Period pain is considered normal for many otherwise healthy women, but it doesn’t have to be. In fact, I would even argue that it shouldn’t be. Sadly, the medical system is broken when it comes to women’s health, and taking a deep dive into the root cause of problems like painful periods isn’t the usual protocol. Instead, the accepted standard of care is to write off symptoms as PMS, or give a prescription for birth control and some well-wishes.

But first as a woman, and second as a functional medicine doctor, I definitely do not see this as an acceptable standard for care, mostly because I know that there are other options that are not only more effective, but also much safer than the pill. Let’s dive in…

A few things to keep in mind as you read this post:

There are many reasons for abnormally painful periods and this post covers just three of them. But more importantly, if you’re struggling with painful periods, or any other symptom, it’s extremely important that you discuss your concerns with a licensed healthcare provider. There are many factors that could be at play, and you deserve to be heard and cared for in the very best possible way.

If this post inspires you, that’s great! That’s the intention. But please, remember that the information on this post or anywhere else on this blog is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

3 Reasons for Painful Periods

As I noted above, there are many women’s health diagnoses that have period pain as a symptom—things like endometriosis, fibroids, PCOS, and more. In this post, I’ll be chatting about reasons for period pain in women who don’t have a formal diagnosis. However, even if you do have an existing diagnosis, addressing some of these issues may actually help improve your symptoms.

1) Hormone Imbalances

The menstrual cycle can be divided into two main parts: the follicular phase (pre-ovulation) and the luteal phase (post-ovulation). We typically think of estrogen as the “main” hormone of the follicular phase, and progesterone as the “main” hormone of the luteal phase, but really? Both are present and working all the time, just at different levels.

Sometimes, the relative proportion of estrogen and progesterone (in relation to each other) fall out of balance, and this can cause symptoms like cramps and other forms of menstrual pain. For example:

During the luteal phase (after ovulation), the menstrual lining starts to build up in case the egg is fertilized. Estrogen’s job is to build up the lining, directing blood flow and tissue growth in the uterus, whereas progesterone’s job is to keep things from getting out-of-control, so to speak. If estrogen levels are disproportionately high in relation to progesterone levels (i.e. estrogen dominance), the uterine lining will become more robust, often leading to a heavy period with clots, which may be painful to pass. Additionally, high estrogen levels lead to higher levels of prostaglandins in the uterus, which causes higher levels of inflammation and pain (see point #3).

Estrogen dominance and progesterone deficiency are just two examples of hormone imbalances that can cause period pain. Other hormones like cortisol and thyroid hormones (especially hypothyroidism) affect the menstrual cycle and can cause symptoms such as pain.

For more details about female hormone changes during the cycle, check out these posts:

2) Feminine Protection Products

I would give a TMI warning but really? I don’t think periods should be a taboo subject anymore. Frankly, ever person alive is here because of the functioning of a woman’s reproductive system, and I think we all could stand to understand it a little bit more. So, yes…we’re going there.

Tampons are convenient, but not if they’re causing painful cramps—and yes, tampons can cause or worsen cramps if they aren’t inserted correctly. Take a look at the graphic above. The tampon pictured is right up against the cervix. When the uterus contracts to expel blood, it will bump up against the tampon causing pain, kind of how punching a wall hurts a lot more than punching into the air.

Instead, angle the applicator downward. By pointing the applicator downward (and relaxing during insertion), the tampon will be able to reach an area of the vagina called the posterior fornix, which is behind the opening of the cervix. Then, instead of bumping into the tampon, which is held firmly in place by the muscles of the vagina, it will slide past the tampon, which is much more comfortable.

However, some women have cramps no matter where the tampon is located. Alternatively, you can use pads or a menstrual cup. The Diva Cup takes a little getting used to (you’ve gotta be up close and personal with your lady parts) but rather than stopping at the cervix, it encircles it, eliminating any possibility of bumping and pain. The plus side of a menstrual cup is that it only needs to be changed every 12 hours, rather than 4-6.

Another reason women tend to tolerate pads or menstrual cups better is because most brands of feminine hygiene products contain preservatives and bleaching chemicals that can irritate the vagina, increasing the local levels of inflammation and causing pain. (More on inflammation in point #3). For this reason, I typically recommend keeping foreign objects out of the vagina and instead using external protection (pads), a menstrual cup (made from silicone), or organic tampons such as seventh generation, Rael, Tampax pure, or OB Organic.

3) Inflammation

When you have cramps? What do you do?

If you handle it the way I did for many years, you pop an Advil, take a nap, and pray that you feel better in an hour. And, if you’re like me, it works.

That’s because napping and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen both reduce inflammation in the body, and it’s inflammation that’s responsible for period pain.

The inflammation caused by a period comes from chemicals called prostaglandins, which are naturally produced in the lining of the uterus to trigger contractions during menstruation and labor. In addition the triggering muscle contractions, these prostaglandins also create low-grade inflammation , which is perceived as pain in the pelvic area (i.e. cramps).

Whenever we have a localized area of inflammation, we have pain. This pain can vary in intensity, but in general, the higher the level of inflammation, the worse the pain is. That’s why bumping your shin on the corner of the bed hurts, but not as badly as breaking your leg would. The injury is much worse in the latter case. However, bumping your shin on the bed hurts more when you already have a bruise from doing the exact same thing the day before, or if you have a sore leg from running a marathon, or if your whole body is sore because you have the flu. That’s because in each of those cases, there is pre-existing inflammation in the body and the higher the level of inflammation, the worse the pain is.

The same is true with the localized inflammation in the uterus during menstruation. The naturally produced (and very necessary) prostaglandins in the uterine lining cause some inflammation, enough to produce mild cramping during the first couple days of a period. However, if there’s already a heightened degree of inflammation in the whole body, be it from chronic stress, poor nutrition, crash dieting, over-exercising, illness, or otherwise, the total amount of inflammation in and around the pelvis is higher. The higher the level of inflammation, the worse the pain is.

No matter the reason for the period cramps, whether due to a hormone imbalance, endometriosis, fibroids, or anything else, reducing the total amount of inflammation in the body will decrease the level of pain.

How to Naturally Reduce Inflammation

Acupuncture: this is probably my #1 recommendation for co-management of care with women’s health concerns in practice. Traditional Chinese Medicine is incredibly powerful in terms of its ability to help balance hormones, reduce stress, and decrease the inflammatory response.
Nutrition: Not eating enough, or enough of the right nutrients, can create imbalances that lead to heightened inflammation. Some of the most common nutritional deficiencies that predispose women to painful periods include omega-3 fatty acids, magnesium, and vitamin D. Talk to your doctor about having your levels checked.
Musculoskeletal Problems: Tight muscles are painful muscles, and if you’re dealing with chronically tight and painful muscles, that probably means you’re also dealing with high levels of inflammation in your whole body. I’m always amazed by how much better I feel when I rub epsom salt lotion into sore shoulders, massage out the knots in my neck with my acucurve self-massager, or stretching out on my foam roller.
Sleep: Poor sleep causes all kinds of problems, not just in terms of periods. Not getting enough sleep is interpreted by the body as a chronic form of stress, and pretty much all other health efforts will be blunted if you’re not sleeping enough. Adults need 8-10 hours per night.

In general, it’s not normal to feel awful during your period. While I’m a firm believer that menstruation is a natural process (and therefore it’s normal to feel different at different times of the month), but if your period is getting in the way of your ability function, that’s not okay. You deserve to find out what’s going on so you can feel your best and live a fulfilling life.