Treating Menstrual Pain With Diet

Treating Menstrual Pain with Diet

Almost half of menstruating women experience painful, crampy periods, also known as dysmenorrhea. According to Dr. Linda French from Michigan State University College of Medicine, “despite the substantial effect on quality of life and general well-being, few women seek treatment, thinking it won’t help.” Treatments are available, though–modern medicine to the rescue! There are surgical options such as neuroablation, where surgeons go in and attempt to cut or destroy the nerves leading to the uterus, or doctors can just take out the uterus completely. There are of course a bunch of hormones in pills and shots that can suppress the menstrual cycle as well.

Since the pain is caused by inflammation, anti-inflammatory drugs like ibuprofen are the most commonly used, achieving symptomatic pain relief in about two thirds of women. While effective, women using them need to be aware of the significant risk as they may cause adverse side effects. Though there are a bunch of non-drug, non-surgical treatments like acupuncture, “the evidence for the effectiveness of these treatments is generally weak.”

One of the latest advances in treatment involves the use of a single high dose of vitamin D. In a randomized, double-blind, placebo-controlled study the placebo did nothing–in fact, most women got worse. But the women who got the vitamin D all felt better. For more on vitamin D, see my series justifying my vitamin D recommendations, starting with Vitamin D Recommendations Changed and ending with Resolving the Vitamin D-Bate.

But wait a second. If it’s pain caused by inflammation, how about putting women on an anti-inflammatory diet? A study outlined in my video, Dietary Treatment for Painful Menstrual Periods, placed 33 women suffering from painful periods on a plant-based diet for two cycles. They experienced significant reductions in menstrual pain duration from four days down to three days and a significant reduction in pain intensity. Women also experienced improvement of PMS symptoms such as bloating.

This was a crossover study, so after two months eating vegan, the women were supposed to go back to their regular diets to see if the pain would return. But the women felt so much better that when the researchers asked them to go back to their regular diet to test before and after, several women refused, even though they were required to by the study.

 Doctors too often patronizingly think that patients simply won’t adhere to therapeutic diets, but when the women were surveyed, they reported having fewer cramps and were losing weight. They also reported increased energy, better digestion, and better sleep. This showed that we don’t have to be in some Ornish or Esselstyn study facing certain death after a heart attack to stick to a plant-based diet. It’s well accepted that even when testing more benign conditions. (For those unfamiliar with the work of Drs. Ornish and Esselstyn, see, for example, my video Our Number One Killer Can Be Stopped or my blog post Heart Disease: There Is A Cure).

I’ve touched on this body of work briefly in Plant-Based Diets for Breast Pain. Plants that may be especially helpful include flax seeds (Flax Seeds for Breast Pain) and the spice saffron (Saffron for the Treatment of PMS and Wake Up and Smell the Saffron).

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image credit: sportpictures / Flickr

  • Ann

    Why do all “plant-based diets”studies exclude meat? I eat a “plant-based diet” with small portions of healthy animal protein I buy exclusively from my local farmers market and have gotten rid of my menstrual pain, am in menopause and am not experiencing any hot flashes. I find it annoying that so many studies are done with extreme vegan diets that I don’t think are so healthy in the long run. Paleo blogs are filled with recovering vegans. I wish researchers weren’t so entrenched in their biases – vegans out to vilify meat for example.

    • Ann

      Vitamin B12 which is lacking in the vegan diet is helpful for PMS – so no cramps but PMS?

      • b00mer

        Anyone with even a minimum amount of education regarding a plant based diet would be taking a B12 supplement, so this would be a non-issue. If someone on a vegan diet decides not to take B12, they’re going to have bigger problems to deal with than PMS.

    • b00mer

      I think the answer is obvious – other people don’t consider a vegan diet extreme.

      Take your diet, remove the small portions of meat, add in some beans and lentils and a weekly B12 supplement – how extreme could that be?

      Using entirely vegan diets is useful in research because it helps in reducing the number of variables. If it can be shown that the presence of a certain animal product has some effect, then people can either omit the offending food entirely, or like you, they can choose to simply limit it. If you have determined your own limit of detection, that’s great, but for others they can use an entirely vegan diet as a benchmark and either stay there (which is quite enjoyable and not extreme in the least), or add back in small amounts as is tolerable. The interpretation and implementation of the research is up to you, but the clearer and simpler the structure of the research, the better.

    • DGH

      ” I eat a “plant-based diet” with small portions of healthy animal protein I buy exclusively from my local farmers market and have gotten rid of my menstrual pain”

      It’s quite possible that you have gotten rid of your menstrual pain as a result of cutting down on meat and increasing your plant intake. That is what the data Dr Greger cites would suggest. I don’t see how going that one next step towards eliminating “healthy animal protein” would make your diet extreme. I consume diverse whole protein sources at each meal, all of which are plant-based. I exercise religiously and have no problem building muscle. And there are other reasons to go vegan beyond better health.

    • Don Forrester MD

      Plant based diets as a description is usually used to designate a diet that excludes meat including fish, dairy and eggs. It might be more accurate to state an “All plant based diet” to avoid confusion. Having been involved prescribing plant based diets for 8 years along with giving science based educational presentations to physicians it is clear to me at this time that an “all plant based diet” is the healthiest approach for homo sapiens as we are best described as “hind gut fermenting herbivores”. The science supports that animal protein is not healthy. If you view the 65 videos and associated studies that Dr. Greger has done I believe you will see some of the problems associated with animal protein. In fact it is probably not possible to consume adequate calories and not get the required essential amino acids your body needs. You mention “recovering” vegans. It is true that you can be a “sick” or “fat” vegan. Dr. John McDougall who has arguably the most clinical experience and success in reversing and preventing chronic disease with proper nutrition writes monthly newsletters which are available free on his website. You might read his articles, Sick Vegan, and Fat Vegan in the 10/2002 & 12/2008 newsletters respectively. I also prefer to think of vegan diets as in the minority and not extreme. Of course the science keeps coming so you need to stay tuned to science based non commercial websites such as I am open to the possibility that there will be studies to support the consumption of certain animal foods but I am aware of none at this time. I’m glad your current dietary approaches have resulted in being free of menstrual pain and hot flashes. Of course beyond health there are environmental, social justice and ethical arguments against consuming animal products.

      • Sharon Shaw

        Beautiful, eloquent and factual post, Doctor!

    • Cupcake

      The Vegan diet isn’t extreme, I’ve been healthier than I ever have. There are always going to be people following different food lifestyles that are unhealthy. I follow a wholefoods plant based diet. The healthier non-processed one. I’ve been studying nutrition at University and everything that I’ve learnt about Paleo’s is pretty grim. They always feel great at first, then the High Protein, Low Carb effect kicks in over the longer term. Risks of Liver Disease and heart disease are significantly higher from any meat source. The body is designed for High Carbohydrate diet. We can live without meat, but not without fruit and vegetables. The phytochemicals are body need prove that our body strives towards a plant based diet. Not just what the industry wants. Paleo diets lead to constipation, bad breathe, low nutrition, bowel cancers so forth. I had a room mate who was paleo too. He went to the gym three hours a day and was still overweight and feeling sick.

  • justme

    Thanks for this.

    • trish

      I follow a healthy vegan diet but still have terrible menstrual pain. I will try to increase my Vit D and see what happens though.

      I do want to point out that the reason women use anti inflammatory drugs is because they restrict the production of prostaglandins an excess of which is the cause of strong cramps so not for the same reasons they are generally prescribed for.

      I had an accident and I’m not able to exercise much. I am sure that it would help if I could get more excercise but my diet is really good today. In spite of this the duration of pain has increased and the intensity is the same. As I no longer want children I am opting for a hysterectomy.

      I totally support a healthy vegan diet but it is not a magic bullet that on its own will solve everything for everyone.

      • Saraa

        trish, try to reduce the consumption of nuts and every other high source of fats, and even the little sugar you may be using. Be carful with soy products. When I did it, I saw a big difference. I’m also investigating about the role of allergies on mentrual pain: high levels of histamine raise extrogens ad prostaglandins, that are responsible for the pain. Good luck!

      • Thea

        trish: I think your last point is a valid one and worth everyone keeping in mind. Soemtimes the whole plant food diet seems like magic because it does so much for so many people. But the diet does not come with a 100% guarantee of preventing or reversing every problem.

        While you may be able to tweak your diet further as Saraa suggests to have a good effect, I totally see your point of view too. Good luck to you.

      • Deitra Jones

        Raw ginger root will also restrict the production of prostaglandins When I feel the cramps coming on, I take a one inch piece and blend it with one 12 ounce glass of fresh squeezed orange juice. (Obviously, put it in whatever you want to get it down). In 30 minutes the pain is gone and doesn’t return. Anyone can Google the study on raw ginger and these cramps. I am SO grateful I found it. It has never not worked for me.

        PS… I went through most of my life PMS and cramp Free until a few months ago. (Had exam and ultrasound to rule out other things). My sister, who is 12 yrs older, said she had terrible pain that worsened at night for the 5 yrs prior to menopause. When her period stopped the pain stopped. I experienced that torture just one time and knew I could and HAD to find a solution.

        I’ve been low fat, whole food, plant based for 7 yrs. I am 45 and the timing seems very similar to my sister. She used OTC pain meds that did not help; she suffered.

        It’s good to learn from those who went before us. I hope my positive experience with raw ginger root will help someone else.

        • Sara

          Thanks Deitra for posting this. Could you give the approximate dose of raw ginger you used in grams?

          • Deitra Jones

            Sure, Sara. I just cut a chunk the size of my thumb and weighed it. It’s 10 grams. That was sufficient for 2 of my experiences. One other time that amount decreased my pain substantially but did not eliminate it so I used another piece, same size, and that totally eliminated the pain. I’m 5’9 and 118lbs so I’m not sure how variations in weight may or may not be a factor in the amount necessary for results.

          • Sara

            Thank you! I will try that :)

        • trish

          Thanks Deitre. Worth a try. I already have fresh ginger in my green smoothies every day but I’ll try stepping it up and see what happens.

          I’m 46 but have had bad period pain since soon after getting my first period.

          • barbarabrussels

            Hi Trish,
            I used to suffer tremendously from pms. It’s improved a lot since becoming wfpb-vegan, and it seems to continue to get better, the longer I eat this way. I do have at least two tbsp of ground flaxseed every day, which I believe is the best way to keep any pms and menstrual cramps at bay. That’s what my experience is. Also, I believe I read about the flax seed thing somewhere, perhaps on this site, I can’t remember. Worth a try though. Good luck.

  • lorilou

    I used to have SEVERE cramping with my periods, with hours of vomiting, diarrhea, and eventually passing out from the pain. This went on for years (actually decades) with almost every period. I finally figured out, just by trial and error, that during the months when I ate whole foods and NO PROCESSED SUGAR my periods became much easier and without pain. It got to the point that I wouldn’t even be able to tell when I was getting my period, as I didn’t even have any PMS symptoms of bloating, depression or the cravings for fatty, sugary foods that accompany it.

    • Thea

      lorilou: That’s a dramatic story. I’m so glad you figured it out!

      • lorilou

        Dramatic in the worst way. Makes me sad to even think about. It was scary. I am a true believer that diet makes a huge difference with dysmenorrhea.

        • trish

          Glad this worked for you. I gave up gluten in 2006 and it did wonders for my arthritis pain but had no effect pn my period pain.

          I gave up added sugar and processed carbs in 2009 for reactive hypoglycaemia. It had an amazing effect on my energy levels but unfortunately had no effect on my period pain.

          Following a low carb, gluten free vegan diet was very restrictive and I couldn’t even eat bananas because it would cause a hypoglycemic event.

          I went raw vegan a few months ago and feel best on this diet. I am able to eat fruit again and so long as I don’t go silly on deserts or dried fruit I have no hypoglycemic episodes. It is wonderful BUT it still has had no effect ony period pain :(

          • Guest

            Have you tried raw ginger root? See my post above for details. Good luck.

          • Emillie

            A carb-restrictive diet is so unhealthy. Glad to hear you’re eating raw but have you heard of Raw Till 4?

  • Rivka Freeman

    Ilana: If your blood level is less than 60ng/ml you can take more than 2000IU daily. Anyone who is heavier than average needs double at least 5000IU daily according to and endocrine society. Anyone with high blood pressure, diabetes, cancer, chronic infections 5-10000iU daily is necessary according to my experience. For the flu you can take 50000IU daily for a couple of weeks.

  • Sara

    I’ve been on a healthy low fat plant based diet for 4 moths to treat my dysmenorrhea and I’m 50% better. I’m still suffering a lot, and since I want to heal completely, I’m investigating the role of histamine for this issue: high histamine levels can lead to dysmenorrhea by raising estrogens levels and it can also give other symptoms all around the body. See this link form the ajcn
    May this be the reason why women with endometriosis seem to improve on a gluten free diet? May dysmenorrhea be a sign of an allergy or intolerance?
    At his point I will try to reduce my consumption of histamine from food.
    Dr. Greger, Have you got any other info about this?

    • trish

      Thanks for the link Sarah. For anyone else interested, scroll down to title Histamine and Sexual Hormones for the most pertinent points.

      My estrogen levels are actually low but I guess there could be a spike just before my periods.

      I’ll look into histamine in my diet (and any meds or supplements I take, take a big load of Vitamin D and increase my raw ginger intake. Those things and my improved vegan diet has gotta give me the best fighting chance to avoid a hysterectomy.

      I would love to be able to call up and cancel the op. I am on a waiting list so don’t have a date but apparently the list is presently fairly short.

      Thanks everyone for your suggestions and advice :)

  • Anne

    I’m wondering if you have any comments on the Maca Plant for hormone fluctuations? For some of us who are near 50, following a WFPB lifestyle for years, oil-free, taking vitamin D supplements, exercising, etc and still having huge hormonal swings, there has to be something else. Any suggestions or comments on Maca?

  • JessicaC

    Dr. Gregor, can you please discuss stopped menstruation after taking birth control for many years? I was taking different forms of birth control (with Lo Loestrin Fe being the most recent – for almost 3 years) for over 10 years, and recently stopped in August 2015. After 5 months, I have no sign of my period returning. I realize that this is commonly discussed as a side effect of birth control, but I am also becoming worried that it has been this long. Any recommendations about foods or supplements to add that might encourage my period to return?

  • Joanne

    Ok, so raw ginger, ground flax, Vitamin D, fennel and avoid sugar. I gave up my old ways of eating 6 months ago and have been vegan/vegetarian except for a few instances since then, but have been slipping a bit in eating really well lately. I am wondering if it may be the sugar, as I have been craving it lately. My periods have always been horrible, but BCPs made my life wonderful. A few years ago I had an endometrial ablation to control the excessive bleeding I had from fibroids. The only reason I did not elect to have a hysterectomy is that I am self-employed and could not close up shop for six weeks. I had to take other meds to prevent/reduce my cycle to tolerate my periods again. Now 50, I stopped all meds a year ago and have been OK until the last month. Feburary has been awful, with only ten days with no bleeding or cramping. I hope refocusing on my diet will be the solution because every day I pray for menopause!