CRAMPING HER STYLE

(How to help manage painful periods)
By Diane Dunniway, DNP, APRN, WHNP-BC

        It is a new school year with the promise of more open social activities, sports, and perhaps a part-time job for your teen daughter. However, she’s awake through the night with painful menstrual cramps, so how will she

have the energy to make it through the day? As a parent, you know how much she already missed due to COVID shelter-in-place last year. Here I will outline some simple steps so her painful periods do NOT have to cramp her style any more. (And although I am writing this for moms of teen girls, anyone with menstrual cramps can utilize the information provided. Maybe it is YOUR style that is “cramped?”)

Dysmenorrhea is the medical term for menstrual pain. It is estimated that up to 90% of women will experience it in their lives (1). Yet a woman’s body is amazing and there IS a purpose to the madness (shedding the lining of the uterus to get ready for the next cycle). However, in the process, chemical messengers called prostaglandins cause the uterus (made up of smooth muscle tissue) to contract, resulting in the cramps that are felt. Since the lining of the uterus has been thickening and changing to a more vascular lining, the uterus is also heavier in the pelvis. Many women can feel pressure and discomfort in their low back, pelvis, and thighs just before and during their periods, as well as nausea and fatigue.

So what can be done to alleviate the pain—or at least make it more manageable?

1. DECREASE INFLAMMATION

When inflammation goes down, prostaglandins (and thus pain) go down, so an anti-inflammatory diet is the number one change that can impact her pain. Basically sugar = inflammation. The typical teen diet of pizza, soda, chips, and other processed foods contributes to inflammation and thus more pain. Making some simple changes can make a huge difference. Here are some options you could try:

• Cauliflower crust pizza
• Increase in-season fresh vegetables and fruit
• Limit/avoid high fructose corn syrup and other processed sugars and foods

Let your teen decide and take ownership of these choices. But you can support her by keeping healthy alternatives on hand at home and in the car.

2. SUPPLEMENTS

1. 1. Magnesium Glycinate acts as a muscle relaxant (2). I have had girls tell me they feel this is a “miracle pill.” However, make sure to avoid magnesium citrate, as this can cause diarrhea, which is already more common around period time. This may also cut down on her use of NSAIDS like Ibuprofen which, if taken routinely, can lead to other issues for gut health, kidneys, and can even cause ovulation issues (where the follicle does not ovulate but instead becomes a cyst).
   2. Calcium and Vitamin D have been shown in some research to improve cramps (2, 3). I usually prefer a plant-based calcium such as AlgaeCal, and a D3 that also has vitamin K2 (the vitamin D helps absorption of the calcium and K2 pushes the calcium into the bones where it belongs). And don’t forget, getting out in the sun for natural vitamin D is always an option! Consider adding foods high in these vitamins such as:
      • Almonds
      • Broccoli
      • Smoothies with almond milk
      • Low sugar yogurt
      • Fatty, wild caught fish
   3. Omega 3s have been proven in research to decrease prostaglandins and improve cramps (4). That being said, most of my young female patients did not like taking a fish oil pill because they would complain of burping fish or feeling like they smelled like fish when they sweat during sports. (Though, if you choose a high-quality supplement, that is less likely.) They preferred the taste of Barlean’s Omega Swirl or Lemon Fish Oil. If your teen likes salmon, make sure that is on your menu as much as possible as well—just be sure to look for wild caught.
   4. B Vitamins have been shown to be of some benefit—especially vitamin B6 and B1 (5, 6). However, taking a high quality B-complex can be simpler and just as effective. I usually recommend finding one that is already methylated, since we are finding many women with genetic defects are not able to methylate their vitamins. (What that also means is that these women often cannot methylate and get rid of their estrogen.) Methylated vitamins can be found at local compounding pharmacies or natural food/supplements stores.

3. WATER! WATER! WATER!

Water acts as a smooth muscle relaxant, so encourage your daughter to keep a water bottle with her (glass or metal, not plastic—to avoid BPA), and encourage water throughout the day. Since caffeine constricts and dehydrates, it is also important to avoid caffeine! Maybe she would be willing to try a naturally decaffeinated herbal tea instead of the latte from the local coffee shop?

4. HEAT

A warm bath can relax muscles that are tense from pain and reduce pain. Putting Epsom salts in the water may be another way to get magnesium (especially if your daughter does not like taking pills). A heating pad can be of benefit, or another over-the-counter heat wrap product applied to the low abdomen

5. MOVEMENT/DEEP BREATHING

Destressing with low impact exercise for endorphin release can also help overall. Deep breathing, prayer, meditation—some of the same things you were most likely taught to help with contractions during labor—can also help the pain during her period. When I was teaching a prenatal class about some of the breathing techniques for labor, one of our staff members who was having dysmenorrhea that same day told me afterwards that she performed it with us and it really helped her cramps. (On the positive side, when I worked Labor & Delivery, I noticed those with a history of dysmenorrhea often tolerated labor better since they would often tell me, “I have had menstrual cramps worse than these.”)

Although dysmenorrhea can be painful, it is usually not a concern if easily managed. However, there are times that call for further investigation. Here are some red flag signs to be aware of:

1. Acute pain that started suddenly and is not getting better
2. Bleeding heavily to the point of feeling as if she is going to pass out
3. Any chance of pregnancy
4. Fever/chills
5. Risk of sexually transmitted disease, along with any of the above symptoms

If you or your daughter have any of these red flag signs, seek out care at your nearest emergency room.

I know these guidelines seem almost too simple. However, I have seen them enable a young woman to go off previously prescribed narcotics and anti-nausea pills and NOT miss school or work days due to cramps. Most gynecologists will suggest starting birth control pills, but those also come with their own set of side effects.

Another benefit to this dysmenorrhea protocol is that it can ALSO help the PMS that often can precede the period as well. So increased peace and less drama may also result for your household.

DISCLAIMER: The medical advice found in this article is based on scientific studies and this doctor’s experience. Before trying at-home remedies, be sure to check with your general practitioner to make sure these remedies may be a good fit for your personal health. Neither Dr. Dunniway nor Construction Beauty Magazine guarantees positive results, nor are they responsible for any reactions that may result from trying these remedies.

References:

1. Ju, H., Jones, M. & Mishra, G. (2014). The prevalence and risk factors of dysmenorrhea. Epidemiologic Reviews, 36(1). 104-113. Published online: 26 November 2013. Doi: https://doi.org/10.1093/epirev/mxt009
2. Charandabi, SMA et al. (2017). Calcium with and without magnesium for primary dysmenorrhea: a double-blind randomized placebo controlled trial. International Journal of Women’s Health & Reproductive Science; 5(4), 332-338. Published online: April 2017. Doi: https://doi.org/10.15296/ijwhr.2017.56
3. Abdi, F. et al. (2021). Role of vitamin D and calcium in the relief of primary dysmenorrhea: a systematic review. Obstetrics & Gynecology Sciences 64 (1), 13 -26, 2021. Published online: 7 January 2021. Doi: https://doi.org/10.5468/ogs.20205
4. Sadeghi, N. et al. (2018). Vitamin E and fish oil, separately or in combination, on treatment of primary dysmenorrhea: a double-blind, randomized clinical trial. Gynecological Endocrinology, 34 (9), 804-808. Published online: 15 March 2018. Doi: https://doi.org/ 10.1080/09513590.2018.1450377.
5. Nayeban, S., et al. (2014). A Comparison of the Effects of Vitamin E and Vitamin B1 on the severity and duration of pain in primary dysmenorrhea. Journal of Midwifery and Reproductive Health, 2(2), 143-146. Doi: https://doi.org/10.22038/jmrh.2014.2397
6. Randabunga, E., et al. (2018). Effect of pyridoxine on prostaglandin plasma level for primary dysmenorrheal treatment. Indonesian Journal of Obstetrics and Gynecology (6)4, 239-242. Doi: https//doi.org/10.32771/inajog.v6i4.848