Period pain or dysmenorrhea should be mild and respond to simple treatments like ibuprofen, zinc, or a dairy-free diet. If period pain doesn’t disappear with simple treatments, it could be endometriosis or adenomyosis.
Debilitating period pain is never normal.
Normal period pain
Normal period pain (primary dysmenorrhea) is a bit of 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 in your uterus and usually improves as you get older.
Severe period pain (secondary dysmenorrhea) is throbbing, burning, searing, or stabbing pain that lasts for many days and can even occur 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 dysfunction. It can get worse as you get older.
👉 Tip: Pain is not a symptom of PCOS.
How to treat normal period pain
Here are a few simple strategies for normal period pain:
Dairy-free diet. Removing normal cow’s milk from the diet is the simplest and most reliable way to relieve period pain. Avoiding dairy helps to reduce inflammation, histamine, and period pain, primarily by avoiding the inflammatory protein A1 casein. It can also help to avoid other inflammatory foods such as wheat, vegetable oil, and high histamine foods.
Magnesium is effective for both prevention and acute care of period pain. For example, you can take 300 mg of magnesium throughout the month to reduce prostaglandins. You can then take extra magnesium during your period to relieve the pain — just don’t take so much that you cause diarrhea.
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 routinely prescribe 30 mg of zinc.
Turmeric. Like magnesium, turmeric is great for both prevention and acute care. I recommend a daily dose of a standardized extract for prevention, and more capsules as needed during the pain. Turmeric also lightens periods.
Give yourself three months with these treatments. If you don’t notice substantial improvement, then ask yourself and your doctor: “Is something else going on?”
Do you have endometriosis?
Endometriosis affects one in ten women, and it’s not just painful periods. It’s actually a whole-body inflammatory disease that includes the presence of inflammatory lesions similar to uterine lining (endometrium) located in places other than inside the uterus. They’re called endometriosis lesions or endometriomas (chocolate cysts) and can cause widespread pain and scarring.
Pain is the main symptom of endometriosis, but it’s not the only symptom. Other symptoms include bleeding between periods, pain with sex, and a puzzling 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 pain-killers you take. Tell her the pain is so bad you can’t go to work. Ask her outright if it could be endometriosis.
Your doctor may be able to order a new type of ultrasound investigation that can detect endometriosis. However, a normal ultrasound cannot rule out endometriosis or adenomyosis.
Until we have a non-invasive test, laparoscopic or keyhole surgery is the only way to definitively diagnose and treat endometriosis. It sounds scary, but surgery is something you should at least consider because early excision surgery can sometimes eradicate the disease. Even when surgery isn’t a cure, it can significantly reduce pain.
For information, read Immune treatment for endometriosis.