitely consult with your physician about that. Endometriosis is an inflammatory condition, so it’s still important to pay attention to nutrition, toxins, infections, stress, etc.
Unfortunately, most conventional health care providers will recommend birth control pills and other risky interventions that can lead to more problems. You may want to check out our Body Bliss program to get the exact strategies we use with our 1-on-1 patients to help them achieve pain-free periods.
Thanks for stopping by! 🙂
I am 18 and experience severe period pains . Once the pains begin I am not able to do anything even do my school work . There was this time when I took 6 psin killers and amoxyllin just for me to sleep and I could still feel the pain . I usually vomit and have diarrhoea when on my period and this happens for 2 days 😓
I’m so sorry to hear that! Please talk to your doctor about getting tested for endometriosis and other conditions that could be causing this severe pain.
I have had really painful periods for the past two years. I am almost 17 now and stater my period when I was 12. I think I have almost always had cramps, but in the past couple of years they’ve got to the point that I haven’t been able to get to school or work. I have been to my GP, and he prescribed Ponstan ( Mefenamic acid) which helps and mostly stops the cramps, but only if I start it early enough. My parents are health conscious so I eat healthy and live in rural Australia so we are reasonably active. Could it possibly be caused by another health condition? Or is it most likely something I’ll ‘grow out of?’
Hi, Kira –
I’m so sorry that your cramps are having such a debilitating impact on your life, and at such a young age. Please know that menstrual health is always connected to the overall health of your body. In my experience, there is a strong correlation with gut health and period pain, and sometimes there are nutritional and/or genetic factors involved. Endometriosis is an inflammatory condition that can cause extreme menstrual pain. I would not wait to see if it’s something you’ll “grow out of,” because inflammation tends to build on itself over time if it’s not brought under control. Since you are in Australia, you may be able to find a licensed naturopathic doctor (ND) to help you sort this out.
I also encourage you to check out the excellent work of Dr. Lara Briden, a naturopathic doctor and women’s health expert from Australia. Your body CAN heal, and I wish you the best of luck! ❤️