Period Pain - What's 'Normal'?
Let's talk for a minute about period pain - what is 'normal' and what might not be. I find many patients have some confusion around this topic when they come to my office, and rightfully so. Every woman is a bit different when it comes to symptoms around their time of the month.
Cramps around your period happen because of inflammation. An inflammatory compound called prostaglandins are released by the body to cause uterine contractions. The strong uterine contractions brought on by the high levels of prostaglandins are what can cause the cramping. As a side note, many patients I see also notice frequent bowel movements or bloating around the time of their period. This is because the bowels are very close to the uterus in our abdomen and the inflammatory prostaglandins can spread over and affect our intestines causing contraction.
So what is ‘normal’ when it comes to period pain? Period pains that are considered normal or ‘primary’ are caused by high levels of prostaglandins during the first few days of bleeding. This type of cramping can also cause pain radiate to your back or your thighs, and you might have headaches or nausea. Symptoms could vary from cycle to cycle, and they can normally last up to 3 days. Studies show that this type of cramping may be improved by regular exercise, and I have seen good results with dietary changes, stress management and acupuncture. This type of ‘primary’ cramping should also improve after taking over the counter pain medications, and not significantly affect day to day activities.
Secondary cramping means cramping can be caused by another underlying issue. The most common cause of severe period pain is a condition called endometriosis, affecting 10-15% of women who are childbearing age. There are cells in the uterus that line the uterine wall and create our uterine lining, which is what sheds every month to cause a period when we are not pregnant. In endometriosis, these cells can migrate outside of the uterus and implant in the fallopian tube or even closer to the ovaries. This causes a problem becuase these cells will still try and grow uterine tissue, no matter where they are or how confined the space they are in is. So if the cells land in your fallopian tube, this can cause intense pain when they respond to prostaglandins triggering a period and try to shed their lining.
Cramping caused by endometriosis is usually associated with extremely heavy bleeding and clotting, and pain can escalate to an unbearable level rather quickly. Women can also experience discomfort mid-cycle during ovulation, or have pain in their lower back or abdomen through most of the second half of their cycle. Other symptoms can include pain and cramping when urinating or having a bowel movement during their period, pain and cramping during intercourse if they are sexually active, and patients may need to miss work or day to day duties for several days at a time during the period to manage pain. Women may also get irregular bleeding or spotting between their periods. Endometriosis can also cause infertility if there is scarring to fallopian tubes or reproductive structures due to severe inflammation. This may prevent an egg from coming into contact with sperm for fertilization.
As a Naturopathic doctor I work with patients to help support the body's detox pathways to get rid of excess estrogen in he body that may be stimulating the endometriosis. Botanical medicine can also be used to help balance hormones and decrease inflammation in the body. Acupuncture can also be used close to an anticipated period to help decrease symptoms and severity. The earlier patients are diagnosed with endometriosis, the better it can be controlled in the long-term with the use of natural therapies or even medications.
Book an initial visit online today to chat about any concerns you have with your period and talk about how we may be able to improve things naturally!
Dr. Sarah Penney, ND, MSc