Is Your Period Pain Free?

I remember the first time I got my period. I was 12 and in school – of course. My bleeding and cramps were severe enough to warrant a get-out-of-school-free card. The only person available to pick me up was my taciturn grandfather. That was fun.
My cycle has varied over the years, and as I approach menopause, I look forward to no longer receiving my monthly visitor. I’m thankful that it gave me two kids, but I won’t miss the sore breasts, bloating, mood swings, inconvenience, or the pain.


The pain. I imagine wringing out a towel; only it’s my uterus.
Everyone’s menstrual cycle is different, as is everyone’s pain tolerance. So how should you deal with period pain, and how do you know when to see a healthcare professional?
Period pain 
As you may have noticed, menstruation can change with time, or even from cycle to cycle, says Dr. Jennifer Lang, MD, OB/GYN, FACOG. Some women, for example, have no discomfort, while others miss days of school or work due to their symptoms.
Typically, girls start menstruating by 12, but it can start as early as 8 or as late as 16. According to the National Institutes of Health, the average menstruation time in normally menstruating women is about five days, and the average cycle is 28 days. In young females, it can range from 21 to 35 days. Up to 14 percent of women have irregular menstrual cycles or especially heavy menstrual bleeding. Prolonged menstrual bleeding is when bleeding exceeds eight days on a regular basis. Menstrual irregularities can sometimes be a sign of other health problems, which is why it’s important to see your provider to rule this out.
As listed by the Cleveland Clinic, symptoms of a normal menstruation include:

• Moodiness
• Trouble sleeping
• Food cravings
• Cramps in lower abdomen and back
• Bloating
• Breast tenderness
• Acne

Only you will know if your pain is excessive. Dr. Lang says if you have to miss work or an important life event because of a period, it’s excessive. Similarly, if you’re vomiting because of pain or doubled up on your bed crying because you’re so uncomfortable, it’s time to consult a healthcare provider.
This is important because one of my friends was told for years by her gynecologist that her pain and gastrointestinal upset were normal and related to her period when in fact she had an incredibly severe case of endometriosis. She didn’t miss any work but scheduled it around her period. She avoided a full-time job so she could have a flexible schedule, and couldn’t plan any vacations in advance. It wasn’t until she got a second opinion, when her doctor immediately said, “This is not normal,” and looked into it. The moral of the story: See someone for menstrual pain, and get a second opinion if necessary.

Consulting a healthcare provider
In fact, clinicians typically state that when a women can’t function as normally, it’s probably time to seek treatment, says Dr. Jenell Coleman, MD, MPH, Associate Professor of Gynecology and Obstetrics at Johns Hopkins School of Medicine and Medical Director, Women’s Health Center, JHOC. She explains that most patients have pain during the first one or two days. If this pain persists throughout the menses or other over-the-counter (OTC) therapies have failed, see a healthcare provider.
If you still aren’t sure if you qualify, here are some indications, courtesy of Dr. Lang:

• Flow is so heavy you’re bleeding through feminine hygiene products and need to change them hourly or more
• Feeling completely exhausted and drained of energy
• Feeling faint or dizzy after heavy bleeding
• Unable to manage pain by over-the-counter acetaminophen or non-steroidal anti-inflammatory medications at doses indicated on packaging
• Any mid-cycle or irregular bleeding patterns
• Significantly inhibiting lives on physical or emotional basis
• Negatively affecting you financially
• Negatively affecting quality of relationships

The bottom line: if the pain is bothersome, seek treatment. “There are so many treatment options that no woman should suffer from menstrual discomfort,” says Dr. Coleman. Medical conditions like endometriosis can cause severe menstrual pain and require specialized treatment, so this is another reason to get checked out.

Pain relievers
There are some go-to remedies for period pain, like OTC medicine (Advil, Aleve, Motrin), but the key is to preload, or get the medication into your system before the period begins, recommends Dr. Coleman. She says a perfect example is taking these at least one or two days before the expected period, and then taking them at prescribed intervals regardless of whether there’s pain. “This will help minimize the prostaglandin effect (which is the cause of the discomfort),” she says. “I think this technique is underutilized and not common knowledge among women.” Unfortunately, for women with irregular cycles, this tactic may not be as successful.
Dr. Coleman also says that hormonal treatments (e.g. contraceptive pills, Levonorgestrel IUD) have had proven benefits in decreasing and eliminating dysmenorrhea, or painful menstrual cramps.
 
Exercise, yoga, and heating pads are other ways to alleviate pain. Dr. Coleman says there are some small reports and anecdotal evidence suggesting that acupuncture and TENS (transcutaneous electrical nerve stimulation) may decrease discomfort. These therapies might be more expensive, however, and there aren’t large trials proving benefit in all women.
Because the uterus is mostly made up of muscle, many of the tips and tricks that help with muscle cramping will help with menstrual pain, says Dr. Lang. She recommends Epsom salt baths with lavender essential oils, taking an oral magnesium supplement or eating magnesium-rich foods. Many women report relief from drinking red raspberry leaf tea or eating anti-inflammatory foods such as cucumber, turmeric, tart cherry, and aloe vera juice. Along these lines, cleansing with a low sugar/low processed grain diet high in vegetables prior to period onset can lead to less water retention, cramping, and irritability. Orgasms can also help (when you experience PMS and are on your period), because they release natural endorphins, which are powerful natural pain relieving chemicals, says Dr. Lang.
 
Advice
Adolescents are particularly impacted by dysmenorrhea, says Dr. Coleman, so parents should acknowledge the discomfort and seek medical advice if the child is missing school, sports, or other activities. “Non-steroidal medications work wonders in this population,” she says.
We live in a world that doesn’t have a lot of patience or tolerance for natural cycles or women’s bodies, and expects us to be constantly “on,” says Dr. Lang. “If you’re able to find that magical balance between honoring the miracle of your body and its rhythms and also recognizing the activities that are important to you, you’ll be golden,” she adds. Luckily there are many tools women can use to improve their menstrual experience. “Find a gynecologist, midwife, or naturopathic doctor who listens, respects your values and your goals, and offers suggestions that you can align with,” she says.