Why Your Menstrual Cramps are So Painful
Posted by Courtney Mayszak, RDN, LDN
Mar 24, 2021
This information is for educational purposes only. It is not a substitute for professional medical advice, and is not intended to diagnose, treat, cure, or prevent any condition.
If you’ve ever muttered “is this normal? This can’t be normal...” to yourself while in the throes of period cramps, keep reading.
This article explains:
- Why your period hurts
- What’s a “normal” amount of pain to experience during menstrual cramping
- Why some people’s period cramps are worse than others’
- How to stop period cramps from happening
“Why does my period hurt?”
Periods involve shedding an organ, which isn’t painless.
About a week before your period starts, if you’re not pregnant, your body’s levels of the hormone progesterone rapidly drop. This hormonal dive triggers the production of prostaglandins in the uterus.
Prostaglandins are hormone-like messenger molecules that cause inflammation in certain scenarios. The specific type of prostaglandins that accumulate in your uterus before your period are pro-inflammatory because they’re responsible for helping the uterus shed its lining as a period.
Prostaglandins make the muscles in the uterus contract, or tighten up, which helps detach the uterine lining and starts your monthly bleed. The uterine muscles are so powerful, they can pinch off the blood vessels that supply the uterus with oxygen when they contract. All muscles need oxygen to function, and when oxygen is in short supply, it hurts. That pain is a period cramp.
Uterine prostaglandins can cause contractions and pain in muscles near the uterus as well, like the bowels (resulting in period poops) or the hips, back, and thighs.
Mild period cramps are “normal”
Some prostaglandin build-up in the uterus is needed to help set your period in motion.
When prostaglandins are produced in healthy amounts, the uterine lining can be shed with only mild cramping (i.e. pain scores of 1-3 on a 10-point scale, with 10 being the worst pain imaginable).
When prostaglandins are overproduced, they trigger muscle contractions that are far more powerful than what’s needed to shed the uterine lining, and result in moderate to severe cramping (i.e. pain scores of 4-10 on a 10-point scale).
Mild period cramps are considered to be “normal” because pain that’s beyond mild can indicate prostaglandin overproduction, which may be a sign of increased inflammation in the body overall, or an underlying issue.
We’ll note, however, that when it comes to period pain, what’s “normal” or healthy isn’t always what’s most common. While period cramps of any severity are very common and affect up to 95% of women, in one large American study, only 27% of women had mild period cramps. 54% had severe cramps, and 19% had severe cramps in multiple locations, coupled with gastrointestinal symptoms.
It’s never considered “normal” for period pain to cause you to miss school or work, limit your social life, or interfere with your ability to enjoy daily activities.
Research shows any recurring menstrual pain can have negative downstream effects on our mood, sleep, sensitivity to pain, overall quality of life, and may predispose people with cramps to other painful chronic conditions.
“But why are *my* menstrual cramps so painful?”
Some people get worse period cramps than others.
Period pain is directly correlated with the amount of pro-inflammatory prostaglandins in your uterus at the start of your period. The greater the amount of prostaglandins, the worse your cramps will be.
A number of genetic and environmental factors may cause you to overproduce pro-inflammatory prostaglandins, but scientists don’t completely understand them yet.
They do know that the prostaglandins that cause period pain are produced in the uterus from arachidonic acid—a type of fatty acid that lives in our cell membranes, and we also get it from food.
The hormone progesterone has a stabilizing effect on the uterine lining. When progesterone drops at the end of your cycle, the uterine lining destabilizes and starts to break down. The body takes the arachidonic acid in the broken down uterine tissue, and uses it to make prostaglandins.
This may be why some researchers have found that people who started menstruating at a younger age, or who have longer and heavier flows get more period pain; they may have a more developed uterine lining at the beginning of their periods, and thus more arachidonic acid to make into prostaglandins.
Top food sources of arachidonic acid include chicken, turkey, red meat, and eggs. While these foods also offer other nutrients that help support menstrual health, overdoing it on high arachidonic acid foods may contribute to more inflammatory prostaglandins, and more period pain.
Habits that contribute to inflammation like drinking alcohol and smoking cigarettes have also been linked to worse period cramps.
Lastly, everyone processes pain differently. According to Laura Payne, PhD, period cramp expert and Director of the Clinical and Translational Pain Research Lab at Harvard Medical School, “All pain is processed in the brain in relation to many other aspects of our lives, whether it’s our thoughts and memories, our mood, our own genetic make-up, biological sensitivities, past experiences, or traumas.” Any of these factors may cause you to feel more period pain in response to the same amount of prostaglandins compared to another person.
How to stop period cramps from happening
Over-the-counter painkillers like ibuprofen, Midol, and Advil are the most common way to treat period cramps. However, these drugs reduce many different types of prostaglandins—including ones that are actually good for you—resulting in more potential side effects.
We created Cramp Aid to be a safer option that’s just as effective. Cramp Aid is formulated with research-backed nutrients and herbs that fight cramps at every step of period pain cascade, even steps that over-the-counter painkillers can’t touch:
- Ginger and calendula are anti-inflammatory powerhouses that help prevent the overproduction of pro-inflammatory prostaglandins in the uterus.
- Dong quai and fenugreek are antispasmodic herbs that help relax uterine muscles, preventing them from contracting too powerfully.
- Zinc and B vitamins help boost the flow of oxygen to the uterus, preventing the cut-off of oxygen to the uterus and the painful cramps that follow.