Can I share with you something that continues to blow my mind? We live in a day in age where humanity is on the verge of being able to purchase tickets to vacation to Mars, medical innovations can restore sight and our ability to walk, and AI technology is allowing us to harness the power of the web to distill information and create content faster than ever before. BUT when it comes to period pain and menstrual cramps, technology hasn't progressed much further beyond ibuprofen and hot packs.

Are menstrual cramps and period pain truly unsolvable? What is the cause of our pain and is there more that we can do to support our bodies during our menstrual cycle than we have been told? 

In this article, we'll cover 

• What causes menstrual pain and cramps
• Are medications safe to use for period pain
• What exercises can assist with managing period pain and cramps
• What lifestyle changes can alleviate painful period cramps
• What are some of the key supplements and herbs that are supported in research for period pain
• How working with a Pelvic Health Therapist is key for your menstrual health journey

I'll discuss some of the most common causes of menstrual pain and give you the tools you need to make peace with your periods. Please note that this is not medical advice. Be sure to consult with your doctor before using any of these tools. Also know that everyone's body responds to tools differently - some of the tools I mention in this article may work great for you and not so well for others. We all have unique biologies, lifestyles, and genetic factors at play. 

What is Normal vs Not Normal? 

Our body's number one goal is to keep us safe and protected so that we have the chance to reproduce  and humanity can continue to exist. Reproduction is the main mission of the body!

Our menstrual cycles are our pathway to reproduction. Over the course of 25-37 days (the typical timeframe for healthy menstrual cycles, measured from the start of one period to the start of your next period), our body puts lots of energy towards ripening and selecting an egg (follicular phase), releasing an egg and crossing its fingers that there is sperm present for conception to occur (ovulation), supporting the lining fo the uterus in case a fertilized egg implants into the lining and begins to grow (luteal phase), and then shedding the uterine lining if no pregnancy occurred (menses, period) so that the body can try and get pregnant again. 

During our periods, the uterus expands to twice its size, and the muscles of the uterus contract to dislodge the uterine lining so that the body can expel it through the vaginal canal. This expelled uterine lining is our period. 

As the muscles of the uterus are contracting to shed the lining and pass it through the body, we may experience some discomfort such as mild cramping, fatigue, and low energy. These symptoms may last for 3-5 days which is the typical length of a healthy period. These minor symptoms are completely normal. 

Periods that last longer than 5 days, are heavy, and/or are accompanied by pain that causes you to miss school or work are not normal symptoms. There is actually a term for these dysregulated and painful periods - Dysmenorrhea. Dysmenorrhea may also be accompanied by nausea, vomiting, diarrhea, back pain, and headaches. Dysmenorrhea could be caused solely from our dysregulated periods, in which case we call it Primary Dysmenorrhea, or it could be indicative of an underlying medical condition such as endometriosis. If our non-normal period pain is caused by an underlying condition, we call it Secondary Dysmenorrhea. Endometriosis should always be tested for and ruled out in the case of significantly painful periods. 

What Causes Period Pain and Cramps? 

The most common cause of menstrual pain is the overproduction of inflammation in the body. Prostaglandins are the inflammatory chemicals that produce inflammation. If we experience dysmenorrhea, is is typically due to the prostaglandin load in our bodies becoming high, thus producing more inflammation, which produces more cramping, which produces more pain. Our bodies get caught up in a pain-inflammation-pain cycle that keeps escalating. 

What Causes Inflammation? 

Sadly, inflammation triggers are everywhere in our modern world. The food-like substances we eat, the pollutants in the air we breath and water we drink, the chemicals in our hygiene products and what we spray in our yards.....theses are all prime sources for increasing the inflammation load in our bodies.

Endocrine-Disrupting Chemicals (EDC) are one of the biggest forms of inflammatory triggers - they are environmental toxins that enter our bloodstream and mimic our own estrogen to wreak havoc throughout our whole body. Within our menstrual system, these EDCs cause higher levels of circulating estrogen which causes the uterine lining to get much thicker than normal. When our period arrives and the uterus needs to shed its lining, it has a much more difficult time shedding the super thick lining caused by EDCs. The uterus has to contract harder and writhe and twist to try and dislodge the lining and expel it from the body. This results in a lot more cramping, pain, and a much heavier period. 

EDCs are also known to damage our DNA, trigger obesity and diabetes, wreak out immunity, and usher in autoimmune conditions. Thyroid problems and dementia are tied to EDCs, as well. 

Here's a short list of some of the main sources of EDCs in our lives: 

• Cosmetics and hygiene products 
• Household cleaners, paint
• Flame retardant chemicals in mattresses and furniture 
• Plastics in food packaging and food storage containers
• Herbicides, pesticides, antibiotics, pharmaceuticals 

Tools for Period Pain 

Medications for Period Pain

The most commonly prescribed "treatment" for period pain are NSAIDS such as Motrin and Ibuprofen. While these medications may do a great job of relieving period pain, they can also do some serious harm when they are used regularly.

In 2015, the FDA issued a safety announcement strengthening their warning that NSAIDS can cause heart attacks and strokes. In research conducted by the FDA, they found that the risk of heart attack or stroke can occur as early as the first week of using an NSAID in people with and without heart disease or risk factors for heart disease. The risk may increase with longer use of NSAIDS. 

NSAIDS may also affect fertility. A 2015 article by Salman et al discovered significantly increased rates of anovulatory cycles (no ovulation, no chance of getting pregnant) and a greater risk of cyst development due to the unruptured follicles present in the anovulatory cycles. The study suggested that safer tools such as heat, trans-cutaneous electrical nerve stimulation (TENS), yoga, and meditation should be used instead of medication to manage period pain. We'll talk about many of these tools later in this article. 

Hormonal birth control (the pill, non-copper IUDs, the patch, the ring) is another commonly prescribed "cure" for period pain. Studies have found that hormonal birth control is less effective in managing period pain compared to NSAIDS and has riskier potential side effects. 

While I am never going to tell you to burn your Motrin bottles and birth control pills, what I do suggest is becoming empowered with knowledge and evidence, taking the time to know and understand your own body, and asking questions so that you can make the most informed decisions for what is best for YOUR body. Many of my clients within my Pelvic Health Practice were put on birth control when they were teens to help manage their painful period symptoms and are still experiencing pain and symptoms of dysmenorrhea as adults. These clients usually express feeling completely defeated because the they were told that birth control was the end-all-be-all cure to solve their pain, and since they are still experiencing pain, there body must be even more "broken" than they thought. This could not be further from the truth and my hope is that every person who reads this article walks away with renewed hope and many more tools to address the root cause of dysmenorrhea.

My personal philosophy is that every tool should be laid out for us on the table with ample education provided so we can make informed choices about what tools we want to use and are best for our bodies. If you are looking for tools that are not linked to scary risks and side effects like heart attacks and infertility, you might want to explore some of the tools discussed later in this article. 

More Fruits and Veggies

Choosing organic, minimally processed, and minimally packed food is a great place to start to decrease the toxin burden in your body. Many fruits and vegetables have anti-inflammatory properties that are called phytonutrients. Increasing your consumption of fruits and vegetables is an immediate way you can support your body and deter the effects of inflammation. 

Eliminating processed foods and sugars is another powerful dietary change. These foods feed the fire of inflammation in the body. When you remove these foods, you'll literally feel and see the effects of decreased inflammation in your body - you'll have more energy, clearer skin, better moods, and better sleep. 

Caffeine and alcohol are other substances that feed into inflammation in the body. I usually encourage clients to limit their intake of both and be sure to drink a glass of water before and after their cup of morning coffee to flush the caffeine out of their bladder. Caffeine is a big bladder irritant that can be a driver for leakage and overactive bladder syndrome (OAB). The bladder and uterus sit snuggled up next to each other within the pelvic bowl.

If the bladder is irritated, it tends to increase the irritation of the uterus because of their proximity to each other within the very small space of the pelvic bowl. It's akin to living in a small apartment with a bunch of roommates - if one roommate is feeling irritable, that irritation tends to spread to the rest of the inhabitants and brings down the vibe of the entire apartment space. This irritation can profoundly impact our period symptoms. 

Supplements

Studies have found that supplementing Magnesium, Vitamin D, Vitamin B1 (thiamine), and Vitamin E can be incredibly helpful in eliminating period pain. While Physical Therapists in the state of Pennsylvania where I practice are mandated against prescribing supplements, I usually make recommendations to my clients about supplementation that they may want to address with their doctor.

Magnesium is the first supplement I am usually eager to recommend as most women in the US have low levels of magnesium and I have seen it work wonders for clients with painful periods. I personally take 600 mg/day of magnesium glycinate 5 days before and leading up to my period and supplement with 300 mg/day on every other day. 

Transform Stress & Get Quality Zzzzs

I gave up on the term "stress management" years ago. In our modern society, managing stress is mostly a loosing game.  Instead of attempting to manage our stress, I encourage clients to think about transforming their stress by interrupting stress patterns through lifestyle changes. 

I believe that one of the most counter-cuturual and rebellious things we can do for our health and wellness is to take the time, everyday, to reset our nervous system and come into a parasympathetic state. Within the autonomic nervous system, we have our parasympathetic nervous system and our sympathetic nervous system. Our parasympathetic nervous system is responsible for resting, digesting, releasing, breathing, and being - it is the state of feeling safe and of being at peace within our bodies.

On the other end of the spectrum is our sympathetic nervous system - this is our fight or flight nervous system that is on high alert for threats in our environment. We are always in one of these two nervous system states and it is impossible to be in both at the same time.

Because we live in a culture infiltrated with chronic stress (think deadlines, work stress, relationship stress, over-exercising, poor physical recovery, etc), most of us are stuck within our sympathetic nervous system state. In this state, the body is hyper-alert and on-guard. Our nervous system is designed to move between these two nervous system states to address threats and then come back into a state of peace.

When we are caught up in a sympathetic nervous system response state, stress hormones like cortisol run through our bodies creating an inflammation cascade. If our bodies are in this elevated cortisol state for a prolonged period of time, the system will start to shut itself down in an attempt to find rest. This is a key driver for autoimmune diseases. 

To help our nervous system reset back into a parasympathetic state, we can use the power of love and gratitude, cultivate a practice of meditation to come into a state of inner peace, and choose to engage with people and activities that help us come into our bodies and feel safe. If we can reset our nervous system daily, we can hep to deter the effects of overloading our sympathetic nervous system. 

Taking a walk in nature, being near water, drinking your tea slowly, meditating, singing, and listening to music are some examples of activities that can draw us back into our parasympathetic nervous system state so that our body can work on resting, healing, and removing inflammation.

Quality sleep is also extremely important. When we enter deep REM sleep, our bodies automatically come into a parasympathetic state to reduce inflammation and thus reduce period pain. One study found that insomnia caused women to report higher levels of more severe period pain compared to women without insomnia. Poor sleep disrupts our Circadian rhythm which directly affects our cortisol (stress hormone) cycles. Chronically elevated cortisol levels create an inflammation cascade that increases pain.

Gentle Exercise for Period Pain

Movement is medicine. Our bodies are created for movement and movement helps out body function better. Movement can be a great tool for period pain because it assists with the motility of menstrual fluid out of the body, and increases natural feel good chemicals in the body known as endorphins which decrease pain. 

Gentle yoga practices such as Yin Yoga or Restorative Yoga positions can be extremely helpful, as well as low impact activities such as swimming and walking. As a yoga instructor and a Pelvic Health Therapist, I typically advise my clients who are yogis to avoid inversion poses during their periods as this can make the uterus's job a bit more challenging as it is trying to push menstrual fluid out of the body. Cat-cow, spinal twists, and child's pose are some of my favorite yoga poses for period pain. 

Detox

Think about the quality of products and substances that are going in and on your body - are they increasing your inflammatory load or helping to clear it? 

Detoxing is a process by which we clear out potential inflammatory triggers so the body can rest and heal. To detox in a way that can support your periods for years to come, consider reading the labels on your personal hygiene products and getting rid of anything with a high chemical load.

Period products are notorious for being filled with chemicals and this is extremely concerning considering these products are usually near or in contact with the highly absorptive tissue of the vaginal canal which has a direct path to the bloodstream. Many of my clients have greatly reduced or eliminated their painful and heavy periods by switching to organic, unbleached tampons and pads, or switching to a menstrual cup. 

Another great detox tool that I personally use and recommend to many of my clients are Castor Oil Packs. Castor oil is easily absorbed into the body and helps to stimulate and support organs that it contacts. Using a cotton pack containing 1TBP of good quality castor oil placed over the liver can support the liver in its work of metabolizing and detoxing the body. My favorite company for quality castor oil and castor oil packs is Queen of Thrones.

Lymphatic massage, rebounding 10 mins a day on a mini trampoline, and dry brushing the skin are other accessible detox tools that can pack a powerful punch in helping the body mobilize and get rid of inflammation. 

Herbal Medicines for Period Pain 

Chewing on a piece of raw ginger root or steeping it in a tea is one of my favorite herbal medicines for period pain. Ginger is widely respected for its anti-inflammatory and pain-relieving properties and is widely supported in the research. 

Black haw and Motherwort are two plants that have been used for centuries to reduce the physical pain and emotional irritability that sometimes accompanies periods. These are great plants to turn to as alternatives to medication as they have been found to be safer options. You can pick up both of these plants in tincture form from your local health foods store. For proper individual dosing, I recommend consulting with an herbalist. I have used both of these plants in my own menstrual health journey and I'm so grateful for the ways in which they have worked with my body in a gentle way to relieve the period pain I have experienced in the past! 

Work with a Pelvic Health Therapist 

I truly believe that every person needs a Pelvic Health Therapist in their corner! Pelvic Health is essential for everyone, and especially women (we just have a lot more going on in our bodies from a systemic standpoint!). Pelvic Health Therapists can assess you for other physical contributors to your period pain symptoms, including a tipped uterus or fascial restrictions. 

A tipped uterus can make it more difficult for the shed lining of the uterus to exit the body, thereby creating irritation in the pelvic bowl which can exacerbate painful period symptoms. Many Pelvic Health Therapists are trained in visceral mobilizations which are gentle, external techniques that can be used to move the uterus into a more optimal position in the body so that it can function better. 

Fascial restrictions around the uterus, ovaries, and within the pelvic bowl can create physical blockages that make the expulsion of menstrual fluid challenging and lead to increased period symptoms. Myofascial release techniques both internally and externally can be utilizes to release fascial restrictions, increase mobility, increase blood flow, and alleviate pain.

I have worked with many clients who have had increased period pain following laprascopic surgeries and endometriosis excisions due to naturally occurring scar tissue and fascial tension creating blockages in the body. Once the fascial layers were released, their period pain was significantly decreased! 

In my clinic, I also fit clients with pelvic pain for acupressure anklets that put sustained, gentle pressure on the uterine point located on the inside of the ankle bone. Accupressure has been used for centuries to decrease pain and has been shown to have cumulative effects.

Accupressure anklets are cost-effective, and when worn for consecutively for a few periods in a row, have been proven to have a cumulative effect to reduce period pain for good! I have used acupressure anklets on my own menstrual health journey and they were an amazing tool to help me manage my period pain while at work. 

Summing it Up

1. Reducing the inflammation in your body is key to reducing period pain! Lifestyle changes that incorporate more phytonutrients, quality, sleep, and stress transformation can have a big impact
2. Decrease your toxin load by reading ingredient lists and knowing what is going on and in your body. Detoxing can be a great way to help your body mobilize toxins and eliminate them from your body
3. Try herbal medicine instead of pharmaceuticals
4. See a Pelvic Health Therapist to assess for a tipped uterus or fascial adhesions

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