Menstrual pain (dysmenorrhea) is responsible for substantial interruptions in the lives of millions of women and girls. An investigation from 2012 reported that 84.1% of women experience menstrual pain with 43.1% of them revealing that the pain occurred during every menstrual period. This research concluded that at least one in four women experience distressing pain during menstruation that requires medication and frequently results in absenteeism from school, work and social activities (1).
During the menstrual cycle, estrogen produced by the ovaries stimulates the endometrium (the tissue that lines the inside of the uterus) causing it to thicken. When pregnancy does not occur, the menstrual period commences and the uterus contracts to help expel the unused endometrial lining. These muscle contractions are induced by hormone-like chemicals called prostaglandins that are produced in the uterus under the influence of estrogen and progesterone. Higher levels of prostaglandins trigger the uterus to contract more strongly and this can constrict its blood vessels, cutting off the oxygen supply and leading to more severe menstrual cramps. Interestingly, prostaglandins come in many different forms and can have a wide variety of effects; for example, some constrict blood vessels while others cause dilation. (2,3,4)
At the recent meeting of the North American Menopause Society (October 12th to 15th, 2022), new research was presented which examined the effects of food choices on pain during menstruation. Note that this research has not yet been published in a peer-reviewed journal and, until that happens, is considered to be preliminary information. The author of this study, Serah Sannoh, analyzed peer-reviewed research, identifying multiple studies that investigated the link between dietary patterns and menstrual pain in adolescent girls. She discovered that the ingestion of foods high in omega-6 fatty acids stimulates inflammation, a promoter of the pain experienced during menstruation. This process involves the production of inflammatory 2-series prostaglandins by the endometrium. Foods pinpointed in this review as being high in omega-6 fatty acids and others also associated with more severe menstrual pain include red meat, dairy products, oils, sugar, salt and coffee. Alternatively, a dietary pattern of foods higher in omega-3 fatty acids results in reduced inflammation and thus, lower production of inflammatory prostaglandins and less pain. People eating a diet consisting exclusively of foods sourced from plants show the lowest rates of inflammation and pain (5,6).
This information is not new. A study from 2000 explored the effects of a low-fat, vegetarian diet on dysmenorrhea (menstrual pain). Participants of this study included 33 women who followed a low-fat vegetarian diet for two menstrual cycles and then switched back to their customary diet along with a supplemental placebo pill (4). Higher levels of sex hormones are associated with the production of prostaglandins and menstrual pain. Sex-hormone binding globulin is a protein produced mainly in the liver that regulates hormone levels through binding with sex hormones (estrogens such as estradiol and estrone; androgens such as testosterone and dihydrotestosterone) so that they are unavailable for cells to use (7). Outcomes of this research showed that sex-hormone binding globulin blood levels were 19% higher when the participants were eating the low-fat, vegetarian diet compared with results observed during the customary diet phase. In addition, during the low-fat, vegetarian diet phase, participants experienced lower body weight and significantly less menstrual pain, a shorter duration of menstrual pain, and fewer premenstrual symptoms related to concentration, behavioural change and water retention. (4)
The researchers involved in the 2000 study noted that there are many mechanisms through which diet could be affecting menstrual pain (4).
1 Reduced estrogen blood concentrations due to the binding of sex hormones by sex-hormone binding globulin would reduce the stimulation by estrogen of the endometrial build-up in the lining of the uterus during the menstrual cycle, thus limiting the tissues responsible for the production of inflammatory 2-series prostaglandins by the endometrium.
2 Vegetables, fruits and legumes contain high amounts of omega-3 fatty acids relative to omega-6 fatty acids. Omega-3 fatty acids lead to the production of 3-series prostaglandins which are anti-inflammatory. Diets rich in animal-sourced omega-6 fatty acids promote the formation of inflammatory 2-series prostaglandins within the endometrial tissue.
3 Dietary fiber, found only in plant-sourced foods, encourages the removal of estrogens from the body by means of bowel movements.
Earlier Danish research also determined that higher intake of omega-3 fatty acids or a higher ratio of omega-3/omega-6 fatty acids was associated with less menstrual pain (8).
Other research shows that low-fat and vegetarian diets reduce blood estrogen levels in both premenopausal and postmenopausal women. (9,10)
Take Home Message
Though more scientific study is needed on this subject there is no need to wait before acting upon this information. This and previous research offer some practical measures that can be undertaken by anyone suffering from menstrual pain.
Action plan: Increase fruits, vegetables and legumes in your diet and reduce foods that are sourced from animals such as meat and dairy products, processed foods, fast foods, and refined vegetable oils. Lowering intake of sugar, salt and coffee may help too.
Fruits, vegetables and legumes offer high amounts of omega-3 fatty acids while animal-sourced products and refined oils are higher in omega-6 fatty acids. Flaxseeds, chia seeds and hemp seeds are particularly rich in omega-3 fatty acids. In addition, eating more plant-sourced foods will increase dietary fiber intake. (11)
Modification of the diet is a relatively simple solution that is non-invasive, can be achieved by any motivated person and offers the possibility of relief from severe monthly pain. Moreover, not only do these diet alterations have no harmful side effects, they offer a host of health-promoting benefits.
1 Grandi, G., Ferrari, S., Xholli, A., Cannoletta, M., Palma, F., Romani, C., Volpe, A., Cagnacci, A. Prevalence of menstrual pain in young women: what is dysmenorrhea? J Pain Res. 2012; 5:169-174. Doi: 10.2147/JPR.S30602. Epub 2012 Jun 20. PMID: 22792003; PMCID: PMC3392715.
4 Barnard, N.D., Scialli, A.R., Hurlock, D., Bertron, P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstet Gynecol. 2000; 95(2): 245-250. Doi:10.1016/s0029-7844(99)00525-6.
5 Sannoh, Serah. The effects of diet on menstrual pain. Abstract presented at The North American Menopause Society annual meeting; October 12-15, 2022; Atlanta, GA.
6 Dr. Monica Christmas, director of the University of Chicago’s Center for Women’s Integrated Health. From a presentation at the North American Menopause Society annual meeting; October 12015, 2022; Atlanta, GA.
8 Deutch, B. Menstrual pain in Danish women correlated with low
n-3 polyunsaturated fatty acid intake. Eur J Clin Nutr 1995; 49: 508–516.
9 Woods, M.N., Gorbach, S.L., Longcope, C., Goldin, B.R., Dwyer, J.T.,Morrill-LaBrode, A. Low-fat, high-fiber diet and serum estrone sulfate in premenopausal women. Am J Clin Nutr 1989; 49: 1179–1183.
10 Prentice, R., Thompson, D., Clifford, C., Gorbach, S., Goldin, B., Byar, D. Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women. J Natl Cancer Inst 1990; 82: 129–134.
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