S1 E10: Period Pain Toolkit


Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it. 

Emily: [Welcome} to our 10th episode where we are going to be diving into a topic that so many women can relate to—and that’s period pain. So what’s funny and kind of unfortunate is that period pain used to be considered purely psychological. And it was kind of known as a reason for women to get out of their responsibilities, which I take as an insult. I think that’s very insulting. But it couldn’t be identified by a physical or gynecological exam or it couldn’t be tested for, so those who suffered were mislabeled and just told to deal with it. And I think that’s really unfortunate, because now we know that period pain is very real. And it can present itself in so many ways ranging from, you know, cramps, back pain, breast tenderness, headaches and migraines, and even joint and muscle pain. And while we will talk about all the specific symptoms and get into the types of period pain in this episode, we really want you to take away from this episode that symptoms are communication from your body, as we’ve talked about before, so it is tempting to want to find a remedy or a cure for every single symptom that you experience. But in reality, we need to understand why do we have those symptoms in the first place, because they are very helpful in learning what our body is going through and trying to communicate to us. And often it comes back to metabolic health. So if you have not listened to the first episode of this podcast, we really recommend starting there, because that’s where we’re going to go into all the facets of metabolic health. And today we’re going to talk about how specifically period pain plays into that.

Amanda: Yeah, it’s so crazy how it was like a psychological disorder. It, what was it? It’s like…

Emily: I know…

Amanda: …hysteria, right? That’s like where the definition of that came from. But it’s hard when you cannot see something, there’s no way to test for it…Like, I feel like I guess you can kind of understand why this phenomenon happened. But now we know that obviously period pain is very real, and it varies per person. So that’s what we really want to get into. The medical term for period pain is dysmenorrhea. So that’s what you would typically be diagnosed with if you ever brought this up to your doctor. And according to Katharina Dalton, she’s a British gynecologist, an expert on PMS—which, like, what a cool thing to be an expert on—there’s two types of period pain. She defined spasmodic period pain and then congestive period pain. In her book, she has a few books, but in the one that she has on PMS, she kind of goes through the two main types, which I thought was fascinating. And I’m, like, why don’t more people talk about this? So if you’re wondering…I don’t, it’s, I think it’s because she’s obviously a British gynecologist…she’s not within the US. And so we want to think about okay, so if I’m learning more about these two types of period pain, which one do I fall into? We find a lot of women can be in between, right? They might not fit perfectly into one but have kind of a mix of both. And that’s totally fine. We still think it’s helpful to understand, okay, if these are the symptoms I’m experiencing, where could they possibly be coming from, because one is more driven by inflammation, and then one is more of a progesterone issue.

So if we get into the first spasmodic type of period pain, that’s the one that’s more related to inflammation within the body, the big difference is how these are presenting and the timing, right? So typically, those that have spasmodic period pain, they’re not going to experience that until right during that first day of their period, maybe a day before, but typically, they’re not going to have that until they actually have their period. And it’s often lower abdomen pain, it can be back pain, inner thigh pain, more like all in that lower type of region. And it comes in spasms, right? It’s, it’s often accompanied by period poops—that’s what we call them when you have loose stools around your period. Because again, those are also driven by inflammation. And with this type, ovulation is always going to be present. So this specific woman will ovulate every cycle. She does make progesterone—that’s not the driver. It’s inflammation that’s the driver. She might not even have PMS symptoms. They’re not always present for this type of person. And what helps is reducing prostaglandins and inflammation in the body.

Emily: Right, so prostaglandins occur in nearly all of the body tissues and fluids, and they’re actually responsible for inflammation in the body. So you don’t want to think of prostaglandins as being a bad thing necessarily, because they’re not—they’re actually really necessary for health. So for example, when you have like a blood vessel that’s injured, prostaglandins will be released at the site of the injury to help with the formation of a clot so that your body can heal the damaged tissue. So they obviously have their job just like everything else in the body, right? But the problem occurs when there are too many pro-inflammatory prostaglandins circulating, so that’s going to be called PG2. There are also anti-inflammatory prostaglandins—that’s PG1 and PG3. But when you get too many of these pro-inflammatory, or PG2, prostaglandins, that’s when you can start seeing unwanted painful symptoms like period pain. And I just want to bring this up, because I feel so like so many women struggle with this. But they’re also the cause of things like period poops. So when you are on your period, and, you know, you experience kind of more violent episodes of bowel movements, that’s going to be those prostaglandins at play. But that’s also just general period pain. So again, we’re gonna talk about, kind of, what causes these higher level of pro-inflammatory prostaglandins and how to support yourself during your period so that you’re not experiencing this often. 

Amanda: And that’s really the big thing I think people are probably wondering is, like, what causes more of those pro-inflammatory prostaglandins to build up? And there’s really five main areas that we tend to focus on with clients. So gut health is a huge one. A lot of the women that experience these types of symptoms may also deal with endometriosis. We have some women that have PCOS that deal with this as well. But we see it a lot with endometriosis and women that maybe have autoimmune type issues that relate back to their gut health. So if you don’t have great digestion, if you have either maybe you’ve tested your gut health, maybe you just have this, like, intuitive feeling that something is off in your gut. That’s a huge category, because of course, if digestion is not going well, if you have more inflammation in the gut, it’s going to spread to other areas of the body. So gut health and digestion is a big one.

Another one is having excessive amounts of polyunsaturated fats. So when we have excessively high levels of things like vegetable oils, canola oil, soybean oil, if we are overeating nuts and seeds, then those can all lead to more pro-inflammatory prostaglandins. Now this doesn’t mean we can never eat nuts and seeds. I’m not going to terrify you guys when it comes to polyunsaturated fats, it’s more of if you are replacing all dairy products with nuts and nut and seed products. If you are also doing lots of vegetable oils, maybe you eat out a lot and you can’t even control the type of oil that’s used in the food—that’s a big one. And then another area is nutrient deficiencies, right? So if we don’t have enough things like magnesium and copper and vitamin E and B vitamins, then we are not going to be able to balance out the anti-inflammatory and pro-inflammatory prostaglandins. And then all those things are going to trickle down and impact metabolism, digestion, gut health—all those areas.

And another big one is estrogen. When we have excessively high levels of estrogen that will also impact our gut health and impact the amount of inflammation the body has. This is particularly important if you’ve, maybe you’ve had a Dutch test done and you’ve seen that there’s a specific type of estrogen metabolite that is high and more inflammatory, then that is one of those telltale signs of, like, this can also be contributing to spasmodic period pain. And the last area is stress, right? Of course, when do we not bring up the stress piece. But excessive amounts of stress—because that’s going to use up mineral resources, vitamins—it’s definitely going to lead to imbalances in estrogen and progesterone, it can impact digestion, all those different areas. So those are the main drivers of prostaglandins in period pain. 

Emily: So I think it’s pretty safe to say that anything that’s going to raise your inflammation is going to lead to these higher level of prostaglandins and affect your period and how comfortable it is. So how do you best support your body during, well, I would say even before your period, to prepare your body to have a healthy and comfortable period? The first thing I would say is supporting digestion using things like digestive bitters, apple cider vinegar before meals to help get those digestive juices flowing. Again, just a foundational thing, relaxing at your meal times, really making time to sit down and focus on what you’re eating. Saying a, you know, a prayer or doing some breathing exercises before you sit down to your meals will all help your body get into that relaxed state, which is going to be so beneficial for digesting your meal but also supporting your gut lining. 

And that really depends on the foods you eat. So we really like bone broth, gelatin that we use in our gummies…those have glycine, which is going to help just kind of heal and seal that gut lining. Reducing stress is a big one, especially around meals, like I said. And then slippery elm is a really good one for, again, it’s kind of like that glycine—it kind of just coats that digestive or gut lining and helps to repair it from the inside. So you can buy that in like a tea, that’s a really good way to consume that maybe one to two times a day, just to kind of help with that inflammation. Any inflammation going on in the gut, these things are really going to help. And then of course, eating foods that are easily digested, right? So maybe trying to cook your veggies instead of eating raw veggies or a lot of salads, trying to focus on things like starchy carbs and fruit which are very easily digested, and just staying away, like Amanda said…maybe the nuts and seeds are not the best thing for you if you’re experiencing digestive inflammation, because they can make it harder for your system to process and break down those, especially raw nuts and seeds. So just try to keep these things in mind, because inflammation, a lot of inflammation, can come from the gut. So this is a huge area to focus on when you’re experiencing a lot of that period pain each month.

Amanda: And the spasmodic type specifically. So if you notice that it’s, like, you’re not really getting it until you have your period, you definitely have period poops or some changes in digestion, and it’s, like, coming in, like, waves, those spasms…those are some like basic digestion and supportive foods, things that you can focus on. I would also say when we’re talking about how are we going to actually prevent this, like, what are you going to do in the moment? There are definitely things you can do like ginger. There’s so much research around ginger and period pain, headaches, lots of any type of pain and inflammation in the body. I’ve seen multiple studies that talk about having 2000 milligrams of ginger, and it could be in an encapsulated form, like Pure Encapsulations has a great one. But it’s literally just ginger. Actually one of our clients mentioned that you can get prescribed ginger.

Emily: Oh, I didn’t know that.

Amanda: But she’s like, no, you can prescribe ginger, obviously, for nausea and stuff like that. But I think that they also use it for mental health stuff, which was, like, very interesting, but I was, so she was like if you guys have period pain, you should see if you can get a prescription for the ginger, because then it’s like obviously a higher dose. But you can supplement with it too. And we have a lot of people that like to take it like a couple days leading up to their period and then during, but most of the research says you need 2000 milligrams. So you want to think about that when you’re reading the labels. Obviously talk to your doctor first before you take anything, but ginger is a big one to help in the moment. Same thing with things like cramp bark, that’s another great herb that can be helpful. Herbs are nice too, because you can take them multiple times, you know. So it’s like if you’re having some pain in the morning, and then you want to take some more cramp bark and ginger later, it’s typically fine to do that. Again, with any herbs like we don’t know you, we don’t know if you’re taking any medications and they can interact, so you want to make sure you talk with your doctor. But ginger and cramp bark are like my go-tos.

Vitamin E can also be helpful for this type, because it is anti-inflammatory. We find it the most helpful for the next type of period pain, the congestive, but that’s another one to consider. And then magnesium and calcium, right. Those two minerals work together, if you’ve listened to our mineral episodes, and calcium can actually help reduce cramps when it’s paired with magnesium. And so eating calcium-rich foods. If you are not doing dairy, then I would consider adding in something like pearl powder, cooked leafy greens, bone broth, those are also going to have calcium, and then taking adequate magnesium…that’s going to differ per person. But if you’re not eating calcium-rich foods and you’re taking magnesium, you could be doing more harm than good. So make sure you balance out your magnesium with some calcium. And then of course castor oil packs. We’ve talked about those before, right?

Emily: Oh yeah, I’m pretty sure. 

Amanda: But anyway we have a blog post we’ll link in the show notes. But castor oil packs are great for inflammation, right? They’re amazing. They’re also going to support your liver. So if maybe one of your issues is high estrogen, it will help. If it’s poor digestion, it can help with digestion. And it can also help with certain imbalances. Like we see a lot of women with spasmodic period pain have really high iron on their hair test or in their blood. And that’s a sign that they’ve got excessive iron, which of course is going to drive up inflammation in the body. Or they have lots of liver stress on their hair tests, like high cobalt levels. So it’s a great one to consider the castor oil packs, and again you would want to do those before your period like you want to do this throughout your cycle. But the things like ginger, cramp bark…you can do those when you’re actually experiencing the pain.

Emily: Just as an example, like, I, I used castor oil packs before I got pregnant and one of the benefits that I did notice from using that…because if you remember, Amanda, on my HTMA the first time around, my cobalt was through the roof. So I was experiencing a lot of liver stress, and those castor oil packs were one of the first things you recommended. And I do remember, I’ve never been someone with a ton of period pain. Like, I know people who cannot go into work, or are stuck in bed all day—it really disrupts their life—and I’ve never been that way. But always pretty consistently, on day one or day two of my period, I will usually have cramps to where I am just not feeling like myself. I either have to take some ibuprofen, I have a hard time sleeping, and usually the only thing that kind of helps is taking like a warm bath with Epsom salts. But I did notice when I was, I was using the castor oil packs, those first…like, I must’ve used it probably for a month before I noticed a huge difference…but my following period, I almost forgot. Like it was, like, day three of my period, and I was, like, I didn’t have any cramps this month. Which is just, it’s so out of the realm of you know what I’m used to that it was just such an, a pleasant surprise. So it definitely does help. That’s a huge one for liver health. And just supporting that liver will do wonders for this type of period pain. 

Amanda: And they can be helpful for iron too. So if you’re someone that’s struggling with the iron piece, like definitely consider those for sure.

Emily: Okay, so now we can move on to the second type of period pain, and that’s going to be called congestive. So this one is more related to a lack of progesterone rather than necessarily inflammation. And obviously these two types can overlap, so you can definitely have both. But this one is going to be a little bit different in that it takes place at a different time. So a lot of women will start recognizing these, this pain or these symptoms crop up in their luteal phase up to 14 days prior to when their period starts and then they’re accompanied by PMS. So PMS is always present in this type of period pain, but things like changes in mood, difficulty falling or staying asleep, feeling hangry, things like that are gonna be present. So it doesn’t really come in spurts. It’s kind of like a heavier dragging, feeling like a continuous increasing until menstruation starts. And it’s very, very common this type. So it has to do with not creating enough progesterone. And that’s usually because ovulation may not be there, like, ovulation doesn’t have to be there, because ovulation is what creates that progesterone. So if you’re someone with maybe PCOS, irregular periods, doesn’t always ovulate every month, this type of period pain can be very common. So there are things to do that can help us boost our progesterone naturally, that’s going to really help with this type of period pain. 

Amanda: And of course we did in Episode Two, when we talk about Nourishing Nutrition Foundations, and we go through how to know if you’re eating enough and eating at your maintenance calories. We did talk about macros, and then of course including nourishing foods. That’s step one, because we use up progesterone when the body is under stress. And so if, the number one way that I personally feel people can reduce their stress is by feeding themselves enough food, right, and eating regularly throughout the day. It’s something that most of us have a decent amount of control over. So that would definitely be step one for supporting progesterone naturally. And what this is going to do is fuel our cells, right. So each of our cells has that tiny engine. This engine requires energy in order to let things in and out of the cell so it can do its job. And when they don’t get that energy everything slows down. And this is of course referring to our metabolism. And when that metabolism slows down, digestion, detox, brain function, but also hormone production slows down. So if you are someone that feels like you fall into this congestive period pain category…maybe you don’t even have a ton of period pain, but you are, like, I have so much PMS, I do not feel like myself, you get skin changes, digestion changes, it’s just, like, not good and you don’t feel great during your period—a lot of that can be related to that lack of progesterone. So we definitely want to think about how much stress is my body under, and am I adding to that stress with food or am I reducing that stress with food.

Emily: Right, and this is the type of period pain that goes back to metabolism 100%. And we’ve talked about this before, but other than building the Nourishing Nutrition Foundation, which we’ve talked about in Episode Two, a key part of this is also eating regularly. So making sure that you’re having breakfast when you wake up, that you’re eating every three to four hours…Because when women are dealing with low progesterone, they’re usually also dealing with a sluggish thyroid—we see these two conditions go hand-in-hand all of the time. I’m a prime example of this. And it makes it difficult to keep your blood sugar balanced. So you always want to make sure that you’re, you’re not getting those blood sugar lows. And there’s actually a really fascinating study that Dr. Katharina Dalton did on this, and it’s called the three-hourly starch diet. So it’s interesting because molecular biologists discovered that progesterone receptors cannot transport or bind to a molecule progesterone if there’s been a drop in blood sugar. So what they did was they had women on a three-hourly starch diet, which I believe they paired with protein, right, Amanda? So it wasn’t for… 

Amanda: For a lot of the meals…Yeah. 

Emily: Okay so it wasn’t just, you know, your whole foods starches, there was also some protein combined, which, you know, supports our balanced meal idea that that’s the best thing. But it had positive impacts on progesterone levels and use in the body. So it actually showed an improvement in PMS, using those three-hour starch food breaks, or whatever, and an improvement in response to progesterone therapy. So again, this just kind of goes back to what we’ve been saying all along that you really need these high quality, whole food carbs in the diet, especially when you have low progesterone, you’re dealing with a sluggish thyroid, your metabolism is suffering—all of that is going to be so necessary, especially if you’re not ovulating, to make your body feel safe enough to ovulate each month. And that just takes nourishment, it takes maybe eating a little bit more than you’re used to, eating more regularly than you’re used to, and including those whole food carbs.

Amanda: And I think one thing that you want to think about too, with the three-hourly starch piece, like, it’s basically just dividing up your food more throughout the day. So the whole point is that you’re eating regularly and consistently getting those carbohydrates. Because a lot of the women, like we said, that are struggling with this type, they usually have thyroid issues, right? But in, in order to help support their thyroid, and even just replenish that glucose in your liver, eating regularly throughout the day is really, really helpful. And another thing that was kind of specific to the study was that they ate every few hours. So they broke up their portions eating smaller portions throughout the day. And then they always ate within an hour of waking and an hour of going to bed. 

Emily: There you go.

Amanda: Which I thought was very interesting. And obviously, we’re always kind of recommending, you know, not waiting too long in the morning to eat, and then having a bedtime snack, especially if you wake up, that’s going to help you sleep better. And of course that, getting sound sleep, that’s going to be so important for hormone production. But yeah, the, just eating regularly, right. Don’t skip meals. Especially if you really struggle with this, you might even find that you eat maybe every three hours in the beginning, but then you slowly build the tolerance to space out those meals more and it’s not having a negative impact on your hormones. Vitamin E is also really helpful for this person, because it does acts similarly to progesterone in the body. And it helps protect the body from stress and inflammation. So if, typically the congestive period pain type person does have a decent amount of stress, maybe they have PCOS, like Emily mentioned, and so when you’re trying to minimize that and regulate the cycles, vitamin E is really helpful. 

But of course, other micronutrients are too. So making sure that you’re getting enough things like magnesium, and even selenium is really important, zinc, copper, I would say is huge, you know, to get those engines going inside the cells for your metabolism. But a lot of times we’ll see pretty big imbalances for these people. You know, we’ll often, if we’re looking at a hair test for them, they usually are the slower metabolic type, and they have really high calcium, maybe high magnesium, but very low sodium and potassium. And so that low sodium and potassium is going to impact their adrenals, their thyroid function, it’s going to require them to eat more regularly. And then that adrenal cocktail and that video we did, the podcast we did on Replenishing Minerals, that’s going to be huge for these people. But yeah, there’s so many different pieces of the puzzle when it comes to supporting progesterone. Step one, I would say: are you ovulating? Like if you feel like you fit into the congestive period pain type, you want to start tracking ovulation, and we are going to have a whole episode on fertility awareness method eventually, which I think will be really helpful. But how regular are your cycles? Are you ovulating? Those are really big, big ones for the people that struggle with congestive period pain.

Emily: Right, and like Amanda said, it’s all going back to ovulation for these people. Like, if you are not ovulating, you, that’s the first place you got to start. You got to get yourself back to that safe place where your body can just kind of prioritize fertility and start the ovulatory cycles again. But, and a lot of that comes back to stress. So especially, not even just in your period or your menstrual phase, but reducing stress actually earlier during your follicular phase—which is your, the phase right after your period—that can be shown to reduce PMS during your luteal and your menstrual phases. So this isn’t just a quick fix type thing where…okay during my period, I’m really going to support my body, I’m really going to support my stress levels. You have to begin at square one, day one of your cycle supporting throughout the entire time, really trying to reduce those stress levels, building up your body’s resilience to stress. And that includes, you know, incorporating all those good minerals, those nutrient-dense foods and just trying to get into that parasympathetic state as much as possible. So trying to lower that cortisol as much as possible, because those elevated stress hormones are what inhibits certain functions in the body, especially hormone production. Because let’s, let’s face it—like fertility…it’s not essential for survival. And our bodies are really smart. They say, you know, I’m dealing with all this other stuff, and I’m kind of twirling so many plates at one time…fertility is going to take a backseat. And so it’s our body’s way of protecting us. And we just have to make sure that we give the body the tools to feel safe and supported. And it begins with nutrition. It begins with mindset. All of those are so important. Mineral balance…everything we talked about is going to contribute to just that healthy metabolism and the body feeling supported enough to be fertile. 

Amanda: I think a lot of women are going to line up with that congestive period pain type. And if you’re like, I don’t know how to increase my progesterone or even just to make sure that I ovulate…like how do I support ovulation? I would really go back and listen to Episode Two. And I would definitely consider doing a hair mineral test because then you can see…what, how is my body responding to stress, right? Do I have any really big deficiencies or depletions or imbalances that I need to work on that could actually help support ovulation? That’s where I would recommend starting, but there’s, there’s so many different ways to build that period pain toolkit. Hopefully, if you identified with the spasmodic type, you took some notes on like cramp bark, ginger, castor oil packs, and you’re going to try to implement those. And then if you have more of that congestive period pain type, you can definitely still use cramp bark and ginger, absolutely, I would just start taking it way before you get your period, because you’re probably already going to be symptomatic. And then vitamin E. Vitamin E is going to be so, so important for those people.

And just keeping in mind that it can take three to four cycles to see improvement. Because the last 100 days impacts your current cycle. And so if you maybe, like, put down this podcast and then you start making some nutrition changes, you’re eating more regularly, you start with that, and then maybe you listen to some of our episodes on supplements that we love and don’t love and you start making changes there. And then eventually you do a hair test, maybe you use some of the herbs, give your body this space and time to heal. We always put so much pressure on ourselves…like, this didn’t work for me this, this isn’t working for me. But we very rarely give ourselves enough time to actually see that change. And for women, it just, it takes longer because we do have these monthly—for the most part—cycles. So you just want to keep that in mind. And I would set your expectations so that you’re going to commit to this for three to four months and see if you have any improvements. And even, I would say at least six months, but people are impatient. So three to four months. See, I, most likely you’re going to have some improvement somewhere. And then that’s going to allow you to keep sticking with it. 

Emily: Yeah, and I can’t tell you like how many women in the Hormone Healing membership will comment on, you know…they’ll say, I’ve been incorporating all these changes, adding the vitamin E, the castor oil packs, eating more pro-metabolically, all of this great stuff. And their first couple of periods after they start doing that are terrible. They basically are just like, you know, are you sure this is working, because I just feel like I’m going backwards in essence. And that’s where we have to remind them that this healing journey, especially with hormones, is never linear. And your hormonal shifts are going to go a little haywire at first, which is going to cause maybe more symptoms. But then they always come back, like Amanda said, maybe four or five even sometimes six months later and say, what, I did not have any cramping this mon

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

Master Your Minerals

Created by
Hormone Healing RD