Periods are a natural physiological process and are an inseparable part of every woman’s life.
But somewhere all of us hates periods (1)
I am sure we all do!
To this ‘why’ I can only think of one possible reason and that is pain, cramps and all the uncomfortable feeling that comes along with it.
Well, it is said that periods are natural and natural things don’t give us sufferings.
While little cramping during periods is normal however if you are experiencing painful periods, that restricts you from doing your daily activities, it is not normal and may indicate a bigger problem.
Let us know what are the reasons behind painful periods and what can we do about them?
WHAT CAUSES PERIOD PAIN OR PERIOD CRAMPS?
Every month the ovary is going to secrete estrogens and progesterone that’s going to come down to the uterus to form a nice thick endometrium lining. This endometrium nourishes the growing embryo.
In case the pregnancy doesn’t happen this thick endometrium lining is no longer needed and so our body naturally removes it. This process is known as menstruation.
So to remove this endometrium lining the uterus contracts, when it starts contracting, the blood vessel lining of the womb compresses. As a result, there is a temporary cut off of oxygen and blood supply to the womb. Due to a shortage of oxygen and blood supply the tissues of the womb release chemicals that trigger pain.
On the other hand, your body is releasing other hormones known as prostaglandins which encourages the uterus muscles to contract more hence elevating the pain.
Also, women that suffer from heavy periods and pass clots can experience severe cramps. Huge clots can be painful to pass because the uterus has to contract more to expel this clot out of the cervix which is like a tiny hole and that gives this crampy pain and once the clot is passed, you will feel that the pain is a lot better.
In medical terms, painful periods are known as dysmenorrhea.
So there are two types of dysmenorrhea, primary and secondary.
1. PRIMARY DYSMENORRHEA
So it is kind of normal, this just describes painful periods in women where there is nothing wrong with the pelvic organs. This kind of pain is generally related to the period so it will come on just before the period and it kind of feels like just a dull, crampy ache in the bottom of the stomach, it can radiate to the lower back.
Some women even feel pain in their thigh and back. This is known as referred pain.
What is a referred pain?
So referred pain is when you are feeling pain in the part of the body that’s different to the source of the pain. For example, when you are having a period and you have got pain coming from the uterus, you feel the pain in your back because you feel the pain in another part of the body that shares the same nerve supply.
The symptoms of primary dysmenorrhea are
- Feeling little unwell
Primary dysmenorrhea is a kind of normal pain, happens to almost every woman and it is easily treatable at home. It doesn’t need a doctor’s assistance.
2. SECONDARY DYSMENORRHEA
In this type of painful period, the cause is due to some sort of abnormalities in the pelvis.
So something wrong is going on with either the ovaries or the fallopian tubes or the uterus.
The pattern of the pain in secondary dysmenorrhea is different from that of primary dysmenorrhea.
You might notice that initially, you had pain free periods, and then when you are in your early 20s or your 30s, you notice that your periods have suddenly become painful and then you might start noticing that the pain is not related to your periods.
The symptoms are shown before periods, and it gets worse during periods and even when it’s gone, the pain still persists.
The symptoms include
- Heaviness in the pelvis
- Heavy periods
- Bleeding after sexual intercourse
- Unbearable pain
- Bleeding in between two cycles
- Noticing large blood clots during periods
- Too short or too long periods
PAINFUL PERIODS DUE TO MEDICAL CONDITION
Some medical conditions can make your periods worse. These are related to secondary dysmenorrhea.
Let us discuss them one by one.
Starting with the most common one,
One out of every ten women suffers from endometriosis. (2)
In this condition, the lining of the uterus implants itself outside the uterus but even though it is outside the uterus, it still builds up every month and bleeds every month, the worst and the problematic part is that there is no way to get that blood go out of the body, so it is bleeding into the pelvis and this can be really painful. (3)
Symptoms of endometriosis include
- Diarrhoea or constipation
- Painful cramps before, during and after periods
- Lower back and abdominal pain
- Bleeding between periods
- Pain during or after sex
- Difficulty and pain in passing urine and bowel movements
There is another condition related to endometriosis called adenomyosis.
It is not as common as endometriosis but again that lining of the uterus has implanted itself somewhere where it shouldn’t be and in adenomyosis, it’s implanted itself in the actual muscle wall of the uterus. Every month this lining is bleeding into the muscle wall of the uterus which is again really painful. (4)
Symptoms of adenomyosis include
- Tenderness in the lower abdomen
- Severe cramps during menstruation
- Painful sexual intercourse
- Blood clots during menstruation
- Heavy and prolonged periods
3. PELVIC INFLAMMATORY DISEASE (PID)
It is a condition wherein there is an infection in female reproductive organs which includes the uterus, the fallopian tubes and the ovaries.
It spreads via sexual contact.
Sexually transmitted bacteria spread through the vagina and affect fallopian tube ovaries and uterus.
Another reason for PID could be an ovarian cyst or uterine polyps.
Sometimes when a woman fails to maintain menstrual hygiene, pelvic inflammatory disease can come into the picture. (5)
Symptoms of PID include
- Painful sexual intercourse
- Bleeding during intercourse
- Heavy and abnormal vaginal discharge
- Difficulty and pain during passing urine
- Pain in the lower abdomen or pelvic pain
- Bowel discomfort
4. UTERINE FIBROIDS
Fibroids are some abnormal growth of tissue in a woman’s uterus. (6)
These are non-cancerous but the situation may worsen if left unattended and cause painful periods.
Symptoms of uterine fibroids include
- Severe cramps
- Pain in leg and backache
- Irregular periods
- Pain and pressure in the pelvic region
- Going to the loo frequently
- Difficulty in passing urine
5. POLYCYSTIC OVARIAN DISEASE (PCOD/PCOS)
PCOS is an imbalance of the female sex hormones.
The most common symptom seen in a PCOD patient is problems in periods. The periods could be delayed, irregular, scanty, heavy, in some cases it can be early or prolonged. (7)
Other symptoms include
- Difficulty in gaining and losing weight
- The excess male hormone results in hair growth all over the body
- Sleep disturbances
6. PERIOD PAIN DUE TO INTRAUTERINE DEVICES (IUD) (8)
Intrauterine devices are a type of contraception that is placed in the uterus.
Cramps and spotting in a woman who has copper T inserted are common in the first 2-3 months and this is mainly because of the minimal inflammatory reaction which occurs inside the uterus because of the copper T.
These symptoms generally subside without any treatment in 2-3 months but sometimes these cramps could be due to a misplaced copper T.
So ideally after one month of insertion of a copper T, the gynaecologist has to call the patient and look for the position of the device.
The pain could be sometimes associated with an infection, symptoms include
- White discharge
- Foul smell discharge
- Painful sexual intercourse
- Heavy bleeding
So if you are someone who is experiencing painful periods after the insertion of an intrauterine device, get yourself checked by the doctor.
HOW TO MANAGE PERIOD PAIN?
Now let us talk about treatments, what can you do to manage period cramps at home and when is the time to see a doctor.
As always the treatment depends upon the cause.
In primary dysmenorrhea, there is no medical condition and hence we can treat the pain at home. Some proven remedies are effective in relieving period cramps fast.
1. APPLYING HEAT
Studies have proved (9) that applying heat to the affected area can reduce
- Muscle tension
- Relax abdominal muscles to reduce pain caused by muscle spasm
- Increase pelvic blood circulation
- Diminish congestion and swelling caused by nerve compression
Hot water bottles work best in relieving period pain. You can get it easily from a chemist shop.
Another way to relieve cramps is to get into a nice hot shower. It’s actually a good way to pamper yourself and show some self-love.
If it’s summertime, I know bathing with hot water is the last thing you want to do and you don’t have a hot water bag.
So what can you do?
Make a DIY heating pad yourself.
Let’s do it.
- Take a big size sock
- Fill it with uncooked rice
- Microwave it or heat it in a pan (make sure you don’t overheat it)
- And apply it to your abdomen
- Reuse if required
And if you are way too lazy to do any of these just fill a plastic water bottle with hot water and use it. Even that will work.
Physical activities and period cramps don’t seem to go hand in hand and I completely understand why so many women are sceptical about exercising during periods.
I know it may sound cliche but exercise can help in the various period related problems (10) such as:
- Menstrual cramps
- Premenstrual syndrome (PMS)
- Irregular periods
Any kind of physical activity increases blood circulation which in turn helps in relaxing sore muscles. When these sore muscles get relaxed the pain ultimately goes away.
When we do some sort of physical activity, our body releases endorphins (feel-good) hormones which are also known as natural painkillers and other “happy neurotransmitters” including dopamine, norepinephrine, and serotonin in the brain. (11)
These hormones elevate our mood and decrease PMS symptoms where we feel irritated all the time for no reason.
Best exercises to do :
- Yoga and pilates
- Low-intensity cardio
- Low-volume strength training
- Light walking and jogging
- Include planks and squats
- Aerobic exercises
- Short lap of swimming (with menstrual cup or tampons)
- Dancing to your favourite music
Exercises to avoid :
- Avoid high-intensity workouts
- High-volume strength training
- Other exercises that consume a lot of energy
However, if you are in a lot of pain and do not feel like going out, try out some floor exercise or lying exercises. Just do a little bit of curling and stretching and see if that works for you for not.
3. MASSAGING WITH ESSENTIAL OILS
Massaging your abdomen area with some essential oils increases the blood flow and can help in soothing period pain.
Studies have shown that massages significantly reduced pain caused due to endometriosis. (12)
The aroma of these oils helps to elevate mood.
Now, always remember to use essential oil with some carrier oil like almond oil or coconut oil because you are supposed to take only a few drops of essential oils which will not be enough to cover a large area.
The most effective essential oils are
4. OVER THE COUNTER MEDICINES
These pain killer medicines are a must-have for managing periods in schools and colleges and even at work. Because you can neither massage your abdomen nor take a hot water bag with you when you are out of your home.
These are easily available at the chemist store and are safe to use unless you have some problems related to allergies.
A word of caution that you are supposed to pop pills throughout your period. One pill should be enough to control the pain. If you are experiencing severe pain even after taking the painkiller, you should definitely go and see a doctor.
5. LIFESTYLE CHANGES
Little lifestyle changes can have a bigger impact on your overall health including period cramps.
A study was done in 2016 on 250 women, they found out that women who maintained a healthy lifestyle experienced less painful periods than those who didn’t. (13)
A healthy lifestyle includes:
- A balanced diet
- Regular exercises
- Proper stress management in life
Dietary changes can do wonders in long run. We put all kinds of junk food inside our bodies and then expect it to function well.
Include these foods in your diet, especially 10 days before your period
- Fresh fruits
- Root vegetables
- Leafy green vegetables rich in iron
- Magnesium-rich food
Say a big NO to
- Fatty foods
- Salty food
- Carbonated drinks
- Spicy foods
- Red meat
- Too much sugar
Drinking a lot of water is always very important, and this is especially true during your period. (14)
Eat fruits that have a lot of water content in them.
WHEN TO SEE A DOCTOR
The points which we have discussed above will only help to relieve pain related to primary dysmenorrhea. If you find that your periods are not normal and the pain is way more severe than it actually should be, it might indicate some other medical problem related to secondary dysmenorrhea.
Secondary dysmenorrhea cannot be treated at home and if left unattended, it can lead to a bigger problem in future.
So whenever you feel that there is something wrong with your menstrual health do see a doctor.
A doctor can ask you about any family history of severe pain, they can ask you to go for an ultrasound or MRI to examine your pelvis.
Painful periods are not normal and you should never overlook the signs that the body is giving you.
Do not consider it as a part of your life, because I am sure nature did not intend to make us suffer. If there is suffering, probably something is wrong with our bodies.
So the takeaway is
- Mild period cramps are normal
- These cramps should not affect your routine in any way
- Severe cramps are not normal
- If no remedies are helping in controlling pain, see a doctor
- Painful periods can be due to other medical reasons which need the doctor’s attention
- Do not overlook your pain
- You are not meant to suffer