By Dr. Shawna Darou
As a women’s health and hormone specialist, I see patients every day who suffer from painful menstruation and often to the degree that it seriously interferes with their quality of life. The good news is that there are many steps you can take to eliminate menstrual cramps, or at least get off of prescription pain medications. Extremely painful menstruation may indicate endometriosis, an inflammatory condition associated with significant pelvic pain. You can learn more about endometriosis here.
The key as a naturopathic practitioner, is to get to the root of the problem. There are several main areas to investigate:
- Hormone balance
The starting point is always with nutrition, as we can greatly tip the balance of inflammation with diet changes. The two main foods to look at for inflammation are dairy and gluten. Dairy is inherently inflammatory, especially cows-milk dairy (goat and sheep dairy are less inflammatory for many), and eliminating dairy alone may reduce or resolve period pain. Gluten intake can also increase period pain, especially in cases of endometriosis. In fact, one study of 207 women with severe endometriosis-related symptoms, 75% had improvement in pain scores with a gluten-free diet (1).
Additional food strategies to reduce inflammation are to eliminate all fried foods, minimize sugar intake, and to avoid red meat (unless it is grass-fed). Foods to emphasize are vegetables, fruits, fish, organic poultry, beans and lentils, gluten-free grains and healthy fats and oils such as olive oil, coconut oil, avocado, nuts and seeds.
Supplements such as omega-3 fish oils and curcumin from turmeric are also anti-inflammatory, and they will increase the impact of your dietary changes on period pain.
When the hormones are out of balance, especially in a state called ‘estrogen dominance’ menstruation can become very intense. If you have both painful and heavy periods, there is likely some degree of estrogen dominance happening. Estrogen dominance means that there is either too much estrogen, or a normal level of estrogen with low progesterone to counter-balance.
Estrogen dominance can be treated with:
- lots of vegetables in the diet, especially the broccoli family (broccoli, cabbage, kale, chard, collards, bok choy, Brussels sprouts)
- sufficient fibre to support regular bowel movements
- regular exercise
- weight loss, if needed (extra abdominal fat will increase your estrogen load)
- supplements to support estrogen detoxification: indole-3-carbinol, calcium-D glucarate, DIM (diindolylmethane), green tea extract, turmeric, milk thistle
The other significant factor to reduce menstrual pain is to address alignment. Misalignment of the uterus and pelvic organs, poor posture, and poor circulation can also affect menstrual cramps. For example, if the uterus is simply tipped or tilted this can greatly worsen menstrual cramping. My top recommendations to address structural issues are osteopathic care, or Arvigo massage.
Well researched supplements for menstrual pain
There are many supplements that have been studied to work systemically and reduce menstrual pain. Here is a list of top supplements:
- NAC (N-acetyl cysteine): NAC is an amino acid derivative that has been shown in studies to reduce menstrual pain, especially from endometriosis (2)
- Pycnogenol (maritime pine bark extract): Pycnogenol has also been shown to reduce pelvic pain caused by endometriosis. It lowers inflammation and supports hormone balance. In practice, I have seen great results with this supplement!
- Essential fatty acids: EPA and DHA from fish oils provide anti-inflammatory effects. It is extremely important to choose a good quality fish oil supplement, as many brands are not at an optimal potency, and may contain contaminants. Top brands include: NFH, Nordic Naturals, Ascenta Nutrasea, Thorne and Metagenics. For period pain, a ratio of EPA: DHA of 2:1 is optimal.Dosage is 1200 mg of EPA and 600 mg of DHA per day.
- Curcumin: Curcumin is a potent medicinal compound found in turmeric, which can reduce inflammation and pain.
I hope that all of these tips are helpful to encourage you to take action to treat and minimize your menstrual cramps. This is most often a highly-treatable issue that you may not need to live with. Here’s to easier months to come!
- Marziali MI, Venza M, Lazzaro S et al. Gluten free diet: a new strategy for management of endometriosis related systems? Minevera Chir. 2012. 67(6): 499-504.
- Porpora MG, Brunelli R, Costa G, et al. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evid Based Complement Alternat Med. 2013; 240702. Epub 2013 May 7.
- Kohama T, Herai K, Inoue K . Effect of Frensh maritime pine bark extract on endometriosis as compared with leuprorelin acetate. Journal of Reproductive Medicine. 2007 : 52(8) : 703-8.