Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

It’s common for women to feel discomfort around the abdomen, lower back and thighs when menstruating. During periods, the muscles of the womb contract and relax to help shed the built-up lining. Sometimes women can experience cramps, which means their muscles are at work. Some people may also experience:
* Nausea
* Vomiting
* Headaches
* Diarrhoea

The cause is not clear as to why some people who menstruate experience painful symptoms and others don’t. Some factors associated with more intense pain include:
* Having a heavy menstrual flow
* Having their first child
* Being under the age of 20, or just starting their period
* Having an overproduction of, or sensitivity to, prostaglandins – a type of compound in the body that influences the womb
Other factors include:
* Growths in the uterus
* Endometriosis (abnormal uterine tissue growth)
* Use of birth control

For mild to temporary cramps, some home remedies can help provide relief. Here are some tips on getting fast relief and learning how to potentially lessen the pain during the next menstrual

1. Taking over-the-counter
(OTC) medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary over-the-counter (OTC) form of pain relief recommended for menstrual pain and heavy menstrual bleeding. NSAIDs include ibuprofen (Advil) and Diclofenac.
These drugs help lower the body’s production of prostaglandin. NSAIDs are not as effective as oral contraception at lowering prostaglandin, but they can help reduce pain.

2. Applying heat
Applying heat to the abdomen and lower back may relieve pain. A 2018 review of studies found that heat therapy (usually a heat patch or pack) was as effective at treating menstrual pain as NSAIDS. It also may cause fewer side effects. However, the authors noted that more research is needed. If persons don’t have a hot-water bottle or heating pad, take a warm bath or use a hot towel. Or, they can make their own heating pad:
1. Cut and sew together two pieces of fabric, leaving a hole at the top.
2. Fill with uncooked rice and sew up the hole.
3. Microwave for a few minutes to the desired temperature. Don’t overheat!
4. Let cool, if necessary. Or, wrap the homemade pad in a towel to reduce heat transfer. Reuse as necessary.

3. Massaging with
essential oils
Massage therapy for about 20 minutes can help. Massage therapy for menstruation involves pressing specific points while the therapist’s hands move around a woman’s abdomen, side, and back. Adding essential oils for an aromatherapy style of massage may have additional benefits.
A 2018 review of studies found that massage therapy and aromatherapy can reduce menstrual pain. Some essential oils that may help include: lavender, peppermint, rose, fennel

4. Having an orgasm
While there are no clinical studies on the direct effect of orgasms on menstrual cramps, science suggests it may help. Vaginal orgasms involve the whole body, including the spinal cord, which signals the release of neurotransmitters. A vaginal orgasm can trigger the brain to release neurotransmitters such as endorphins and oxytocin. Endorphins can decrease pain perception.

5. Avoiding certain foods
During menstruation, it’s a good idea to avoid foods that cause bloating and water retention. Some of the biggest culprits include fatty foods, alcohol, carbonated beverages, caffeine, salty foods.
Reducing or cutting out these foods can help alleviate cramps and decrease tension. Try soothing (caffeine-free) ginger or mint teas, or hot water flavoured with lemon instead. In case a sugar fix is needed, snack on fruits such as strawberries or raspberries.

6. Adding herbs to dietary meals
These herbal remedies contain anti-inflammatory and antispasmodic compounds that can reduce the muscle contractions and swelling associated with menstrual pain.

Curcumin, a natural chemical in turmeric, may help with symptoms of premenstrual syndrome (PMS). A 2015 study looked at 70 women who took two capsules of curcumin for 7 days before their period and 3 days after. Participants reported a significant reduction in PMS symptoms.

Always make sure the purchase of herbs and supplements is from a reputable source, as they are not regulated. While most of these herbal remedies have few side effects, check with a doctor before trying them.

Some herbs may also cause unintended side effects, especially if they’re taken with medication. Most of these herbs and supplements also do not include specific instructions for menstrual periods. The doctor may have more information on dosage recommendations.

Maintaining a healthy diet and keeping up a regular exercise regimen can go a long way towards preventing menstrual pain. A 2016 study of 250 women found significant differences between period pain in women who maintained a nutritious diet, exercised regularly, and reduced stress.

Generally, a diet geared toward decreasing menstrual pain should be high in minimally processed foods, fibres, and plants.
Give these foods a try:
* Papaya is rich in vitamins.
* Brown rice contains vitamin B6, which may reduce bloating.
* Walnuts, almonds, and pumpkin seeds are rich in manganese, which eases cramps.
* Olive oil and broccoli contain vitamin E.
* Chicken, fish, and leafy green vegetables contain iron, which is lost during menstruation.
* Flaxseed contains omega-3s with antioxidant properties, which reduce swelling and inflammation.

Boron is a mineral that helps the body to absorb calcium and phosphorus. It also reduces menstrual cramps.
A 2015 study that looked at 113 university students found that boron reduced the intensity and length of menstrual pain.

Foods with a high concentration of boron include: avocados, peanut butter, prunes, chickpeas, bananas.

Women can also take boron supplements if their diet doesn’t provide enough. However, they should consult their doctor before taking boron supplements.

It sounds odd, but drinking water keeps the body from retaining water, and helps to avoid painful bloating during menstruation. Warm or hot water is usually better for cramps, as hot liquids increase blood flow to the skin, and may relax cramped muscles.

Hydration can also be increased by eating water-based foods, including lettuce, celery, cucumbers, watermelon, berries, including strawberries, blueberries, and raspberries

This mineral can help reduce muscle cramping during menstruation. Foods high in calcium include: dairy products, sesame seeds, almonds, and leafy green vegetables.
Calcium is also available in supplement form.

The idea of exercising immediately before or during a period may not appeal to everyone, but exercise releases endorphins.
Research suggests exercise is effective at reducing menstrual pain to the extent it may also eliminate or reduce the need for pain-relief medication.

Moderate activity such as walking can be beneficial during a period in place of more strenuous activity.

Yoga is a gentle exercise that releases endorphins, and can help prevent or reduce menstrual symptoms. One study compared the effects of aerobic exercise and yoga on PMS symptoms. The researchers found that both yoga and aerobic exercise significantly reduced PMS symptoms and pain intensity. However, yoga was more effective than aerobic exercise at reducing symptoms.

Women should contact a healthcare worker if they have severe pain and very heavy bleeding.
* The pain consistently prevents persons from doing day-to-day activities
* The pain worsens, or bleeding gets heavier over time
* Over 25 years old and severe cramps are a new development
* OTC medication doesn’t work.

For severe cases, the best way to get treatment is for a doctor to diagnose the cause of the menstrual pain.