OK, I admit that this is far from my favourite topic. However, if ever there was a topic in need of some explanation, it’s period pain. Period pain, in medical vernacular, is called primary dysmenorrhoea. ‘Menorrhoea’ refers to menstruation, ‘dys’ means something’s wrong (as in, ‘dysfunction’) and ‘primary’ basically means that there’s no obvious other cause for the problem, such as pelvic pathology.
The vast majority of women that experience pain during their period, which is about 2 out of 3 women, have primary dysmenorrhoea. It is thought to result from excessive uterine muscle contractions.
It would be a fair assumption to say that if you’re reading this article, you (or someone close to you) suffer from dysmenorrhoea. However, for the uninitiated, dysmenorrhoea is usually experienced as crampy and intermittent abdominal pain, often accompanied by nausea, vomiting, diarrhoea, headache, dizziness or back pain.
The pain and associated symptoms typically begin several hours prior to the onset of menstruation and continue for one to three days. The severity of a woman’s condition can be graded by the level of menstrual pain, presence of systemic symptoms, and the impact on daily living.
While this is an article specifically about period pain, I need to cover off an important point first.
If you are experiencing sudden onset, severe pelvic or abdominal pain, or unusual bleeding, or have severe systemic symptoms – do not assume it’s period pain. Apologies for being Captain Obvious. While rare, acute gynaecological conditions such as ectopic pregnancy (implantation outside of the uterus), uterine rupture and abdominal or pelvic infection do occur and are life threatening. If this is you, stop reading and get to the doctor.
That being said, we can concentrate on managing period pain.
Managing Period Pain
As I always say, the best place to start is with simple, non-pharmacological management. For instance, heat packs have been shown to be as effective as ibuprofen – albeit more cumbersome and annoying to apply than taking a couple of nurofen tablets! Also, if you can manage to find a heat wrap (40 degrees or so), again, this has been proven to be at least as effective as simple analgesic tablets.
I’ve written before about TENS machines previously – they’re frequently used for back pain. These devices are very effective in reducing period pain. They’re cheap too – I picked mine up on eBay for about $50. And no, I don’t use it for period pain.
Yoga, but more so, meditation are potentially very helpful in improving the experience of period pain. My favourite Yoga app is Daily Yoga Video, and I recommend Headspace for mindfulness meditation. Having said that, 10% Happier is also very good and I’m looking forward to the release of Sam Harris’s meditation app (he’s been promising it for a while!).
Some women find moderate exercise to be beneficial, and much to the delight of the blokes (and female partners too) out there, sexual activity can reduce dysmenorrhoea. There have actually been reports describing a reduction in pain with orgasm.
There is also some evidence for the use of acupuncture, and while there are even reports of spinal manipulation working – please don’t do it. I don’t want any of my readers getting their necks wrenched!
In terms of other non-pharmacological interventions, it’s worth pointing out that the placebo effect for the treatment of period pain is extremely powerful. Taking a sugar pill that you think will work, will actually work! The downside is that the placebo effect lasts only about a month before reality bites. So anything will work for a month. The true test is month two onwards.
Here are some non-drug treatments for which there is at least some evidence in the reduction of period pain. As I said, with any of these, you’ll know after a couple of months what works and what doesn’t and they’re all safe:
• Low-fat diet and weight loss
• Vitamin B1
• Fish oil (omega-3s)
• Single high dose of vitamin D (in consultation with a GP)
• Ginger & Chinese herbs.
• CBD oil– my new favourite, for which early evidence suggests an effect on pain and inflammation.
Dr. Harry holds qualifications in optometry and medicine and works regularly as a general practitioner. He completed his Masters and PhD at the University of Melbourne in the fields of visual neurophysiology and visual development and has been published in Nature Medicine, Science, PNAS and Investigative Ophthalmology and Visual Science.