Falling pregnant with my baby boy marked the end of my journey with painful periods. I was one of the lucky women who’s period pain simply didn’t return after birth. I always hated my period pain when I did get it, but with the exception of a few very heavy and painful periods as a teenager, my period pain was mostly tolerable. As I dive deeper into the hormone space I am confronted more with horrific period pain stories that come from women without a secondary dysmenorrhea diagnosis eg, endometriosis, adenomyosis, PID. I’m shocked to hear stories of women calling the ambulance due to period pain just so they could get morphine even when they do not have an underlying disease. I wanted to write this article not only because I am studying hormones but also because being a plant-based food blogger, I have been confronted with stories from women who say that switching to a plant-based diet made their period pain disappear. There is some research that confirms this to be true, but although eating more plants can and does help; it is not the only answer for everyone. I wanted to write this article to give an outline of what the research has to say about the underlying causes of period pain. This article does not address the management of period pain through different home remedies or the use of pain medication but rather hopes to reveal some of the underlying issues behind period pain. It also does not address the more serious conditions like endometriosis, adenomyosis PID etc which often requires a much more in-depth approach.
Improving period pain without the use of hormonal contraception (which only offers symptomatic relief and does not address or fix the underlying cause) takes a multi-faceted approach. It is not an easy fix and it’s usually something that requires a total lifestyle change.
Prostaglandins: The cause of period pain is due to the release of inflammatory prostaglandins which cause the uterus to contract to shed the lining. The more prostaglandins someone has, the more intense the period pain. Prostaglandins are a type of steroid hormone made directly from fat. There is evidence that suggests prostaglandins made from omega 3 fatty acids are anti-inflammatory and create less pain compared to omega 6 fatty acids. Eating a diet rich in omega 3 while also lowering omega 6 content will help to create more anti-inflammatory prostaglandins. There is some debate over the correct ratio between omega 6 and omega for as both are essential for health but most agree omega 6 to omega 3 ratio should ideally be 4:1, however, I have heard estimates that a standard diet is more like 25:1. Cutting out deep-fried foods, junk foods, and inflammatory vegetable oils and replacing these fats with omega 3 rich sources like chia seeds, walnuts, flax seeds, pumpkin seeds, hemp seeds as well as some algae and other sea plants can help to improve the balance between omega 3 and omega 6. Since omega 3s are more difficult to get from a normal diet, it is necessary to eat the above-mentioned foods daily and incorporate at least 2 TBSP a day if possible. Some fish are also an excellent source of omega 3 however fish are also highly contaminated with toxins accumulated in the oceans, these toxins cause inflammation which is known to make period pain worse. If you are not plant-based and choose to eat fish, be careful with the type of fish you consume (predator fish that eat other fish are more toxic than fish that just eat sea plants).
Inflammatory diet: The reason plant-based diets work so well for many people with period pain is that they are highly anti-inflammatory. There are a couple of studies that report improved period pain when switching to a vegan diet. There are also studies that rate meat and high sugar foods like soft drinks causative factors for period pain. The research on dairy and period pain is mixed. I’ve seen many discussions online about dairy being the main cause of period pain and that only A2 dairy from sheep and goats should be consumed. Since I myself have very minimal dairy I was so excited to dig into the literature and talk about just how bad dairy was for period pain. However, after a quick scan of the literature, I do not see this in the studies. Nearly all studies have shown that high-fat dairy is better than low-fat dairy but some studies have shown that high-fat dairy consumption actually helped to improve period pain compared to women who consumed no dairy at all. This is theorized to be because of the high amount of calcium in dairy (calcium helps with period pain). It is important to note that there are limited studies on dairy and period pain in particular, but there are studies on dairy and hormone balance and there is an association with dairy and various hormone imbalances. Dairy is also difficult to digest for many people. Anecdotally many women find major improvement from period pain when they cut out or eliminate dairy especially if there are digestive concerns. Excluding or limiting alcohol and caffeine has also been shown to be beneficial for period pain.
Overall the evidence suggests that reducing high-sugar “junk” or processed foods and increasing consumption of plant-heavy wholefoods, mono and polyunsaturated fats with an emphasis on omega 3 is associated with less period pain.
Stress: High cortisol produced by stress drives the inflammatory response and leads to all-round inflammation which is the main underlying cause of period pain. Chronic stress can also lead to other hormone imbalances that may also affect period pain. One study found that stress had the ability to increase PMS symptoms, including period pain by 4 times when stress was experienced 2 weeks before the beginning of a period. The most plausible explanation for this is that more prostaglandins are released in a higher inflammatory state due to stress as well as a drop in progesterone levels under stress. When the body is stressed, the pituitary in the brain down-regulates the production of progesterone in favour of cortisol. Progesterone is needed to counterbalance the effects of estrogen. Low progesterone is associated with heavier and more painful periods. It is important to remember that stress is not just situational, stress can be caused by many things like lack of sleep, too many toxins, emotional trauma, undereating or overeating, under-exercising or over-exercising as well as underlying infections and many other causes.
Hormone Imbalance: A hormone imbalance can indirectly lead to more painful periods. Excess prostaglandins are seen in high estrogen states. Excess exogenous (external) estrogen is due to an increased intake of estrogens from previous or current use of hormonal contraceptives containing synthetic estrogens as well as xenoestrogens in our plastics, beauty products, and cleaning supplies. Excess estrogen is also seen in estrogen-containing foods like meat and dairy (the same is not observed with high-quality phytoestrogens found in plants: read my phytoestrogens article here: https://hazelandcacao.com/how-phytoestrogens-affect-womens-hormones/).
Excess exogenous estrogen can also be due to poor liver and gut function. If estrogen is not excreted from the body, it will re-circulate and lead to excess estrogen. If the liver is burdened with too many toxins (eg, alcohol: one standard alcoholic drink can double estrogen levels) or if the liver does not have adequate nutrients to perform its job, it will not be able to metabolize estrogen properly. The gut also needs to be functioning well in order to get rid of excess estrogens (regular bowel movements at least once a day). Cruciferous vegetables like broccoli, cauliflower, kale, brussel sprouts, and cabbage are a good source of fiber which is important for adequate gut function and DIM (diindolylmethane- a compound that helps get rid of excess estrogen from the liver and gut). Broccoli sprouts are a particularly potent source of DIM and are wonderful for liver function.
Nutrient deficiencies: Some studies have reported certain nutrients being able to help improve period pain. It would then stand to reason that a deficiency in some nutrients can make period pain worse. Specific nutrients associated with period pain include Omega 3, calcium, vitamin D, vitamin E, and magnesium. As always it is best to get nutrients from whole foods as opposed to supplements as supplements are not always well-tolerated and can create imbalances. Adequate sunlight is the best source of vitamin D. Nuts, seeds, are great sources of calcium, magnesium, and vitamin E. Olive oil is also a great source of vitamin E. Leafy greens are good sources of calcium and magnesium. Dark chocolate is also a very high source of magnesium.
Muscle Tension: Period pain is significantly worse when uterine muscles are tight. This is why “age” has been shown to be the main causative factor in painful periods. It is normal and expected for younger women to have more painful periods. Young women have tighter uterine muscles. This is one of the reasons why pregnancy can greatly improve or completely irradicate period pain as the muscles expand and relax. Reducing stress, applying heat, gentle exercise, and massage can all help with muscle relaxation. Vitamin D and magnesium are crucial in helping to ease muscle contractions and help muscles relax. Magnesium has been shown effective in reducing period pain in preliminary studies. Many women find better relief by using a topical magnesium oil spray over the abdomen during that time of the month as opposed to ingesting oral magnesium supplements.
To summarise: Period pain is caused by inflammatory prostaglandins. The more generalized inflammation in the body, the more inflammatory prostaglandins will be produced. Although diet is a major contributor to inflammation for many people it is not the only aspect. Inflammation has many different causes for lots of people and so it is important to address the unique problems for each individual.
Personally for me, although switching to a plant based diet did help to improve my period pain overall, it wasn’t enough to completely remove it until I had my baby. In hindsight I can see that although I was plant-based, my diet was still lacking in adequate omega 3, I had an underlying mild anxiety disorder that took a long time to heal up, my liver function was probably compromised – not due to excess toxins but more likely due to the multiple nutrient deficiencies I had before changing my diet and I was well and truly very deficient in magnesium. All these things meant that going plant based was not the only answer for my period pain problem. I encourage you to have a look at your own lifestyle and figure out what things could be holding you back from a pain free period.