Cramps and menstrual pain

Almost all women of childbearing age suffer from some disorder associated with menstrual flow, but for some the discomforts can be so significant as to significantly reduce the quality of life for one or more days a month. Epidemiological estimates indicate that only two out of ten women are lucky enough to pass through “those days” unscathed.

When symptoms such as pelvic and back pain that can also radiate to the legs, heavy bleeding, stomach cramps, gastrointestinal disorders (such as nausea, vomiting, diarrhea with semi-solid or liquid stools), headache, exhaustion and general malaise are such as to distract the woman from her usual activities, sometimes forcing her to stay in bed and resort to medication specific in an attempt to alleviate them, we speak of dysmenorrhea. A condition in itself benign and without sequelae for general health, but frankly difficult to bear every month, which affects about 10-15 percent of women of reproductive age.

Dysmenorrhea shows a certain degree of familiarity, meaning that the disorder tends to be found and to present similar physiological and psychoemotional characteristics in several women of the same family. The reasons for this phenomenon are not entirely clear, but it seems that, in addition to an unspecified genetic predisposition for the development of this condition, the attitude with which the period of flow and the associated malaise are faced may also play a role, which can be transmitted (more or less consciously) from mother to daughter.

Primary and secondary dysmenorrhea

Dysmenorrhea can be primary or primitive, i.e. not linked to a pathological organic cause, or secondary to other disorders or dysfunctions affecting the female reproductive system or other sites. In the first case, in general, intense menstrual pain is mainly linked to the increase in contractions of the uterine muscles and local inflammation that occur, together with other typical symptoms, from the first menstruation in conjunction with the flaking of the superficial layer of the endometrium, then accompanying the woman for the duration of fertile life and giving respite only after any pregnancies.

Secondary dysmenorrhea, on the other hand, can appear at different times in the woman’s life and is generally induced by a clinically detectable organic cause, such as inflammation of the uterus or fallopian tubes, the presence of cysts in the ovaries, endometriosis or even anatomical abnormalities of various types. In these cases, removing or treating appropriately the underlying problem, after a careful specialist visit (which includes a gynecological examination and any instrumental examinations such as transvaginal or abdominal ultrasounds), allows to eliminate all or most of the menstrual pain and associated disorders.

In order to plan any therapies and preventive interventions, it is important to point out that dysmenorrhea is a different thing from premenstrual syndrome. The latter, in fact, is a complex condition characterized by physical and psychological symptoms that occur in the period preceding the beginning of the flow (during which the loss of transparent or white secretions can be observed) and that end with the arrival of menstruation, that is to say just when dysmenorrhea begins.

Premenstrual syndrome occurs in the last phase of the menstrual cycle (second part of the luteal phase, corresponding to days 21-28 from the beginning of the previous menstruation), as a consequence of the physiological drop in female hormone levels. In women more sensitive to these hormonal fluctuations, physical and psychoemotional discomforts can begin immediately after ovulation (which generally occurs between the 12th and 16th day of the cycle) and, if they continue in the first days of menstrual flow, they add to the disorders of dysmenorrhea, aggravating them.

All the fault of hormones and prostaglandins

The onset of symptoms of primary dysmenorrhea is linked to hormonal changes characteristic of the first days of menstrual flow and the increased production of prostaglandins that follows, concentrated at the level of the reproductive and gastrointestinal system.

In addition to promoting the inflammatory response and lowering the tolerance threshold to painful stimuli (thus making it more sensitive to pain), prostaglandins stimulate the contractions of the muscles of the uterus and reduce oxygenation: two events that the body perceives as abnormal and potentially harmful, signaling them to the person concerned through pain.

In addition, it is believed that prostaglandins, by abnormally stimulating the gastrointestinal tract, may be at least partly responsible for the onset of nausea and vomiting and the alteration of transit and intestinal functions, as well as sometimes of real transient inflammatory intestinal disorders and related manifestations (diarrhea and abdominal swelling, frequent stimulus to go to the bathroom, colitis, intestinal cramps etc.).

The “classic” treatments against menstrual pain

In the forms of primary dysmenorrhea in which the cyclic discomforts are mainly due to excess prostaglandins, the simplest and most effective remedy to relieve abdominal pain and general malaise consists in the administration of non-steroidal anti-inflammatory drugs (NSAIDs), which act by “blocking” the production of these substances.

To obtain maximum effect, it is important to take NSAIDs (at the dosage indicated on the package or recommended by the doctor) from the very first symptoms because only by turning off the pain in the bud it is possible to prevent the stimulus from amplifying and take full advantage of the pain-relieving effects of these drugs. In addition to easing pain within a few tens of minutes, NSAIDs can also help relieve nausea. To avoid gastric problems, however, remember not to take NSAIDs on an empty stomach.

In some cases, to relieve significant and recurrent dysmenorrhea, the gynecologist may prescribe the pill or other estroprogestin contraceptives (patches, vaginal rings, etc.). The inhibition of ovulation and the decrease in blood loss that results from taking the pill have a positive impact on abdominal pain associated with menstruation.

Estimates indicate that the majority (about 80 percent) of women suffering from dysmenorrhea are able to derive a substantial benefit from taking estroprogestin contraceptives. A similar effect can also be obtained with intrauterine devices with slow release of only progestogen (medicated spiral). However, these solutions are effective and particularly welcome to women who wish to avoid pregnancies, but evidently not very appropriate otherwise.

Against menstrual cramps, especially if also characterized by an intestinal component, antispasmodic drugs can also be useful which, by reducing uterine contractions and muscles surrounding the digestive tract, allow to remove at least in part a safe source of pain.

In addition to conventional medicines, menstrual pain can also be alleviated with heat applied locally in the area where the discomfort is characterized by greater intensity, i.e. at the level of the lower abdomen or lumbar region of the back. To do this you can use simple homemade strategies such as a hot water bottle or heating pads (which are decidedly impractical outside the home or at work) or more comfortable and manageable adhesive self-heating bands, which can be purchased in pharmacies without a prescription.

Applied with light pressure and left in place for 8 hours, the heating bands, invisible under clothing, help to alleviate uterine and intestinal cramps and counteract the propagation of painful stimuli from the point of onset to the brain, offering significant relief from the main symptom of dysmenorrhea.

Fighting menstrual pains at the table

On every day of the month, including those of the menstrual period, women’s well-being and health find sure allies in healthy eating and regular physical activity. Two aspects that, often, are not taken into due consideration and that should instead always be optimized before resorting to pharmacological remedies against dysmenorrhea or in association with the latter.

On the dietary level, first of all the rule is to drink plenty of water (also to avoid states of dehydration in case of repeated episodes of diarrhea) and follow a varied diet, which does not exclude any food and that allows you to obtain all the macro and micronutrients necessary to ensure the perfect functioning and full efficiency of the body, without weighing it down. Fruits, vegetables, whole grains, vegetable or (to a lesser extent) animal proteins and quality vegetable oils remain the reference food categories,to be taken according to individual energy needs and expenditure.

Instead, theconsumption of animal fats should be as limited as possible, which provide arachidonic acid (precursor compound of prostaglandins, therefore with pro-inflammatory activity) and make digestion slower and more difficult, favoring the onset of bloating, abdominal cramps and headaches. An excess of animal fats in the diet also promotes weight gain, in turn a source of extra inflammation, absolutely to be avoided if you want to contain cycle disorders and more general health risks on the cardiovascular, metabolic, oncological level, etc.

To relieve menstrual pain and abdominal cramps, as well as the tension and nervousness that accompany the days of the flow and those that precede them, it is advisable to enrich the diet with foods that contain high amounts of tryptophan, such as legumes, cereals, dried fruits etc. This essential amino acid is, in fact, the precursor of serotonin (neurotransmitter primarily involved in the regulation of mood and sleep) and helps to promote relaxation and a better psychoemotional state. To facilitate intestinal absorption, the ideal is to associate foods rich in tryptophan with foods that contain B vitamins, such as brewer’s yeast, blue fish, egg yolk, liver, lettuce, broccoli, spinach and other green leafy vegetables, bananas, avocados, plums, dried fruits and flax seeds.

Almonds, hazelnuts, brewer’s yeast, bananas and dried apricots, as well as millet and buckwheat, also provide magnesium, zinc, potassium and other mineral salts very useful for the general balance of the organism and with a recognized favorable activity against the typical disorders of dysmenorrhea. In fact, these substances optimize nerve conduction and muscle contraction and help counteract water retention. Zinc also has specific antioxidant properties, which indirectly contribute to reducing the degree of inflammation in the body.

In addition to the table, these same essential micronutrients can be taken through targeted supplements of single principles or in the context of multivitamin and multimineral supplementation, advantageous on several fronts, especially in case of increased need (unbalanced or restrictive diet, periods of fatigue and stress, infections, etc.). It should be noted that magnesium, zinc, potassium and other antioxidant minerals, such as selenium, remain important even at the end of childbearing age, in the context of natural remedies useful to reduce menopausal disorders.

Finally, to combat intestinal disorders that may occur in conjunction with menstrual flow, it may be useful to restore a correct composition of the bacterial flora that populates the intestinal mucosa by taking probiotics, live microorganisms, usually bacteria or yeasts, which, administered in adequate quantities, bring a benefit to the health of the host.

Other remedies from nature

Always in consideration of the antioxidant and anti-inflammatory action, women suffering from dysmenorrhea should include in their recipes aromatic herbs and spices, such as ginger and turmeric, and often consume saffron, with sedative, antidepressant and antispasmodic properties (at the level of the digestive and reproductive system), particularly advantageous in counteracting both the disorders of the menstrual cycle and the symptomatology of the premenstrual syndrome.

In addition, during the menstrual flow and in the days preceding it, you can take chamomile and relaxing herbal teas, especially useful when the drop in estrogen hormones typical of this phase of the menstrual cycle is accompanied by irritability, nervousness, agitation and sleep disorders. In this regard, it should be remembered that sleeping well, for at least 6-7 hours every night, is essential not only to protect overall health, but also to avoid aggravating the fatigue that often accompanies menstruation and to ensure an optimal hormonal balance, thus reducing the risk of additional menstrual discomfort.

Always to promote relaxation and reduce the tendency to depressed mood that often anticipates and accompanies the flow, you can also take advantage of some essential oils with a specific activity on these fronts. The most used are those of jasmine, chamomile, marjoram, bergamot, lavender and mandarin.

In summary, the main natural remedies against cramps are:

If you choose to use them, it is important to buy products of certified quality (preferably in pharmacies or reliable herbalists) and use them sparingly, following the instructions indicated on the packages or provided by an experienced and competent herbalist / pharmacist. Essential oils can be applied directly to the skin (2-3 drops) or diluted in water, for an anti-stress evening bath, and are also useful against the emotional instability typical of the beginning of menopause.

Physical activity

Moving on to the physical activity chapter, it is almost superfluous to remember that taking advantage of every opportunity to move a little every day and practice sports or aerobic exercise for 30-60 minutes, at least 2-3 times a week, is a real “medicine” as it helps to stay healthy and fit, to release tension and stress, to improve mood and to prevent an incredibly wide range of pathological conditions, from cardiovascular diseases to osteoporosis, from osteoarticular disorders to diabetes, from obesity to depression.

Experience teaches that regular physical activity also helps to counteract the discomfort of the menstrual period and menopause thanks to its rebalancing action on the muscles (with consequent antispasmodic effect), on blood circulation (with improvement of both general cardiovascular performance and peripheral venous circulation), on lymphatic drainage (with reduced water retention and related swelling in the feet and legs) and on the psychoemotional state.

You don’t need to become Olympic champions to benefit from the favorable effects of movement: just a walk or a bike ride, preferably in the green of a park, or a swim in the sea or in the pool to immediately feel better and suffer less during the days of the cycle. In this regard, it should be remembered that fairly prolonged muscle work and metabolic activation also induce the production of endorphins, endogenous analgesic compounds that reduce sensitivity to pain and improve mood.

Both with a view to making physical activity easier and more beneficial and with the specific aim of reducing menstrual cramps and protecting general health, it is essential that women smokers suffering from dysmenorrhea abandon smoking, a known promoter and aggravating factor of the disorder. Similarly, it is advisable not to take alcohol.