Trina Palomarez, CNS
Herbs for painful periods
*This post was originally featured in the March 2018 edition of Aroma Culture Magazine
Painful periods. Every woman has experienced painful periods at some time in her life. Often the most notable and pronounced aspect of painful periods are menstrual cramps.
Dysmenorrhea is the clinical term for the labor like pain associated with menstrual cramping. It is best classified into sub categories of primary and secondary dysmenorrhea. Primary dysmenorrhea is painful cramping caused by uterine contractions that occur without any physical irregularity. This is the most common type of cramping women experience during their period.
Secondary dysmenorrhea is painful menstrual cramping due to a specific pelvic or systemic condition. Frequent causes of secondary dysmenorrhea include endometriosis, ovarian cysts, pelvic inflammatory disease, adhesions, fibroids, congenital malformations and narrowing of the cervical opening.
Menstrual cramps pose a significant problem for women of menstruating age. It is estimated that 50 percent of menstruating women are affected by cramping and about 10 percent have severe pain that renders them incapacitated for one to three days of each month.1 Unfortunately, painful cramping is not the only symptom associated with menstruation. Women can also experience nausea, vomiting, lower back ache, dull aching pain in the pelvic region, bloating, fatigue, diarrhea, weight gain, breast tenderness, headache, irritability and faintness along with cramping. Painful period symptoms can last for a few hours or up to two or three days depending upon the severity.
Why does this happen?
There are many factors that contribute to the pain and cramping of dysmenorrhea. Behavioral factors such as smoking, being overweight or even underweight have been related to more painful periods that last for longer lengths of time. Women who begin to menstruate at a younger age and have longer periods tend to have an increase in severity of pain and cramping.
Physiological factors include lack of blood flow to the uterus, called ischemia, and increased production and release of uterine prostaglandins. Prostaglandins are inflammatory chemicals produced in the body that are normally low in the first half of the menstrual cycle and early part of the second half.
As women approach their period, there is a sharp rise in prostaglandin levels causing uterine contraction that leads to ischemia and pain. Increases in prostaglandin production may be associated with the decline in progesterone levels prior to menses. Overproduction of prostaglandins are almost always associated with dysmenorrhea.2 Studies have found that women with dysmenorrhea produce 8 to 13 times more prostaglandin than women without dysmenorrhea.
Although there seems to be a natural hormonal component to the rise in prostaglandins prior to menses, there are many dietary and lifestyle components that can increase overall prostaglandin production. This altered production disturbs normal hormonal balance and directly contributes to more period pain. Foods rich in arachidonic acid, found in polyunsaturated fats such as cotton, soybean and safflower oils and animal foods, are directly used by the body to produce the series-2 prostaglandin (PgE2) that cause cramping.
Exposure to endocrine disrupting chemicals is also a major inflammatory trigger, creating hormonal imbalance that can lead to more painful periods. Endocrine disrupting chemicals enter our body via contact with pesticides, plastics, flame retardants, personal care products, household cleansers and pharmaceutical residues, creating higher levels of circulating estrogens. Estrogens naturally cause increased thickness in the uterine lining, with excess estrogens leading to more cramping and heavier periods as the lining is shed during menses.
Conventional approaches to pain relief due to menstrual cramping usually involve NSAIDS, a class of drugs known as prostaglandin synthase inhibitors such as ibuprofen, or the use oral contraceptives. Although both birth control pills and NSAIDS are highly effective for minimizing menstrual pain and reducing overall blood flow, they are also not without side effects and may not be appropriate choices for all women. NSAIDS and birth control pills have become such a standard protocol for cramps that many women are unaware of natural or alternative protocols for cramping. Luckily, there are many herbs, dietary modifications and lifestyle suggestions which can ease cramping, lower inflammation and create more harmonious and less painful periods.
There are a wide variety of herbs which are useful alternatives to NSAIDS and birth control for period pain. As cramping is one of the most common symptoms associated with period pain, antispasmodic herbs offer a valuable resource for pain relief. Herbs such as Crampbark (Viburnum opulus), Black Haw (Viburnum prunifolium) and Wild Yam (Discorea villosa) can be helpful for relaxing uterine tissue.
Both Black Haw and Crampbark are considered uterine tonics, improving circulation to the uterus and ovaries, while also possessing antispasmodic properties due to plant constituents such as scopoletin. Wild Yam, rich in anti-inflammatory steroidal saponins, is an effective antispasmodic for a variety of body systems and physical conditions including uterine contractions, muscular spasm, urinary tract spasm and intestinal colic.
Anti-inflammatory herbs such as Ginger (Zingiber Officinale) are also useful for cramping. Ginger is well known as a culinary herb with a medicinal cross over component. It has naturally stimulating properties, promotes the flow of bile from the liver and gallbladder, has a carmintive action, while also easing nausea and motion sickness. The pungent constituents in Ginger, shagol and gingerol, have an inhibitory effect on inflammation and spasmodic prostaglandins.
Traditionally Ginger is used to relax the smooth muscle of the intestines, but can have a relaxing effect on the uterine tissue which works well for cramping, pain and bloating associated with menstruation.
Black Cohosh (Cimicifigua Racemosa) is probably most well-known for its use in menopause, but it can be a beneficial ally for women with painful periods. Black cohosh has a relaxant effect on the uterus, acting as an antispasmodic, while also helping to improve uterine congestion associated with dysmenorrhea. If cramping is accompanied by PMS, anxiety, irritability, lower back ache, dull uterine pain or even irregular cycles, black cohosh can be of help. Black Cohosh has many hormonal balancing qualities. It has a regulating type of effect on estrogens, improving pain and also increases dopamine, which can improve mood.
Kava (Piper methysticum) is another supportive herb for painful periods. Its primary active constituent, kavalactone, possesses anticonvulsant, antianxiety and mild sedative properties. Kava’s strong smooth muscle relaxant action make it ideal for easing tense, aching and spastic muscles. Due to Kava’s relaxant effect on all muscles of the body, it can help create an overall sense of relaxation, which may provide a sense of wellbeing and improved mood.
Herbs with pain reliving properties are tremendously useful for cramping. California Poppy, a relative to the opium poppy (Papaver somniferum), contains analgesic and antispasmodic properties making it a useful herb for relieving pain. It can be helpful for chronic muscle pain, nerve pain, dental pain and pain associated with menstrual cramping. It is frequently used as a sleep aid for insomnia. Due to its sedative effects, it can also be used to support nervous tension and anxiety and may be supportive to emotional irritability associated with menses.
Corydalis (Corydalis turtschaninovii, Corydalis yanhusuo) is a Chinese herb that has received recent attention for its pain relieving properties. The tuberous rhizome is most commonly used medicinally, with tetrahydropalmatine, the most notable alkaloids in the plant, having both an anodyne and sedative effect on the body.
Corydalis is used for insomnia, cardiac arrhythmias, peptic ulcer, headache and dysmenorrhea. In addition to its general pain relieving properties, Corydalis has been shown to exhibit a positive effect on nerve pain. One Chinese study showed that 75 mg of THP (tetrahydropalmatine ) reduced nerve pain in 78% of patients tested.
Nervine herbs, although not a traditional treatment for cramping, may be of use for painful periods when combined with other antispasmodic, anodyne and anti-inflammatory herbs. Nervines have a calming effect on the central nervous system, subduing tension and stress.
Menstrual cramping can be associated with intense pain and labor like contraction. Utilizing nervine herbs to keep the mind calm and at ease, may play a role in lowering the sense of overall pain perception. Nervine herbs can also be helpful in lessening the emotional components of PMS, irritability and anxiety that may occur during menses.
Calming nervines include such herbs as Skullcap (Scutellaria lateriflora), Oats (Avena sativa), Linden (Tila platyphllos), Vervain (Verbena officianalis) or Lemon Balm (Melissa offinalis). Their gentle nature makes them an ideal choice for both adults and children, with many nervines having a pleasant flavor, suitable for tea formulations.
Diet and Lifestyle
Utilizing herbal formulas while also making changes in diet and lifestyle, may help to lower inflammatory prostaglandins and lessen severity of period cramping. Eating a low inflammatory diet, a plant based diet or limiting portion sizes of polyunsaturated fats while increasing consumption of vegetables will help to add fiber to the diet, lower arachidonic acid, remove toxins and excess hormones from the body. Maintaining a healthy body weight, avoiding smoking, limiting alcohol consumption, meditation and regular exercise have all been shown to be beneficial in easing cramping and period pain.
Herbs are a useful, and often overlooked tool for cramping and painful periods. They can provide a healthy alternative for women looking for substitutions to NSAIDS and birth control for the cramping, bloating, pain and malaise associated with menses. Herbs can be used singularly or combined into formulas for more comprehensive support for period pain. Herbal allies used along with diet and lifestyle modifications can provide gentle, safe and effective support for women wanting a more natural approach to pain relief.