Normal period pain or dysmenorrhea should be mild and respond to simple treatments like ibuprofen, zinc, or a dairy-free diet.
If period pain does not respond to simple treatments, it could be something more serious such as endometriosis or adenomyosis.
Debilitating period pain is never normal.
Normal period pain versus endometriosis
Normal period pain (primary dysmenorrhea) is mild cramping in your lower pelvis or back. It occurs during the first day or two of flow and improves with ibuprofen. It doesn’t interfere with your daily activities.
Normal period pain is caused by the release of prostaglandins and usually improves with age.
Severe period pain (secondary dysmenorrhea) is throbbing, burning, searing, or stabbing pain that occurs during the flow and/or between periods. It doesn’t improve with ibuprofen and can be so bad that you vomit or miss school or work.
Severe period pain is caused by an underlying medical condition such as endometriosis or adenomyosis, or pelvic floor problems. It tends to worsen with age. Importantly, pelvic floor problems and non-endo causes of severe pain are common and often overlooked.
👉 Tip: Pain is not a symptom of PCOS.
How to treat normal period pain
Here are some simple nutritional strategies for normal period pain:
Dairy-free diet. By avoiding normal cow’s dairy, you can avoid the inflammatory protein A1 casein, thereby reducing inflammation, histamine, and period pain.
Magnesium. Taken daily, magnesium reduces menstrual cramps by reducing prostaglandins and relaxing the smooth muscle of the uterus.
Zinc reduces prostaglandins and improves blood circulation to the uterus. It did well in a 2015 clinical trial for the period pain of teenage girls. I usually prescribe 30 mg of daily zinc (taken with food or it can cause nausea).
Turmeric. Taken daily, turmeric or curcumin can reduce the prostaglandins and histamine that cause normal period pain. Turmeric can also lighten periods.
Give yourself three months with the normal period pain treatments. If your pain doesn’t improve, ask yourself and your doctor: “Is something else going on?”
Do you have endometriosis?
Endometriosis affects one in ten women and more than just painful periods. It’s actually a whole-body inflammatory disease associated with significant immune dysfunction.
Pain is the main symptom of endometriosis, but it’s not the only symptom. Other symptoms of endometriosis include bleeding between periods, pain with sex, and an array of digestive and bladder problems. For example, one of my patients suffered recurring bladder pain and was given multiple courses of antibiotics that didn’t help. She finally asked her gynecologist: “Could this be endometriosis?” On further investigation, it was discovered that yes, she did have endometriosis lesions on her bladder and urethra, and they were the cause of her bladder problems.
This kind of story is not uncommon. Endometriosis can take ten years to diagnose. Of all the teens who report chronic pelvic pain, 70 percent go on to be diagnosed with endometriosis.
Don’t let that happen to you. Don’t suffer a decade of crippling pain being told it’s “just period pain” and there’s nothing you can do. Watch the film Endo What? and speak to your doctor. Tell her how many painkillers you take. Tell her the pain is so bad you miss work. Ask to be referred to a gynecologist to discuss the possibility of endometriosis.
👉 Tip: Your doctor may be able to order a new type of ultrasound investigation to try to detect endometriosis.
Until we have a non-invasive test, laparoscopic or keyhole surgery is the only way to definitively diagnose and treat endometriosis. Early excision surgery is not a cure but can sometimes provide long-term relief.
For natural treatment ideas, see Immune treatment for endometriosis.
