Period cramps

An introduction to period cramps

Stomach cramps (dysmenorrhoea) are one of the most common symptoms of menstrual periods and up to 80% of women are thought to be affected each month.

Cramp often starts a couple of days before your period is due and can continue throughout the first few days of menstruation, finally beginning to ease off towards the end. Menstrual cramps typically cause lower abdominal pain but in some cases this can radiate through into your back, or down your thighs.

Primary dysmenorrhoea is the most common type of period pain and occurs when the structure and function of the womb is perfectly normal. Secondary dysmenorrhoea describes the pain that occurs as a result of a disorder of the womb – it is often worse at the time of a woman’s period but in many cases can become apparent at any time of a woman’s monthly cycle. Common conditions giving rise to secondary dysmenorrhoea include fibroids, endometriosis, or pelvic inflammatory disease (PID).

The risk of having a painful period is thought to be dependent on a number of factors. Typically pain can become worse as we age; this is for a number of reasons but changing hormones are thought to have a part to play, for example in the lead up to the menopause. Other potential risk factors for period cramps include starting your periods early (age 11 or younger), having particularly heavy or irregular periods, if painful periods run in your family, or if you have some condition affecting the womb. Lifestyle factors are also important as we will go on to discuss below.

Some woman experience pain alone or it can be in combination with other symptoms including nausea, dizziness, headaches or altered bowel habits. Period cramps can also be a part of pre-menstrual syndrome (PMS). Generally, PMS involves a range of more severe symptoms which really inflict on your day to day life.

Here, I describe some of the causes of period cramps and how a range of home, herbal and conventional remedies can potentially offer you some relief.

How can your period cause cramp?

A number of factors are thought to contribute to periods cramps:

• Contractions and limited blood flow – Painful periods are primarily a result of your womb contracting which gives rise to the uncomfortable feeling we call ‘cramp’ (much like what can be felt at the start of labour but hopefully much milder!). Your womb contracts in order to expel the spongy lining which gives you your period. As the womb contracts, blood flow can become limited to nearby blood vessels. This can result in limited oxygen saturation in the surrounding area which adds to the pain

• Hormones – Female sex hormones, (oestrogen and progesterone) dropping below a certain level, are responsible for initiating your period in the first place. However, levels of these hormones throughout the course of your monthly cycle can also influence how heavy or painful your period is. Oestrogen initiates the proliferation of the lining of your womb in the first part of your cycle and an imbalance can result in it becoming overly thick – this can result in a heavier and more painful period as this lining is shed

• Prostaglandins – Prostaglandins are hormone-like chemicals which have a role in initiating the contractions of the womb. These are generally classed as pro-inflammatory chemicals and in excess they can give rise to more forceful contractions and can even diffuse out into surrounding areas. This can contribute to uncomfortable cramps

• Leukotrienes – Other inflammatory mediators such as leukotrienes are thought to be raised at certain times of the month and may also be contributing to the pain you feel during your period

• Lifestyle – Although lifestyle factors aren’t thought to be the sole cause of period cramps, they could be making your symptoms worse. Smoking, for example, is thought to have an impact on inflammatory markers which can contribute to the pain you feel each month. Stress can also have an influence. In states of stress (including anxiety and depression) it is thought people experience a heightened sensitivity to pain

• Medical conditions – Medical conditions affecting the womb, for example, fibroids or endometriosis can result in secondary dysmenorrhoea which can give rise to very painful periods.

Home remedies

There are some simple home remedies which can help to take the edge off of the pain associated with menstrual cramps:

• Chamomile tea – Chamomile is a well known nervous system relaxant and research has suggested that it might also be useful for reducing period cramps. Take 2-3 cups of chamomile tea per day to help with the pain

• Heat – Applying heat gently helps to increase blood flow. Press a hot water bottle into your pelvic region to help ease cramps

• Exercise – Gentle exercise can also be useful as it helps to increase blood flow to the affected area which can help to relieve your pain. Exercise also releases feel-good endorphins which can improve your mood, and this can make your pain more bearable

• Sleeping position – Lying a certain way may help with period pain. Lie on your side with your knees pulled up (also known as the foetal position) as this can help to take the pressure off of your abdomen

• Psychological factors – Addressing any issues such as anxiety or low mood can be an important step in managing your menstrual cramps. Psychological issues may affect your sensitivity to pain

Sharifi, F., Simbar, M, Mojab, F., Alavi, M.H (2014) Comparison of the effects of Matricaria chamomile (chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome. Complementary Therapies in Clinical Practice 20(1), 81-8

Natural remedies to help

There are some supplements available which can help to reduce your period cramps:

• Agnus castus – Agnus castus is a licensed herbal remedy for the relief of premenstrual symptoms. If you suffer from painful periods, alongside other symptoms such as sore breasts, bloating, irritability and mood swings, this remedy can be really helpful. Please note, if you are taking hormonal contraceptives such as the pill, hormone-balancing herbal remedies may not be suitable for you.

• Magnesium with vitamin B6 – Magnesium is a natural muscle relaxant and having a magnesium deficiency can make your period pain worse. Vitamin B6 is important for the manufacture of many hormones which are important for the smooth running of your menstrual cycle

• Evening primrose oil – Evening primrose oil contains an important essential omega-6 fatty acid called gamma-linolenic acid (GLA) which can help to balance pro-inflammatory mediators which can contribute to period cramps. Ensure you are getting sufficient omega-3 too!

How can my doctor help?

If period cramps are troublesome your pharmacist or doctor may be able to help.
Pain killers and anti-inflammatory medication such as paracetamol and ibuprofen can be bought over the counter which can be taken to help ease period cramps.

In more extreme cases your doctor might suggest putting you on a hormonal contraceptive, such as the pill. Depending on the type, your periods can become lighter, less painful or even stop altogether. Always carefully discuss your options with your doctor and consider any side effects of medication you plan to take.