Nutrition Strategies For Menstrual Pain

In this episode, we explore the pathophysiology of painful menstrual periods and review what the research says about dietary strategies for reducing pain.

From vitamin D and magnesium to caffeine, we highlight the evidence, proposed mechanisms, and study strengths behind each intervention. This episode is packed with clinical pearls for dietitians looking to support clients with food-first, evidence-based menstrual care.

Visit the whnlearninghub.com for more learning opportunities.  

References: 

Brown, N., Martin, D., Waldron, M., Bruinvels, G., Farrant, L., & Fairchild, R. (2024). Nutritional practices to manage menstrual cycle-related symptoms: A systematic review. Nutrition Research Reviews, 37(3), 352–375. https://doi.org/10.1017/S0954422423000227

He, Z., Chen, R., Zhou, Y., & Li, Y. (2009). Effect of Vitex agnus-castus extract on primary dysmenorrhea. Chinese Journal of Integrative Medicine, 15(6), 456–460.

Jafari, A., Alimoradi, Z., Khosravi, A., & Khedmat, L. (2019). The effect of zinc on primary dysmenorrhea: A double-blind randomized clinical trial. Journal of Pediatric and Adolescent Gynecology, 32(2), 121–125. https://doi.org/10.1016/j.jpag.2018.10.003

Kashanian, M., Akbarian, A. R., & Baradaran, H. (2013). Evaluation of the effect of vitamin E on primary dysmenorrhea. Archives of Gynecology and Obstetrics, 287(3), 527–530. https://doi.org/10.1007/s00404-012-2582-5

Moini, A., Javanmard, F., Hosseini, R., Ebrahimi, S., & Kashani, L. (2016). The effect of vitamin D on primary dysmenorrhea with vitamin D deficiency: A randomized double-blind placebo-controlled clinical trial. Gynecological Endocrinology, 32(6), 502–505. https://doi.org/10.3109/09513590.2016.1140897

Najafi, N., Khalkhali, H., Tabrizi, F. M., & Zarrin, R. (2018). Major dietary patterns in relation to menstrual pain: A nested case-control study. BMC Women's Health, 18, 69. https://doi.org/10.1186/s12905-018-0558-4

Saei Ghare Naz, M., Kiani, Z., Rashidi Fakari, F., Ghasemi, V., Abed, M., & Ozgoli, G. (2020). The effect of micronutrients on pain management of primary dysmenorrhea: A systematic review and meta‐analysis. Journal of Caring Sciences, 9(1), 47–56. https://doi.org/10.34172/jcs.2020.008

Turner, W., Steele, N., & Carr, C. (1993). A double-blind clinical trial on a herbal preparation containing Vitex agnus-castus. British Homeopathic Journal, 82(4), 177–183. https://doi.org/10.1016/S0007-0785(05)80126-5

Zarei, A., Eslami, M., Khodakarami, B., & Dashti, M. (2016). Comparison of the effects of calcium plus vitamin D and calcium alone on dysmenorrhea: A randomized clinical trial. Obstetrics & Gynecology Science, 59(6), 465–471. https://doi.org/10.5468/ogs.2016.59.6.465

Transcript

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Hi, and welcome to the Fem Health Nutrition Podcast. I'm Nilou Deilami, a registered dietician and founder of the Women's Health Nutrition Learning Hub, a platform where dieticians and nutrition professionals can learn, connect, and collaborate on all things related to female health and nutrition. If you haven't already, you can check out the website at w hn learning hub.com. The link is also in the episode description. This podcast is intended as an educational podcast for dieticians, healthcare professionals, and anyone interested in female health and nutrition. The content covered in this podcast is not intended as medical advice, and if you have any questions or concerns about your health, please consult with your healthcare team. Now before we get started, there is an announcement that I wanted to share the menopause course for dieticians and nutritionists will be available Sometime on the week of April 21st. So if you are interested in that and you're part of my email list, you will. Get a notification. If you're not on the email list yet, you can head over to whnlearninghub.com and join the email list, and you can either just join the wait list for the course or if you're interested, you can also sign up for the biweekly newsletter as well, where I send out research updates and practical clinical tips, you'll also be the first to know about offers and updates to courses and everything that I'll be offering through the Women's Health Nutrition Learning. All right, so let's get into the content for today. So the episode today is dedicated to menstrual pain and specifically primary dysmenorrhea, so we're going to break down what it is, how it's actually different from something else called secondary dysmenorrhea, and we're going to explore some of the mechanisms behind the pain and dive into evidence-based nutrition interventions that may help reduce its severity. We'll also talk about some non nutrition interventions as well. So, as I mentioned, the focus today will be on primary dysmenorrhea. So dysmenorrhea in general refers to menstrual cramps or painful menstrual periods, that originate in the uterus. And there are two types. So you have primary dysmenorrhea, which is painful periods without any underlying pelvic pathology, and it typically begins within six to 12 months of menarche, which is that first menstrual period in adolescence. and tends to be the most intense in adolescents and people under 30. Secondary dysmenorrhea, which is outside of the scope of this particular episode, is caused by an underlying condition such as endometriosis or fibroids, adenomyosis, pelvic inflammatory disease. There can be many different reasons for it. For most people it usually starts a little bit later in life and tends to progress and worsen over time. Primary dysmenorrhea or painful periods is very common and can affect around 60 to 70% of adolescents and young adults, and even up to 90% in some populations, depending on how they classify and define primary dysmenorrhea. Yeah. So what causes the pain? The pain is related to excessive uterine contractions that are driven by the release of prostaglandins. Prostaglandins are lipid compounds that are derived from fatty acids and they're also pro-inflammatory. And what they do is that they stimulate the contraction of uterine muscles. They can also lead to a constriction of blood vessels and can increase pain sensitivity. In people with primary dysmenorrhea, prostaglandin levels are elevated, leading to stronger and more painful contractions and that can ultimately lead to lower abdominal cramping that can also radiate to the back or thighs sometimes. That's why NSAIDs like your Advil or Naproxen, are recommended as first-line treatments a lot of the time because they can actually inhibit prostaglandin synthesis. Now, in terms of symptoms, typically there can be cramping that starts from one to two days before menstruation up to one to two days after menstruation. If it's very severe, it can be accompanied by nausea, vomiting, digestive symptoms like diarrhea, fatigue, and headaches as well. And sometimes symptoms are so severe that they interfere with school, work or social life. And pelvic pain, whether it's cyclic or chronic, can lead to absenteeism. It can lead to reduced quality of life. It can cause a lot of issues for adolescents and young adults, and also people of all ages. So it's really something that needs to be taken seriously and a lot of people may not even know that periods that are this painful are not actually normal and they may not talk to their healthcare providers because of either shame or not knowing what's normal or not. And I find that sometimes these conversations will come up in dietician appointments where you have that hour long. Time with patients, they might be coming for another reason entirely, and then they start to reveal that they're in this immense pain around the time of their periods. Now in terms of non nutrition interventions, as I mentioned, NSAIDs are one of the first line treatment options. Especially if they're taken a little bit earlier, they can kind of prevent the pain, oral contraceptive pills may be recommended for some people. Also, things like heat therapy, like the application of heat exercise, especially mind body exercises like yoga can help, reduce some of that pain as well. But I'll be mainly focusing on nutrition today. Of course. Now before we get started, I do just want to mention that a lot of the studies that I'll be talking about right now are not of the highest caliber research. So in this area, unfortunately we don't have as much high quality research. Most studies are small. They may or may not be randomized. They're usually short term, so there is definitely more need for research in this area because there is some promise here. Now, I'll start first with the research on vitamin D. So vitamin D is involved in regulating immune and inflammatory pathways and may suppress prostaglandin synthesis. There's this one study, it was a randomized control trial, and there were 50 women who had low vitamin D levels and they either received 50,000 units of vitamin D weekly for eight weeks, or they got a placebo. And the people who received the vitamin D. To correct the deficiency actually had lower pain scores compared to placebo at the end of those eight weeks. There's also a meta-analysis that found the same thing, that in those people who were deficient in vitamin D, when that deficiency was resolved, there was a reduction in pain. So the takeaway here is really that we want to prevent or correct a deficiency of vitamin D and individuals who have these very painful menstrual symptoms. The next is calcium. So calcium theoretically supports muscle contractility and nerve conduction and low calcium might exacerbate those uterine spasms. So several studies have been done. On calcium supplementation. And there's also been, studies on dietary calcium, which show that, somewhere around 1000 to 1200 milligrams of calcium with or without Vitamin D can help menstrual pain compared to placebo. Now most of the research, the calcium is introduced for few cycles or two to three cycles at least, uh, for the benefits to be seen because a lot of the people with these painful periods are younger, usually in adolescence or young adulthood. I personally would not recommend providing. A thousand to 1200 milligrams of calcium supplementation. per day to these individuals long term, but rather to focus on dietary calcium as there is evidence for dietary calcium as well. The next is magnesium. So magnesium is. Able to help, muscle relaxation and can support serotonin regulation and also may help reduce some of that prostaglandin synthesis. So there are some studies that have found that about 300 milligrams of magnesium daily from mid cycle to menstruation, can help improve symptoms in about two cycles. And when the magnesium is paired with calcium, the effects are amplified. The next micronutrient that's studied in this context is vitamin E. So vitamin E is an antioxidant and it may help reduce prostaglandin synthesis. There was a study with a hundred young women where they provided participants with 400 units of vitamin E per day for five days, so two days prior and three days during menstruation. And they found that the pain was reduced in terms of intensity and also duration compared to placebo now, this wasn't the only study. There was also a meta-analysis that showed consistent benefit as well, so this is an interesting one. Again, there might be some evidence there that vitamin E supplementation can prevent some of this pain. Next we have zinc zinc is anti-inflammatory and may impact, prostaglandin production. Now again, there is some evidence that zinc, when taken around the time of menstruation for about three cycles or more, may help reduce pain and the need for NSAIDs. And the final micronutrient supplement that may help is vitamin B one or Thiam. And that's because it can support nerve function and blood flow and it may reduce pain signaling. So there are studies again when supplementation is taken for 90 days or a few cycles, can. help a bit with improved pain scores There are very few studies on this and we do need more research, but the results are interesting. One thing to keep in mind here is that with both B one and B six, we do wanna be very careful with dosage and, doses above a hundred milligrams per day do put people at risk of peripheral neuropathy. So, if somebody's taking a B one vitamin or they're considering it, that's definitely an important conversation to have. And also to look at all the supplements they're taking. If they're taking a multivitamin and then a B complex and then a separate B one, it may add up to more than that 100 milligrams per day. So just being mindful of that. Now there's another supplement that is actually quite popular, for menstrual pain. And that's Vitex, Agnes Castus or Chasteberry. And basically it's a botanical extract thought to modulate dopamine receptors in the hypothalamus, And through some hormonal mechanisms, it may have some benefits for PMS or premenstrual syndrome, and it may have. Benefits for reducing menstrual pain. There are a few moderate quality studies that show that taking Chasteberry for three months or for a few cycles can help reduce menstrual pain compared to placebo. It may actually also help with other PMS related symptoms like breast tenderness and mood symptoms. Now just moving away from supplements and more towards food and dietary patterns. There are a few things to note. So one is that. Caffeine for some people can contribute to the pain, and for others it may not. And caffeine is a vasoconstrictor and it can exacerbate some of those menstrual cramps by contributing to uterine vasoconstriction and dehydration that can potentially worsen the pain. Again, as I mentioned, some studies show that high caffeine intake, for example, more than 300 milligrams per day may contribute to painful symptoms, and some don't find that effect. So really we need to look at that on an individual basis. So if you're doing an assessment. And you're seeing that somebody's having multiple cups of coffee per day and they're experiencing these symptoms, it may be a good idea to experiment how it might be if they have less coffee. Now in terms of overall dietary patterns, unsurprisingly, whole food diets, Mediterranean style diets that are rich in omega threes, fiber antioxidant and anti-inflammatory phytonutrients are associated with less pain. And there was a study that found that those with what they call the snack heavy eating pattern, so including more snacks with processed foods, refined sugars, refined grains, had four times greater odds of moderate to severe, menstrual pain. So that's something to consider as well. So just to summarize and bring it all together. Primary Dysmenorrhea is menstrual pain that is driven by prostaglandin mediated inflammation and uterine contractions. When it comes to supplements. We do need more research. Most of the studies currently are either very small. They may have been done many years ago and have not been replicated, or they're poor quality. So we do need more research, but there may be some promise in things like vitamin D, vitamin E and B one, as well as calcium, magnesium, and zinc. We also know that generally a healthy eating pattern that includes whole foods and anti inflammatory foods can also show prevention and relief. So if you have a client who comes in and they're experiencing a lot of pain, the first thing, if they haven't already spoken to their physicians, is to refer them back and they would need to be assessed. In order to make sure that they don't have any underlying gynecological conditions like endometriosis or fibroids. And if it is primary dysmenorrhea, then a little bit of cycle tracking and symptom tracking and trialing. Some of these suggestions that we talked about today can hopefully help you as a clinician figure out what's working and what might need to be changed. So thank you so much for tuning in if this episode was helpful and if it resonated with you, please feel free to subscribe or share with a colleague If you haven't had a chance to check out the website yet, I do encourage you to visit w hn learning hub.com. You'll see many blog posts on different topics related to female health on the website, as well as several free resources you can download and use in your practice. That's also where you can join the wait lists for some of the upcoming courses. After the menopause course is launched, I will be working on creating a whole course on menstrual disorders and how they can be managed through nutrition. Thank you again for joining me in this episode. If you have any feedback or suggestions for topics for the podcast, feel free to email me at hello@whnlearninghub.com. Thank you and have a lovely day.