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)
- Pain with bowel movements
How to Stop Period Pain NaturallyI 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.
- 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.
- 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.