Painful menstrual cramps (dysmenorrhea) can have you rocking back and forth with your knees pulled up to your chest and your hot water bottle sandwiched in between, wondering how you will ever be able to manage a lifetime of monthly periods.
Menstruation and cramps are a normal part of the reproductive cycle and can even show that you’re healthy, but it doesn’t mean that you have to live with the pain. There are things you can do to feel better.
First, know you’re not alone. In a 2023 survey for Women and Gender Equity Canada, 61% of menstruators said they experience pain or cramps from their period. That’s a lot of people!
So, what is dysmenorrhea?
Dysmenorrhea is painful menstrual cramps. Pain and cramping can be in the lower abdomen, but pain can also be in the lower back and can spread down the legs.
There can also be other symptoms, including:
-
nausea
-
vomiting
-
diarrhea
-
headaches
-
dizziness, or feeling faint
-
fatigue
Primary Dysmenorrhea
Primary dysmenorrhea usually begins a year after your menstruation starts and is not caused by a medical problem. It’s more common in menstruators under the age of 30 and usually gets better as you get older or after the birth of your first child. This type of pain can start a day or two before your period and lasts one to four days.
Secondary Dysmenorrhea
Secondary dysmenorrhea is intense menstrual cramp pain caused by a medical condition. The most common cause is endometriosis, which is when endometrial tissue (the tissue that lines the uterus) implants and grows outside of the uterus, such as on the ovaries, fallopian tubes, or bowel. But there can be other causes of secondary dysmenorrhea, such as from fibroids, ovarian cysts, uterine infections, and contraceptive coils (intrauterine devices - IUDs) — to name a few.
If you have moderate or severe menstrual pain, it’s important to see your healthcare provider (doctor or nurse practitioner) to rule out that there isn’t something more serious going on.
What causes menstrual pain in the first place?
Every month, one of the ovaries releases an egg, and in preparation of the egg being fertilized, the lining of the uterus thickens and blood flow increases. If the egg is fertilized and becomes an embryo, it embeds itself into the uterine wall, where it has protection and the nutrients to grow.
If the egg is not fertilized, hormone-like substances called prostaglandins are released and the uterus starts to tighten and contract, which you feel as cramps. This allows the top layer of the uterine lining to be shed and expelled, along with blood and the unfertilized egg. Higher levels of prostaglandins are associated with more intense and painful cramps.
So, what helps to make menstrual pain better?
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can relieve pain by reducing the amount of prostaglandins produced.
If you have primary dysmenorrhea, pharmacists can be your best ally when it comes to deciding what pain medication would be helpful for your menstrual cramps. Usually, these medications can be found in the regular aisles of the pharmacy. Medications can help a lot.
However, remember to tell your pharmacist about your medical history, including your age. (Children and teens should not take aspirin (Acetylsalicylic Acid) because it is linked to Reye’s Syndrome.)
For example, it’s important for them to know if you’re a diabetic or have inflammatory bowel disease (IBD), and what medications and herbal supplements you’re taking. Once, the pharmacist has this information, they can help you select a safe and effective medication.
If your menstrual pain is not relieved by over-the-counter medications and your healthcare provider has ruled out all other possible causes for the pain, they may recommend a hormonal birth control e.g., oral contraceptive. When you take a hormonal contraceptive the lining of the uterus doesn't thicken as much, and bleeding is lighter. This helps to reduce menstrual pain.
Other than taking pain medications, what can you do?
-
Share what you're going through with people who are supportive — a family member, a friend, or a healthcare provider. More than likely, you will be met with empathy and people’s willingness to share their experiences, which can help you not to feel alone.
-
Have a warm bath or apply warmth to your abdomen, such as a heating pad or a hot water bottle. Warmth helps to improve blood flow and relaxes abdominal muscles, which can reduce pain.
-
If you have back pain, lie on your back with a pillow under your knees or on your side with your knees pulled up to your chest. These positions can help reduce back pressure.
-
Concentrate on breathing slowly and deeply. When we’re in a lot of pain, we tend to take shallow, rapid breaths and we become tense. Yoga and meditation can help with our breathing.
-
Exercise can improve blood flow and help to reduce pain. Go for a walk or do other activities that you enjoy, such as running, swimming, or cycling.
-
Do an activity that distracts you—work on your favourite hobby or listen to music.
Most importantly, show yourself self-compassion. If you’re feeling tired and unwell, listen to yourself and take the time to rest. That might mean not going to work or school. Or you may feel you need to take a break from sports or music practice. And that’s okay.
About the Author
Marina Rowbotham
Marina Rowbotham is a freelance health writer and registered nurse living in Ottawa. She is interested in how social issues, such as lack of safe and affordable housing and not having a family doctor or nurse practitioner, impact health. She is particularly interested in the effects this has on women and children, the LGBTQIA+ community, and Indigenous people and the possible solutions.
Sources
Government of Canada. (2006, December 7). Reye’s Syndrome.
HealthLinkBC. (2022, August 2). Menstrual Cramps.
Informed Health. (2023, May 12). Period Pain.
Jo, J. & Lee, S. H. (2018, November 2). Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific Reports.
NHS. (2023, May 2). 10 ways to reduce pain.
The Society of Obstetricians and Gynaecologists of Canada. (n.d.). Menstrual Pain and Other Symptoms.
Women and Gender Equality Canada. (2023, March). Attitudes and Awareness of Menstrual Equity and Period Poverty among Canadians.