Primary dysmenorrhoea is the medical name for painful periods. Period pain can be debilitating and taxing on the soul, with painful periods being a huge contributor to us taking sick days off school or work. It’s important to understand the differences between period pain caused by a really crampy uterus, and period pain caused by something else entirely. You must be sure it’s just regular (though possibly severe, debilitating) period pain, and not something else. Period pain can be extraordinarily painful, and stands in its own right as a pain condition.

Period pain can be dull and heavy (congestive period pain) or spasms, or be accompanied by headaches, vomiting, nausea, diarrhoea, constipation or clots. The bowel is quite affected by hormone changes and the muscle contractions of the uterus, so is often affected in unusual ways.

Primary dysmenorrhoea = no disease causing the pain, just a really crampy uterus
Secondary dysmenorrhoea = an underlying, identifiable health condition causing the pain

     Primary dysmenorrhoea – just regular ole period pain
Period pain starts before or at about the six-month mark after your first period has arrived, and starts just before or after the blood starts to flow. If this isn’t happening, you have something else (see below). The cramping of your uterus is very painful, and is likely to be accompanied by lower back pain that radiates to your back or thighs. Nothing can be found upon pelvic examination by your doctor (everything will seem normal).

It is understood that painful periods are caused by something called prostaglandin F2α (PGF2α), which stimulates the middle layer muscle in the uterine wall, while acting to constrict blood vessels in the uterus. The pain comes from long uterine contractions and decreased blood flow to the area.The pain is actually a lack of oxygen in this middle muscle layer of your uterus.

The degree of pain experienced correlates with the amount of prostaglandins in the blood. These particular prostaglandins increase from mid-cycle (around ovulation) and when you get your period they bump up production a bit more. This causes the excessive uterine contractions and sometimes extreme pain. Your period pain is a combination of events that cause this response that includes hormones, mediators, body temperature, sleep patterns, and the nervous system. Researchers are still not 100 per cent sure why it happens. This period pain is likely to be diagnosed in teenage years.

     Secondary dysmenorrhoea – pain caused by something else
If periods start to get more painful as you get older, or suddenly start being painful, it could indicate secondary dysmenorrhoea. The pain might arrive with suddenly heavier or irregular periods, or it could be pain during the first or second periods of a girl’s life, indicating a blockage of some kind.

A pelvic examination may find something unusual. Usually oral contraceptives and non-steroidal anti-inflammatory drugs (NSAIDs) don’t help these types of pain. Infertility, painful sex (dyspareunia) and vaginal discharge may be present. This form of period pain is most likely to be diagnosed between the ages of 30 and 45.

Increased prostaglandins may play a role in secondary dysmenorrhoea too, but there must be another condition going on at the same time for it to be classified thus. Secondary dysmenorrhoea may be caused by:

     Diagnosing period pain
There is no one specific test for period pain, except to rule out any underlying conditions as per symptoms. Your practitioner may take blood tests, do scans, and other tests to exclude secondary dysmenorrhoea. Figuring out what level of pain you are suffering is important to providing treatments, so your practitioner will need to know the exact nature of your pain.

     Treating period pain
The medical way to deal with period pain is using anti-inflammatory painkillers (drugs), but secondary dysmenorrhoea requires treatment of the underlying condition. The most effective drugs include NSAIDs like ibuprofen and aspirin, but each of you will respond best to one or another. The oral contraceptive pill is also used, plus lifestyle modifications where required (exercise, quitting smoking, etc.). Painkillers that block prostaglandins (anti-inflammatories) work very well for most people, and because periods tend to get less painful as we get older, the need for pain medication should reduce over time.

Treating period pain with herbal medicine and some key supplements can be effective for many women, but having the right herbs and supplements for your body is important. A uterine tonic may help to regulate and normalise the uterus, plus some relaxing, pain-relieving or prostaglandin-blocking herbs to reduce pain. Hormone-regulating herbs may be used to help normalise hormones. Herbs would be taken all month, not just at your period.

     Self-massage to reduce period pain
Massaging your uterus firmly while lying down can ameliorate the spasms for some women. Lie down on a comfortable surface and push gently but firmly around your uterus area, until you feel the muscle start to relax. Give yourself at least 20 minutes to really massage your uterus. You’ll notice your period pain reduces or disappears, at least for a while, for most people. This is probably due to improved blood flow to the middle muscle layer that is spasming.

     Diet adjustments to reduce prostaglandins and reduce period pain

  • Reduce intake of saturated fats
  • Eat more vegetarian meals
  • Low fat foods

     Supplements that can help period pain

  • Omega-3 fatty acids (high dose fish oil, 2.5g per day with total EPA of about 1,000mg and DHA 700mg – this is high, therapeutic doses, check label for EPA and DHA quantities)
  • Vitamin B12 combined with fish oil works even better (7.5mcg per day).

Get help from a trained herbalist when using strong herbs to treat period pain, since you can get more bang for your buck by treating smartly.

     Uterine tonic herbs

  • Aletris farinosa
  • Caulophyllum thalictroides
  • Angelica sinensis
  • Rubus idaeus
  • Combine generally with Vitex agnus-castus or Paeonia lactiflora as indicated

Hormone-regulating herbs

  • Vitex agnus-castus
  • Paeonia lactiflora
  • Paeonia suffruticosa
  • Actaea racemosa
  • Verbena officinalis

Anti-spasmodic herbs (for crampy pain, vomiting, diarrhoea)

  • Viburnum opulus
  • Viburnum prunifolium
  • Caulophyllum thalictroides
  • Dioscorea villosa
  • Ligusticum wallichii
  • Paeonia lactiflora
  • Glycyrrhiza glabra

Warming herbs (works well mixed with anti-spasmodics)

  • Zingiber officinale
  • Cinnamomum zeylenicum

Relaxing herbs

  • Valeriana officinalis
  • Piscidia erythrina
  • Corydalis ambigua
  • Verbena officinalis
  • Matricaria recutita
  • Paeonia lactiflora

     Pain-relieving herbs

  • Corydalis ambigua
  • Piscidia erythrina
  • Lactuca vrisa
  • Anemone pulsatilla
  • Zingiber officinale
  • Tanacetum parthenium
  • Curcuma longa

      Other things you can do to naturally reduce your period pain

  • Acupuncture
  • Reflexology
  • Relaxation techniques for pain perception
  • Aromatherapy
  • Heat packs/hot water bottles
  • Sex (orgasm can help relieve pelvic congestion, though that might be the last thing you feel like)

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