When Period Pain Is Not Normal

by Dr. Alessia Milano, Naturopathic Doctor

Let’s face it, most of us ladies have experienced period pain at some point in our lives.

In fact, when we bring this issue to the attention of health care providers, we’re often told that it’s normal.

It can be frustrating and discouraging to hear what you’re experiencing is normal, and not worthy of treatment.

So, what happens if you’re in unbearable pain each month? What happens if you can’t go to work because of the pain?

Most importantly, how do you determine if the pain you’re experiencing is normal?

How Much Pain Is Too Much Pain?

In a perfect world, we would experience no period pain at all.

Sometimes, when we’re properly taking care of ourselves, we can absolutely get to this place. That said, most of us do experience some mild discomfort the day before, as well as the first 2 days of our period.

Mild discomfort definition:

  • You can go about your regular daily activities
  • It does not impair your quality of life
  • It doesn’t interfere with work, school, or other commitments
  • Taking Advil or Tylenol effectively reduces the pain
  • Other than using feminine hygiene products, your period does not interfere with your life in any significant way

If your periods are much more painful than what I just described, it might be time to take a closer look.

If you are regularly doubled over in pain, can’t get out of bed, can’t perform your regular daily activities, you’ve missed work or school due to the pain, taking Advil/Tylenol doesn’t help, and your quality of life has been impacted, we need to make some changes and do some investigative work.

Types of Period Pain

Before we get into strategies for managing period pain, we need to quickly address the fact that there are two distinct types of period pain, known medically as dysmenorrhea.

Determining if your period pain is normal includes knowing which category you fall under.

1. Primary Dysmenorrhea

Primary dysmenorrhea is period pain with no obvious underlying cause. There are no anatomical abnormalities causing the pain, and you otherwise look healthy.

This type of period pain usually starts with your very first period and reaches a peak in your early to mid 20s. After 24-25 years old, the pain begins to subside and becomes more bearable.

The pain is directly related to how heavy your flow is, thus making the most painful days the first 2-3 days of your period. This type of pain usually improves with Advil, warm pack applications, and pressure.

Primary dysmenorrhea can be normal. If the pain is more than mild discomfort, there are a lot of strategies we can implement that should safely and effectively reduce the intensity of pain you’re experiencing.

2. Secondary Dysmenorrhea

On the other hand, secondary dysmenorrhea is period pain caused by some underlying pelvic pathology.

The pain usually starts after 20 years of age, may continue to worsen with age, and does not coincide with menstrual flow.

You may experience this pain outside of the menstrual cycle, such as the 1-2 weeks leading up to your period, as well as the days following the end of your period. Unfortunately, drugs such as Advil or Tylenol usually don’t relieve this type of pain.

Secondary dysmenorrhea is clearly not normal. The most common causes include endometriosis, adenomyosis, use of an IUD, ovarian cysts, or pelvic inflammatory disease.

Although the strategies I list below may help, this type of pain often requires a more extensive medical investigation to determine the exact cause and associated risks.

Strategies for a Pain-Free Period

So you want to try reducing your period pain, what do you do? Here are some strategies for pain-free periods:

  1. Eat Your Greens. A crossover study was completed in which women with period pain were placed on a plant-based diet for 2 months, followed by a return to their regular diet. These women experienced such significant relief in the duration and intensity of their pain on a plant-based diet, that they actually refused to complete the study and return back to their normal diet. Moral of the story, make sure you’re eating enough vegetables and plant-based foods, it can significantly help. As a general rule of thumb, I tell my patients that half of every meal should be veggie-based.
  2. Increase Antioxidant Intake. Although eating more vegetables will in effect increase your antioxidant intake, supplementation with antioxidants has also proven beneficial.

Research has shown that women with period pain are deficient in antioxidants which may be contributing to the development of pain. Moreover, supplementation with antioxidants has been shown to significantly reduce period pain.

Even in severe secondary dysmenorrhea cases such as endometriosis, antioxidant supplementation has been shown to help. My favourites for dysmenorrhea include vitamin C, vitamin E, and NAC. Always speak to your Naturopathic Doctor before incorporating these supplements into your daily routine.

Regulate Hormone Imbalances.

Research has shown that women with period pain tend to have higher levels of estrogen relative to progesterone. Estrogen and progesterone need to be in perfect balance with one another for your body to function optimally, and are central to tolerable periods. It’s important to see a Naturopathic Doctor for a thorough workup to see where your hormones need improvement. On your own, ensuring you are reducing your exposure to endocrine-disrupting chemicals such as BPA, and increasing your fibre intake is a great start. Check out EWG’s site here to read more about reducing your exposure.

Support A Healthy Microbiome.

I’ve said it before, and I’ll say it again, your gut (and your microbiome) is the key to good health. If you’re experiencing period pain, please don’t ignore your microbiome! Preliminary research has suggested that contamination with ‘bad bacteria’ may play a role in the development of endometriosis. In addition, when your microbiome is unhealthy it alters estrogen metabolism and causes widespread systemic inflammation, both of which contributes to increased period pain. To improve the health of your microbiome, eating foods rich in prebiotics and taking a good probiotic is an easy place to start.

When Period Pain Requires A Second Look

If you’re experiencing severe pain and the above strategies didn’t work for you, that’s a warning sign.

If you’re experiencing severe pain consistent with a ‘secondary dysmenorrhea picture’, that’s also a warning sign.

Last but not least, if you regularly experience period pain and have been trying to conceive unsuccessfully for 12 months, that’s a warning sign. If this sounds like you, please see a naturopathic or medical doctor to get to the root cause.

Pain classified as more than mild discomfort is your body’s way of telling you something is not right. We shouldn’t experience significant period pain the way so many of us unfortunately do.

Women are told all the time that these symptoms are normal, I’m telling you that they’re not. I believe period pain is a sign of physiological imbalance that in many cases can be resolved.

To this day I’m still amazed at the improvements I’ve seen in my patients with determining the underlying cause and making some simple changes. Pain free, or at the very least bearable periods, are totally possible.

You don’t have to live in pain forever! If you want to learn more, or you’re ready for a customized plan, that’s what I’m here for.

Contact us at 416-792-4400 or by using the form below and we’ll book you for a FREE 15-minute phone or in-person session.

With loving compassion,
Dr. Alessia Milano


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  2. https://nutritionfacts.org/video/dietary-treatment-for-painful-menstrual-periods/
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