If you’re struggling with menstrual cramps, achy awful period pain, or even mild but annoying monthly pain that’s making you pop ibuprofen here and there, I’ve got some great news for you. The first is that there’s nothing uniquely wrong with you. About 50% of all women are struggling right along with you and there are reasons for this. That brings me to the second bit of good news: I know what those reasons are, and can give you the tools you need so period pain does not have to your permanent status quo. In fact, it can, often in as few as three months, become a thing of the past.
Say What? Dysmenorrhea?
First, let’s get clear on the pain we’re talking about. We’re talking about period pain that starts right around when your period starts, feels achy or crampy and lasts for as long as three days. This is called primary dysmenorrhea. While it may also be accompanied by its nasty friends – nausea, vomiting, and diarrhea, backache, headache, and dizziness – this kind of period pain is, you might say, run of the mill. That’s a good thing because it means that it’s not likely being caused by any underlying medical issues, for example, endometriosis. You can use much of the information I discuss here for the pain of endometriosis as well, and the dietary and environmental information is totally relevant, but you’ll also want to see my blog on endometriosis. Also, if pain is happening at other times of the month, or all month long, it’s important to get a proper medical evaluation.
What Causes Menstrual Cramps and Period Pain?
Menstrual pain is almost always due to the overproduction of inflammatory chemicals called prostaglandins which cause your uterus to get all up in a bunch with spasms, cramping, and pain that make you want to curl up with a bottle of Motrin, a heating pad and the TV remote until it the pain ends.
The problem is that while Motrin, ibuprofen and other NSAIDS may work like a charm to relieve period pain, and are also effective at reducing a heavy menstrual bleeding,- they can also be doing serious harm. Even short-term use of NSAIDs for just 5 to 14 days has been proven to cause fertility problems, gastric bleeding, and get this – heart attack in women!
“The pill” (birth control pills), also commonly prescribed for period pain, not only has equally if not riskier side-effects, it’s also less effective for period pain than plain old NSAIDs for pain – in fact, studies show it just doesn’t work that well for this at all.
While I’m not going to be the one to snatch your bottle of Motrin away from you (or your teenage daughter if you’re reading this for her!), and taking a dose or two of ibuprofen on occasion (i.e., emergency rescue use for severe pain or pain that’s going to keep you from taking your board exams, showing up for your wedding, or something like that!) is safe for most women; as a habit, even for a few days a month, it’s not necessarily safe and it’s certainly not healthy. Bottom line: none of the pharmaceutical solutions are anything more than potentially risky band-aids. They don’t get to the root causes of the inflammation that is wreaking havoc on your periods, and that can also be impacting other areas of your health without you even knowing it.
Where’s the Inflammation Coming From?
Sadly, we’re pretty much all living in a sea of inflammatory triggers. Over time, chronic inflammation affects our blood sugar, immunity, thyroid, and our hormones, to name a few of the hits we take. One of the biggest forms of inflammatory triggers, and also direct insults to our hormonal balance, are Endocrine Disrupting Chemicals (EDCs), environmental toxins that enter our bloodstream and mimic our own estrogen – but like our estrogen ‘on steroids’. When it comes to menstrual cramps, what’s happening is that these cause higher levels of circulating estrogen which make the lining of your uterus get thicker between periods than it’s supposed to and it’s this lining that gets shed when you have your period. A thicker lining means a lot more cramping and pain for your uterus to expel it, and in many women, can lead to much heavier periods than they’d have otherwise.
EDCs also cause all kinds of other serious problems: they damage our DNA, trigger obesity and diabetes in many people, and wreak havoc on our immunity leading to autoimmune conditions. They are also a major cause of thyroid problems and have a role to play in dementia. There are literally tens of thousands of EDCs in our environment, and literally thousands of medical and scientific journal articles demonstrating exactly how they are causing not only inflammation, but are a major cause of much of the hormonal suffering women are experiencing from menstrual problems to endometriosis, uterine fibroids, and fertility challenges, to breast and other forms of cancer. It’s also causing early puberty in too many of our daughters.
Here’s a partial list of the sources of EDCs in our lives:
- Residues from herbicides, pesticides, antibiotics, and other pharmaceuticals that end up in our food act as direct toxins, increase our estrogen, and also cause other hormonal problems including diabetes, obesity, and hypothyroidism.
- Plastics in the form of phthalates and other toxins that leach from food packaging and plastic food storage containers into our foods
- Household furnishings and other sources of flame retardant chemicals
- Household cleaners, paints, stains, and other commonly used chemicals
- Cosmetics and body products including lotions, sun screen, shampoo, conditioner, and much more.
Additionally, the diets so many of us are living on in our busy lives contribute to both inflammation and EDC body burden (how much of it we’re carrying around) in a big way. Processed foods, added sugars, poor quality oils, artificial ingredients, artificial sweeteners, and more, all cause inflammation. But so can skipping meals, and not getting enough of the nutrients your body desperately needs to support the detoxification and elimination of these exposures, many of which we’ll inevitably get from our environment despite our best efforts.
Period pain does not have to your status quo. Read this article to put it in your rearview mirror
Whoa, this is Serious! What Can I Do About These Triggers?
Let’s start with what we eat.
A recent large study done by the CDC found that in every state in the US, less than 16% of people are getting the amount of fruits and vegetables they need for basic health, and less than 14% the amount of fruit. Keep in mind the CDC standards are based on bare-bones minimums for preventing disease – which are set at about half the amount needed for optimal health. Fruits and vegetables contain key phytonutrients we need to protect our bodies from environmental toxins – and you guessed it – prevent and reduce inflammation. You’ve got to increase your intake of a wide variety of veggies, especially dark leafy greens, onions and garlic, yellow and orange veggies like sweet potatoes and winter squashes – all of which actively support natural detoxification, reduce inflammation, and help clear excess estrogen from our systems.
Organic foods are easier to find and more affordable than ever. If you’re on a tight food budget, you don’t have to do everything organic to get rid of most of the toxins. Because animal fat holds the largest amounts of these fat loving environmental toxins, make sure all meats are hormone and antibiotic free, and ideally when possible, free range and grass fed, and all dairy should always be organic. For produce, check out the Environmental Working Group’s Dirty Dozen and Clean 15 as an easy guideline. And for everything else, go organic as much as possible. Also, remember that food packaging and storage containers are a source of plastics that act as EDCs so buy as little as possible that’s wrapped or stored in plastic, use only glass (Life Factory, for example) or stainless steel (i.e., Kleen Kanteen) for your water bottles, and glass storage containers for foods – easily found at Target, Walmart and on Amazon very affordably.
A Mediterranean style way of eating has been shown to be the most effective of all types of diets for preventing and reversing excess inflammation and it naturally contains the healthy types of plant nutrients we need to block excess environmental estrogen from EDCs. This way of eating includes LOTs of veggies, olive oil, nuts, legumes, and just small amounts of meat, fish and poultry in the daily diet. Olive oil and nuts, especially walnuts and pecans, are also ant-inflammatory. Legumes, veggies, fruits, and whole grains all provide the important fiber we need to keep daily elimination healthy, act as ‘food’ for your microbiome (called prebiotics). [If you’re wondering about lectins, the science just isn’t there for most people to take them out of the diet, and there’s abundant science supporting the health of legumes, etc. in the diet]. Our Paleo ancestors got about 100 gm/day of fiber from plants in their diet; most Americans are getting about 15 grams per day! Not only does this affect our gut flora and hormones, it’s a huge colon cancer risk.
Primarily Plant-Based is Great for Period Pain
Going mostly plant-based can also help you to get period pain free in just 2 to 3 months. In one study, going vegetarian for just 2 months significantly improved period pain, and led to a little bit of weight loss, too. Keep in mind that there are healthful versions of vegetarian diets that rely on plenty of legumes, veggies, nuts, seeds, and give you a healthy dose of good quality oils, and ones that rely on mostly quick carbs, which isn’t healthful or anti-inflammatory. But you don’t have to go vegan or vegetarian to be mostly plant-based. Just make sure that at each meal your plate is basically half covered in vegetables and that you’re getting about 8 servings of veggies and fruits daily. For fruits I recommend sticking to those that are highest in nutrient value and lowest in sugar – all of the berries (fresh or frozen is fine) fit the bill. Eight servings of veggies and fruits each day will also give you the fiber we need each day to keep our bowels moving, gut flora healthy, and estrogen detoxifying, healthy fats from nuts – especially walnuts and pecans which are rich in ellagic acid, and almonds, healthful fruits especially berries, olive oil, and even some dark chocolate! While dairy can be a healthy compliment to the diet for many women, during the 3 months that you're working on clearing out inflammation, put a pause on the dairy because for some women, it is an inflammatory trigger, and even good quality organic dairy does deliver some extra hormones.
Boot Out Sugar and Processed Foods
I know you've heard it before so I don't want to sound like a finger wagging meanie – but here's the reality: sugar, processed white flour products, and bad quality oils stoke up the fires of inflammation throughout your body and is a major cause of inflammation and with it period pain. So rip off the band-aid all at once and just empty out your pantries and fridge, get rid of hidden stashes, and pass on the sugar and junk when it gets offered to you. The reward? You're going to have more energy. You'll have clearer skin and better moods. You'll think more clearly and feel more steady all day long. You'll sleep better. You might find you lose a few unwanted pounds. Or ten or more if you're needing to. And you're going to get rid of those awful cramps. I promise, it's easier than it sounds and you'll feel better than you even realize.
Add Fish or Supplement with Omega 3’s
Adding oil-rich salmon to your diet, about 4-6 ounces, 2-3 times per week, or taking a daily supplement with Omega 3 fats (about 1000 mg EPA and 700 mg DHA) can be really helpful, too, because Omega 3’s are anti-inflammatory. Several research studies have found that fish oil at this dose leads to reduction in menstrual pain and also the need for ibuprofen within just 3 months. You have to make sure to eat only low mercury fish to avoid getting too much mercury and adding to your body burden! To find out which fish are low mercury, head over to Seafood Watch.
One common question I get is what about coffee. There are very few studies looking the impact of coffee on menstrual pain symptoms, but one study found a very significant correlation. I can tell you from my clinical practice that I see a very strong association, and interestingly, the only time in my life that I personally experienced menstrual cramps was in medical residency – when I was drinking coffee to keep up with all-nighters. And while I might contribute the pain to the stress of residency and lack of sleep, the cramps immediately went away in the following month after I gave up the liquid fuel!
Get More Magnesium
Several studies have found that supplementing magnesium, a nutrient that most women in the US are low in, can reduce menstrual cramps and aching. It’s my first go-to in my practice and can improve a number of symptoms including depression and sleep. I recommend increasing up to about 600 mg/day starting about 5 days before your period is due, and continuing throughout the month at about 300 mg/day. I recommend magnesium glycinate for this.
Optimize Your Vitamin D Level
A 2012 clinical trial found that when a high dose of vitamin D (300,000 IU) was given to women aged 18-40 with vitamin D levels below 45 ng/mL for at least 4 consecutive months, after just two months or two menstrual periods their pain scores decreased by 41% – while there were no improvements in a placebo group, While I don’t recommend ever taking this high a dose of vitamin D, another study found that boosting vitamin D levels to a healthy range also improved menstrual pain. Given that a large percentage of women are chronically low in vitamin D, and that normal levels improve menstrual pain, taking vitamin D to achieve a blood level of 50-70, the optimal range, is a good step toward eliminating menstrual pain. For most women, 2000 to 4000 IUs taken daily will achieve or maintain this level. Your primary care provider can check your levels and help you supplement to the optimal range.
Thiamine for Severe Menstrual Pain
Yet other studies have found that 100 mg of thiamine (Vitamin B1), taken daily, can significantly improve even severe menstrual pain. I recommend taking B1 for 3 months at this dose to see if there is improvement, and if there is and you wish to continue, take a complete Vitamin B Complex, with enough thiamine to achieve this dose, so that you don’t imbalance your other B vitamins by taking just one form.
Vitamin E May Help, Too
Vitamin E, 400 IU/day, starting a few days before your period and continuing throughout your period may also improve menstrual cramping after a couple of months.
Happy Gut, Less Period Pain
One of the ways we can suppor natural daily detoxification and reduce toxic body burden, including getting rid of the excess estrogen that might be impacting our health, is by keeping our gut happy and healthy. As I mentioned above, eight servings of fruits and veggies each day, as part of a healthy Mediterranean-style diet, can give us the fiber we need for a healthy, happy gut and thus reduced inflammation and easier periods. Adding in a daily dose of lacto-fermented veggies (for example, sauerkraut, kimchi, or naturally pickled vegetables), a small amount of unsweetened, live active culture yogurt or kefir (raw milk is ideal as long as you’re not pregnant) in the diet if you tolerate dairy (about half of people tolerate dairy very well and it may be a healthful source of lactobacillus for the gut), or a probiotic can you to keep your estrogen levels healthy.
Tame Stress and Sleep Better
Not getting enough good quality sleep can increase the amount of period pain you experience while and reducing your ability to cope with it. One study found that having insomnia caused women to report higher levels of more severe dysmenorrhea and greater interference with daily activities due to period pain than women without insomnia. Poor sleep also leads directly to inflammation due to disruption in circadian rhythm and our cortisol cycles. Circadian rhythm disruption has been found to be associated with disturbances in menstrual function.
Stress can similarly have a negative impact on our hormone balance and cortisol levels. Bringing in daily practices that reduce stress – yoga, meditation, dancing, a hot bath or shower, time in nature, reading a book curled up in a chair with your fave mug of tea – and having an evening wind down practice to ease you into sleep – can help support your body and mind and reduce inflammation.
To get your sleep groove back on, read this article here, to reset your circadian rhythm here, and stay tuned for my book The Hidden Hormone Epidemic for a deep dive into all things women and hormonal health (January 2019, Harper One).
Get Rid of Dirty Looks and Clean Greener
Going clean and green with your cosmetics does take a little more work and may even be a little more pricey upfront, but I promise you when it comes to not just period pain now, but your long-term health, it’s a pay now or pay later situation – and paying later means paying with your health. Two of my online buddies do a lot of blogging about healthier cosmetic choices: Crazy, Sexy Cancer author Kris Carr is living vibrantly with cancer, is very committed to what she puts on her body, and reviews clean make-up – and Alexandra Jamieson, the co-producer of the ground-breaking movie Super-Size Me and author of Women, Food, and Desire has a section of her website dedicated to healthier beauty.
Clean and green housekeeping is super easy – there’s not much that white vinegar, baking soda, and lemon can’t handle – but several companies, for example, Seventh Generation and Ecover make affordable products for everything from your dishes to your floors to your laundry. The Environmental Working Group is my recommended go-to site to check up on my products in their registries, reviews, and guides.
My Favorite Herbal Medicines for Period Pain
I’ve been turning to herbal medicines as a midwife, herbalist, and MD for over three decades now, and one area that we have especially good insights into benefits is menstrual pain and pain with heavy menstrual bleeding.
My core recommendation is to start with magnesium, vitamin D, and Omega 3s (fish oil), plus possibly the thiamine if you have heavy pain as described above, plus ginger as described below. If after two cycles you don’t see substantial change, you can add in or swap in additional botanicals. You can also use any combination of the nutrients above with the herbs below if you're feeling more adventurous and ambitious. But the core plan often works beautifully, too.
Ginger and Cinnamon
The two herbal remedies that rise to the top are ginger root and cinnamon bark. Ginger is widely respected for its anti-inflammatory and pain-relieving effects, with several studies showing impressive results for menstrual cramps and pain. Probably the most reliable and easiest way to take it is powdered in capsules. The effective dose is 500 mg three times/day, though up to 3,000 mg/day is considered safe, so you can take 1000 mg 3 times/day or 500 mg 6x/day. It can also help with nausea, vomiting, bloating, and headaches that sometimes come along with crampy painful periods.
Cinnamon has been found to be similarly effective for reducing pain, menstrual bleeding, nausea, and vomiting with primary dysmenorrhea. The dose in the most impressive study was 420 mg of cinnamon bark in capsules with 2 capsules taken three times/day for the first 3 days of the period. Both cinnamon and ginger have also been found to lessen heavy menstrual bleeding. I haven’t used cinnamon much in my practice because the data is newer and I’ve been very impressed with the ginger.
Cramp Bark, Black Haw, and Motherwort
Herbalists have a wide pharmacy of herbs that we use for relieving menstrual cramps – the most common perhaps being an herb actually called cramp bark! Both cramp bark – and its cousin, black haw – have been used for centuries for the relief of women’s monthly pain. While this is not preventative the way changing your diet is, for example, they are a great alternative to the medications we too quickly turn to because we didn’t know there are safer options. I use either of these alone, or often in combination with both cramp bark and black haw plus motherwort, equal parts in tincture form. The dose of any of these alone, or the combination, is about 30-40 drops every few hours, or up to 1 (measured) tsp (=5 mL) three times/day. Motherwort is also wonderful for emotional irritability during your period while helping ease the discomfort or cramps.
Not What You'd Expect! Valerian and Black Cohosh
Another surprising herb for menstrual cramping is valerian. While we usually think of valerian for sleep, one study of 100 women found that 255 mg/day for the first three days of the period dramatically reduced menstrual cramps compared to placebo, and it too is a very safe herb. At this dose it isn’t likely to make you sleepy, but do take care by first trying it on a day off from work (and driving). If it does make you sleepy, consider using it in the evening and again before bed to help with cramps.
We typically hear about black cohosh for menopause, but it’s another classic herb not just for menstrual cramping and pain, but low back ache and that pulling sensation in the backs of the thighs that sometimes accompanies period pain, and it may boost your mood a little, too, without being stimulating, because it increases dopamine. It can be combined with any of the other herbs I’ve discussed here, and the typical dose is 250 mg 4 times/day, or as tincture, about ½ tsp (2.5 mL) 2-3 times/day.
More Aromatic Herbs to the Rescue
A recent study found fenugreek seed to benefit symptoms of dysmenorrhea. The participants included 101 women of similar age, who received either 900 mg of ground fenugreek seed in capsules 3 times daily or placebo control for the first 3 days of menses for two consecutive cycles. Both placebo and fenugreek treatment groups exhibited lower pain levels compared to baseline after two months, but the decrease observed with fenugreek was far more statistically significant.
Dong quai, a Chinese herb classically used in women’s health, may also be helpful in reducing menstrual cramps due to the antispasmodic effects of several chemical constituents in the plant. The tricky part is that it can increase menstrual bleeding if taken during or right before your period, so it’s probably not for you if you have heavy bleeding unless you use it under that guidance of a skilled herbalist who knows how to combine it with other herbs to prevent this.
Practical Tips for Making Dysmenorrhea Disappear!
Some favorite additional tips include:
- Many women find that making the switch from tampons to pads brings huge relief from menstrual cramps. It's a quick fix so give it a try!
- Practice women’s restorative yoga during your period and practicing yoga to relieve period pain by improving pelvic circulation between periods.
- Use aromatherapy oils including lavender, clary sage, rose, which have been shown to improve period pain in studies in college students, to scent up your room, a hot shower, or warm bath.
- Arvigo pelvic massage with a certified practitioner may be helpful. Though no studies have been done, I often recommend this technique in my medical practice.
The Mind-Body-Pain Connection
Finally, some thoughts about our periods, our beliefs, and listening to our bodies. Anthropological research has shown that our attitudes and beliefs about menstruation, birth, and menopause are culturally shaped and influence how we experience these aspects of being women. In our culture, the messages we get about having a period, pregnancy and birth, and aging are less than positive -and women in our culture experience a lot more problems in all of these areas of our health than women in places with more body-positive attitudes. While there are very real nutritional, inflammatory and environmental triggers that can lead us to develop a true hate-hate relationship with an experience that leaves us curled in a ball at worst once a month, or struggling to get through while popping ibuprofen, depending on the severity of your period discomfort, making friends with your period can be a game-changer in how you experience your flow. There's a powerful and enormous connection between what's going on in our lives and in our body when it comes to pain.
Also, for some women, the first few days of their period are the only time they feel they can hit the pause button. I had one patient, a mother of three young kids, whose period pain was her doorway to time to herself! Here’s an important question we can ask ourselves, as I asked her, “Is there another way I can get my needs met without having a symptom that gives me permission to pause?” This is not meant to say we create period pain on purpose – of course not – but the mind-body connection is powerful, and sometimes our bodies scream out with symptoms when we’re not listening any other way. That’s certainly the case with dietary and environmental triggers of inflammation and estrogen overload – we get period pain. Perhaps sometimes it’s the same with stress overload! Symptoms are always a message that some aspect of your health needs attention. Perhaps period pain is, too. Listen to your body speak; there is likely a message that is waiting to be heard.
Summary: What You Can Do to Kiss Period Cramps Goodbye
- Eat a low-inflammatory Mediterranean style diet with 8 servings of a rainbow of veggies and fruits daily and get plenty of good quality fiber and fermented veggies to support healthy daily elimination.
- Kick out the toxins out of your foods, home, and body care products wherever you can, and remember, stress and poor sleep can act as toxins to your body, too.
- Supplement your nutrients to optimal levels with Magnesium, Vitamin D, and Omega 3s fatty acids.
- Try herbs instead of medications for pain relief with top go to’s – ginger, cramp bark, and motherwort.
- Listen to and love your body, and learn to hit the pause button on purpose, rather than only when symptoms force you to.