It’s no secret that period cramps are a buzzkill. They can interfere with your training schedule, social and work life, and make your day(s) overall unenjoyable. But what’s lesser known is how you can go about minimizing those symptoms when they do roll around. Here are 6 key ways to menstrual cramping (spoiler alert: it can include exercise!)
Before we dive into how to treat period cramps, it's important to understand what causes them. Menses (aka the period) is essentially the body getting rid of the environment that it spent much of the cycle creating for the potential implantation of an embryo. To rid the body of the uterine lining safely and effectively, there is the release of multiple factors that cause inflammation and pain. This inflamed environment can lead to ischemia (decreased blood flow) and hypoxia (decreased oxygen). When coupled with the increased contractions of the uterus (did you know the uterus is a muscle?!) the result is pain (1).
And now to answer the question that everyone wants to know: how do I limit my period pain?
As goes much of the knowledge we have about female physiology: there is not enough research to reach a clear conclusion on some methods but this is what has been shown to be the most helpful:
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
The most used method for limiting menstrual cramps is NSAIDs (think ibuprofen or Midol/Feminax). The easiest way to understand how this medication limits pain is that they minimize the inflammatory environment that can lead to lower blood flow and oxygen availability characteristic of cramping (1).
While the fact that close to 70% of users experience pain relief from NSAIDs, there are some important risks that should be considered before reaching for your bottle of Advil (2). Some commonly reported side effects are stomach upset, rash, dizziness, headache, etc. More serious side effects include kidney and liver failure, ulcers, and varying cardiovascular risks (3).
2. Oral Contraceptives
Although general combined oral contraceptives are also often used as a treatment for menstrual pain, they can sometimes mask underlying conditions that are causing discomfort. Extreme cramping could be a symptom of a more serious condition, such a PCOS or endometriosis. If you are experiencing such pain, please consult with your primary care physician to rule out other gynecological conditions.
This treatment is thought to limit the thickness of the uterine wall that develops throughout the menstrual cycle, which in turn will decrease the inflammatory response during menstruation (3).
Oral contraceptives have numerous side effects that should be considered carefully. Namely, they have been shown to lead to headaches, nausea, irritability, fatigue, mood changes, blood clots, tumors, and cancers (3).
3. Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is a commonly used, non-medical intervention for pain. Although the word sounds complex, it can be broken down quite easily: trans (across) cutaneous (skin) electrical nerve stimulation. In essence, TENS delivers electrical currents to nerves through leads that are attached pads applied to the skin.
TENS is thought to have both systematic and local effects that can help in the management of period pain. On the local level, stimulation is said to increase blood flow and alter the anti-inflammatory environment that causes uterine cramping talked about earlier (4). Additionally, lower-frequency TENS has been shown to stimulate the production of pain-relieving compounds developed in the body. TENS is also thought to alter how your brain interprets the pain signal (4).
The side effects of TENS are relatively limited in comparison to the medical interventions discussed above. The most common side effect is skin irritation at the electrode site (4). Additionally, the increased blood flow to the uterus may cause a heavier flow than normal. There also have been some reports of headaches that follow the use of TENS (4).
Another non-medicinal treatment of choice is superficial heat. In fact, several studies have reported that heat provides a similar pain relief effect to that over-the-counter medication (5,6). When discussing superficial heat, we are often referring to heating pads, hot water bags or bottles, etc. Typically, the max temperature used is between 40 and 45°C (104-113°F), and the maximum depth reached by the heat is 1 cm (7).
Superficial, localized heat causes relaxation of the abdominal muscles that can contribute to period cramps. Additionally, heat causes increased circulation that can help mediate the lack of blood flow to the uterus. This circulation can also help limit fluid retention swelling that is linked to cramping (7).
Alternatives to Western Medicine are increasing in popularity as the emphasis is boosting the natural human response to unpleasant sensations. In this instance, acupuncture and acupressure encourage employing self-derived pain-relieving mechanisms. For example, using the trigger points of the nerves that innervate the uterus (T5 and L4) is thought to aid in relief (8). Additionally, acupuncture has been shown to induce the production of self-produced opioids that decrease pain (8).
Thus, we reach the treatment we have all been waiting for: exercise.
As is the case with most studies in female exercise physiology, the research into the effect of exercise on period pain is relatively limited and the methodology is fairly poor.
Of what we do know, aerobic exercise may cause pain relief. It has been proposed that the endorphins that you experience because of exercise may extend to relief at the level of the uterus (9). Similarly, the increase in progesterone that results from exercise in the later phase of the menstrual cycle suppresses the release of inflammatory molecules that contribute to cramping (9). In fact, moderate-to-high-intensity exercise may stimulate the release of anti-inflammatory agents, limiting the pain in the uterus (10).
If aerobic type exercise isn’t your style, there’s evidence to suggest that lower-intensity, stretching-based exercises, like yoga, may also provide some relief. In addition to producing endorphins, lower-intensity exercises are thought to limit the stress response (primarily through the effect of cortisol) that can contribute to pain (11).
Ultimately, the intensity of the exercise you choose should fit with what you think you can tolerate. Some exercise is almost always better than no exercise at all. If you don’t feel like you are up for a high intensity running session, just go for a walk to get the blood flowing and endorphins pumping.
If you are looking to explore exercise as a way to decrease your period pain, download Wild.AI. Our goal is to help maximize the power of the female athlete. We can help you understand how to exercise around your period, can help you track and understand your symptoms, and can help you mitigate and minimize the impact that they have on your life.
Please remember that if your period pain is abnormally painful to contact your primary care physician. Severe cramping may indicate a serious gynecological condition.
- Stella Iacovides, Ingrid Avidon, Fiona C. Baker, What we know about primary dysmenorrhea today: a critical review, Human Reproduction Update, Volume 21, Issue 6, November/December 2015, Pages 762–778, https://doi.org/10.1093/humupd/dmv039
- Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13;332(7550):1134-8. doi: 10.1136/bmj.332.7550.1134. PMID: 16690671; PMCID: PMC1459624.
- Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception. 2010 Mar;81(3):185-96. doi: 10.1016/j.contraception.2009.09.014. Epub 2009 Nov 6. PMID: 20159173.
- Elboim-Gabyzon, Michal, and Leonid Kalichman. “Transcutaneous Electrical Nerve Stimulation (TENS) for Primary Dysmenorrhea: An Overview.” International Journal of Women’s Health, vol. 12, Jan. 2020, pp. 1–10, https://doi.org/10.2147/IJWH.S220523.
- Akin MD, Weingand KW, Hengehold DA, Goodale MB, Hinkle RT, Smith RP. Continuous low-level topical heat in the treatment of dysmenorrhea. Obstet Gynecol. 2001; 97: 343–349.
- Akin MD, Price W, Rodriguez G Jr, Erasala G, Hurley G, Smith RP. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. J Reprod Med. 2004; 49; 739-745.
- Jo J, Lee SH. Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life. Scientific reports. 2018;8(1). doi:10.1038/s41598-018-34303-z
- HELMS J. ACUPUNCTURE FOR THE MANAGEMENT OF PRIMARY DYSMENORRHEA. Obstetrics and gynecology. 1987;69(1):51-56.
- Kannan, Priya, et al. “Does Aerobic Exercise Induced-Analgesia Occur through Hormone and Inflammatory Cytokine-Mediated Mechanisms in Primary Dysmenorrhea?” Medical Hypotheses, vol. 123, 2019, pp. 50–54, https://doi.org/10.1016/j.mehy.2018.12.011.
- Armour M, Ee CC, Naidoo D, Ayati Z, Chalmers KJ, Steel KA, de Manincor MJ, Delshad E. Exercise for dysmenorrhoea. Cochrane Database Syst Rev. 2019 Sep 20;9(9):CD004142. doi: 10.1002/14651858.CD004142.pub4. PMID: 31538328; PMCID: PMC6753056.
- Kim, Sang-Dol. “Yoga for Menstrual Pain in Primary Dysmenorrhea: A Meta-Analysis of Randomized Controlled Trials.” Complementary Therapies in Clinical Practice, vol. 36, 2019, pp. 94–99, https://doi.org/10.1016/j.ctcp.2019.06.006.