Prostaglandins (hormones) are released during various points in our menstrual cycles, and during labour. It assists with the shedding of the uterine lining during periods, aids ovulation and helps with contractions in labour. Things like our diet, or stress can lead to an overproduction of prostaglandins. This over production can cause pain, either mid cycle or during periods.

What is ‘normal period’ pain?

‍Normal period pain should only be present on one or two days of your period, the pain should go away with pain medication, and you should be able to continue with your daily life activities. Anything that impacts your life more than this is not normal, and should be investigated with your doctor, or gynaecologist. There are a range of issues that could be causing this, such as PMDD, PCOS, Endometriosis and many more.

‍Management of period pain

‍There are multiple management options for combatting period pain. Some of these options include

• Apply heat on the belly or lower back, or use of a TENS machine
• Gentle movement and stretching
• Diet changes or supplements*
• Pain relief*, such as ibuprofen, naproxen or diclofenac
• The Pill*
• Intrauterine Device (IUD) such as Implanon or Mirena*

*These should be done under guidance and direction of a health professional.

Make sure you take pain medications at the onset of pain, because you do not need to "just get on with it". 

It can be useful to eat to prevent period pain through the month, so when your period does show up, you feel ready to combat anything that comes your way. There are a few nutrients that have research to show they are game changers in fighting period pain.

Nutrition for Period Pain

Vitamin B6

Pyridoxine, known as a co-enzyme for synthesis of dopamine and serotonin might help in improving mood symptoms associated with PMS. It has been shown to improve symptoms of bloating, anxiety, cramps, moodiness and forgetfulness. Vitamin B6 can be found in pork, poultry, fruit and fortified cereals.

Magnesium

‍The research for magnesium in improving mood and sleep quality is well documented. It is no surprise that this is a key nutrient involved in management of period pain and endometriosis.

Magnesium is involved in the contraction and relaxation of smooth muscle (the type found in the uterus). Magnesium may reduce the production of prostaglandins (Walker, 1977). Interestingly, magnesium levels in those with painful periods was shown to be lower (Abass, 2012). The use of magnesium supplementally or via diet can reduce period pain and the number of prostaglandins present in the blood (Proctor & Farquhar, 2006). Magnesium is found in wholegrains, leafy vegetables (green), legumes and nuts and seeds.

Vitamin E

‍Research has shown than vitamin E caused a significant improvement in period pain and menstrual flow. Vitamin E is involved in stopping the release of prostaglandins, which plays a role in reducing the severity of period pain (Sadeghi et al 2018). Vitamin E is found in nuts, seeds, avocado, extra virgin olive oil and olives.

Omega-3 fatty acids

Research has shown that supplementation of omega-3 fatty acids can reduce cramping prior to periods (Behboudi-Gandevani S, 2018). Another study showed that supplementation with fish oil tablets, was more effective at treating severe period pain, than ibuprofen (Nurofen) (Zafari M, 2011). It was also found that bloating, headaches, and breast tenderness were also reduced with omega-3 intake/supplementation. Again, this effect was seen most significantly in those who had a consistent, and prolonged duration of omega-3 intake. Vitamin E is found in avocado, nuts and seeds, fish, extra virgin olive oil and olives.

How about nutrients that worsen period pain?

Avoid alcohol where possible

‍Alcohol is a depressant. This means it slows down our responses and reflexes, however it can also cause psychological differences such as feelings of anxiety, sadness or depression. Alcohol is also a gut irritant and contributes to inflammation in the body (which could exacerbate period pain). It can also disrupt sleep, and sleep is important for balancing our hormones, and improved mental health.

Reduce excess caffeine

‍Caffeine can cause feelings of anxiety, disrupt sleep, changes in bowel function and may contribute to breast tenderness. Of course, if you find caffeine doesn’t affect you, then keep reaching for your coffee! Ideally you should keep your coffee intake to a maximum of three daily.

Reduce intake of refined sugars

‍It is important to continue to consume carbohydrates during your luteal phase, to account for the drop in blood sugars that occurs. Ideally, these carbohydrates would come from wholegrains, fruits, vegetables, and dairy. Blood sugar regulation is important for all hormones in the body. When we consume refined sugars, or simple sugars this causes our blood sugar to spike and then dip. This can leave us feeling fatigued and with reduced concentration. Anecdotal evidence has shown that PMS symptoms such as period pain, are worsened with increased sugar consumption.

‍When should I reach out for more help?

‍Heavy, prolonged, and painful periods are NOT normal. If your periods are stopping you from participating in school, work, or social activities, or if pain medication does not work you should reach out to your GP for further investigations.

*Any information presented should not replace seeking individualised medical or health advice from a qualified health professional*‍

References

• Abass MQ. Evaluation of Serum Magnesium, Hemoglobin and body mass index in Dismenoreric Women in Tikrit City /Iraq. Tikrit J Pure Sci. 2012;17(4):59-62
• Behboudi-Gandevani S, Hariri FZ, Moghaddam-Banaem L. The effect of omega-3 fatty acid supplementation on premenstrual syndrome and health-related quality of life: a randomized clinical trial. J Psychosom Obstet Gynaecol. 2018 Dec;39(4):266-272. doi: 10.1080/0167482X.2017.1348496. Epub 2017 Jul 14. PMID: 28707491. https://pubmed.ncbi.nlm.nih.gov/28707491/
• Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332(7550):1134-1138. doi:10.1136/ bmj.332.7550.1134 
• Sadeghi N, Paknezhad F, Rashidi Nooshabadi M, Kavianpour M, Jafari Rad S, Khadem Haghighian H. Vitamin E and fish oil, separately or in combination, on treatment of primary dysmenorrhea: a double-blind, randomized clinical trial. Gynecol Endocrinol. 2018;34:804–808.
• Walker SM. In vitro synthesis of prostaglandin F2a by human endometrium. Abstracts of the Twenty- first British Congress of Obstetrics and Gynecology (1977) P: 37. Sheffield. Website available at: http://iasj.net/iasj?func=fulltext&aId=7202
• ‍Zafari M, Behmanesh F, Agha Mohammadi A. Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian J Intern Med. 2011 Summer;2(3):279-82. PMID: 24049587; PMCID: PMC3770499. https://pubmed.ncbi.nlm.nih.gov/24049587/ 

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