Having painful periods is the most common female reproductive complaint worldwide. It is estimated that between 45% to 95% of women are experiencing this condition depending on the definition of the “pain” [1]. Some may only have mild pain for a few hours every month, whereas others can have intense cramps for up to 3 days and accompany with other symptoms such as back and thigh pain, headache, diarrhoea, nausea, and vomiting [1].
What are the causes of painful periods?
Medically, the term dysmenorrhea is used to refer to any painful cramp originated from the uterus that occurs during menstruation [2]. There are two types of dysmenorrhea: primary and secondary. Simply put, if the doctor can’t find any other underlying diseases that may trigger such pain then it is primary dysmenorrhea.
The lower abdominal pain in primary dysmenorrhea is due to the natural biological process of uterine contractions that discharge blood from the uterus [2]. As such, primary dysmenorrhoea normally begins six to 24 months after a girl having her first period. Normally due to the overproduction of a type of hormone called prostaglandin in the uterus. Prostaglandin is released to trigger the uterine contraction. Too much of it causes may lead to higher intensive of contraction and cramp. For women with greater sensitivity to pain, the cramp becomes unbearable [3].
While secondary dysmenorrhea can begin anytime after the start of menstrual, it typically occurs when a woman is in her mid-20s to 30s. Many female reproductive organ disorders, such as pelvic inflammatory disease, endometriosis, fibroids, polyps, etcetera [1], can be the cause of secondary dysmenorrhea. Hence, it is important to discuss with the doctor if the one starting to experience painful period only later in life [2].
If you go to the doctors for painful periods, you will be given painkillers for relieving the pain. For more severe cases, patients will be prescribed with oral contraceptives or hormonal therapy to suppress the production of prostaglandin. Clearly, these treatment options are not appealing to many women.
Dietary habits
The condition of primary dysmenorrhea is linked to dietary habits. A recently published systematic review that analysed data from a total of 38 research studies found the main influencing dietary factors to be as follow [4]:
Fruits and vegetables – women who eat fewer fruits and vegetables tend to have more painful periods. Fruits and vegetables are great sources of vitamins, minerals, and anti-oxidants. The rich vitamins E, C, beta-carotene, and zinc in fruits and vegetables appears to reduce menstrual pain. Hence, it is important to eat more fruits and vegetables if you want to be free from this monthly nuisance.
Fish – Fish consumption is also associated with the occurrence of dysmenorrhea. Fish is a good source of omega-3 fatty acids. During menstruation, omega-3 fatty acids play a role in lowering the potency of prostaglandin synthesised. This helps to reduce the intensity of uterine contraction.
Milk and dairy products – The increase consumption of milk and dairy products is also associated with lesser painful periods. The calcium and magnesium in milk and dairy products are minerals that the body needs for pain reduction and muscle relaxation.
Skipping meals or going on diet – Skipping breakfast in the morning is not only unhealthy but also a leading factor that is associated with the intensity of the pain during menstruation. Similarly, going on diet to lose weight also appears to increase the chance of suffering from dysmenorrhea. This is because, by skipping meals and following a weight-loss diet, the body is deprived of the necessary nutrients for proper function of the reproductive system.
Another study that analysed the dietary habits of a group of college students also found that students who “snacks” more with higher intake of sugars, salty snacks, sweets and desserts, tea and coffee, salt, fruit juices and added fat are 3 to 4 times more likely to have painful periods than those who ate more healthily [4]. Hence, girls, you must pay a price if you choose to snack on the junk food.
Nutritional supplements
Nutritional supplements that are commonly used to address painful periods are as follows:
- Fish oil (Omega-3) – A clinical study conducted in 2010 with 120 university students found fish oil supplementation to be more effective than the pain-killer ibuprofen to reduce the intensity of menstrual pain [5]. Another study also showed fish oil is more effective than calcium supplement in the treatment of primary dysmenorrhea [6].
- Vitamin B1 – A clinical study found both fish oil and vitamin B1 can be used to treat primary dysmenorrhea better than placebo. Vitamin B1 is better than fish oil in reducing pain duration and mixing vitamin B1 tablets with fish oil capsules appeared to have the best results [7].
- Vitamin E – Taking 200 IU of vitamin E twice a day, starting from two days before menstruation, and continue for the first 3 days of the period has been shown to be an effective treatment to relieve menstrual pain and reduce blood loss [8].
- Calcium – A small study with 85 university students found taking 1000 mg of Calcium supplement alone starting from the 15th day of the menstrual cycle until menstrual pain disappearance in the following cycle can reduce menstrual pain [9].
- Magnesium – Evidence from 3 clinical studies showed good results on the use of magnesium to relief menstrual pain [10].
Conclusion
As many as 95% of adolescents and young women experiencing menstrual pain each month. The severity ranges from mild cramp to severe pain. Dietary patterns are associated with this condition. Eating a healthy diet that is high in fruits and vegetables, fish, milk, and dairy products can help to reduce the risk of a painful period. In contrast, unhealthy dietary habits including snacking, skipping breakfast, and going on diet to lose weight appear to increase the risk of menstrual pain. Nutritional supplements that can help to reduce the menstrual pain intensity include fish oil, vitamin B1, vitamin E, calcium, and magnesium.
References
[1] M. Proctor, Diagnosis and management of dysmenorrhoea, Bmj. 332 (2006) 1134–1138. doi:10.1136/bmj.332.7550.1134.
[2] M. Bernardi, L. Lazzeri, F. Perelli, F.M. Reis, F. Petraglia, Dysmenorrhea and related disorders [version 1; referees: 3 approved], F1000Research. 6 (2017). doi:10.12688/f1000research.11682.1.
[3] S. Iacovides, I. Avidon, F.C. Baker, What we know about primary dysmenorrhea today: a critical review, Hum. Reprod. Update. 21 (2015) 762–778. doi:10.1093/humupd/dmv039.
[4] Z. Bajalan, Z. Alimoradi, F. Moafi, Nutrition as a Potential Factor of Primary Dysmenorrhea: A Systematic Review of Observational Studies, Gynecol. Obstet. Invest. (2019). doi:10.1159/000495408.
[5] M. Zafari, F. Behmanesh, A. Agha Mohammadi, Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea, Casp. J. Intern. Med. 2 (2011) 279–282. https://www.ncbi.nlm.nih.gov/pubmed/24049587.
[6] M. Mehrpooya, A. Eshraghi, S. Rabiee, A.L.-H. and S. Ataei*, Comparison the Effect of Fish-Oil and Calcium Supplementation on Treatment of Primary Dysmenorrhea, Rev. Recent Clin. Trials. 12 (2017) 148–153. doi:http://dx.doi.org/10.2174/1574887112666170328125529.
[7] A. Hosseinlou, V. Alinejad, M. Alinejad, N. Aghakhani, The effects of fish oil capsules and vitamin B1 tablets on duration and severity of dysmenorrhea in students of high school in Urmia-Iran, Glob. J. Health Sci. 6 (2014) 124–129. doi:10.5539/gjhs.v6n7p124.
[8] S. Ziaei, M. Zakeri, A. Kazemnejad, A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea, BJOG An Int. J. Obstet. Gynaecol. 112 (2005) 466–469. doi:10.1111/j.1471-0528.2004.00495.x.
[9] F. Effati-Daryani, S. Zarei, S. Mohammad-Alizadeh-Charandabi, M. Mirghafourvand, Y. Javadzadeh, Effects of Calcium-Vitamin D and Calcium-Alone on Pain Intensity and Menstrual Blood Loss in Women with Primary Dysmenorrhea: A Randomized Controlled Trial, Pain Med. 18 (2017) 3–13. doi:10.1093/pm/pnw121.
[10] F. Parazzini, M. Di Martino, P. Pellegrino, Magnesium in the gynaecological practice: A literature review, Magnes. Res. 30 (2017) 1–7. doi:10.1684/mrh.2017.0419.