Painful menstruation is a common, neglected, and improperly treated ailment affecting young and adult women. Painful cramps in the lower abdomen characterize it. They start shortly before or at the beginning of menstruation and can persist for up to 3 days. Often accompanied by mood swings, headaches, and general irritation, pain relief medication, which can significantly burden our bodies, seems like the only way out. However, research indicates that an appropriate diet can mitigate painful menstrual cramps. So, what should one eat and avoid to reduce pain symptoms?
Painful menstruation, or dysmenorrhea, refers to painful menstrual cramps from the uterus. It is the most common gynecological complaint in women of reproductive age. It is estimated that between 45% and 95% of women suffer from it. The pain usually begins with intense cramps in the lower abdomen and spreads to the groin and buttocks. Severe pain often accompanies headaches, diarrhea, nausea, vomiting, and mood swings. The pain intensity varies; some women experience mild discomfort, while for others, it can be so severe that it impacts daily life. Severe painful menstruation reduces productivity, work quality, and academic performance.
The cause of painful menstruation is an increased concentration of prostaglandins – hormones responsible for increasing the overall inflammatory state. These hormones act locally, synthesized in the endometrium, among others. Prostaglandins are metabolites of arachidonic acid metabolism under the influence of cyclooxygenase. They are not stored in tissues; their synthesis occurs directly before release.
Many new studies have shown that painful menstruation can be associated with several risk factors, such as:
- earlier age of the first menstruation,
- heavier and painful menstruation in the family,
- anxiety and depression,
- irregular diet.
The Impact of Diet on Menstrual Pain
An improperly balanced, deficient diet intensifies the inflammatory state in the body, which can lead to increased menstrual pain.
Dairy products are a good source of high-quality protein and calcium. Studies show that consuming 2-3 servings of dairy daily can reduce menstrual pain. According to human nutrition standards, the RDA for women is 1000 mg per day. A lack of daily intake can increase neuromuscular excitability, causing muscle contractions.
Whole Grain Products
Products such as:
- coarse groats (buckwheat, spelt),
- whole wheat pasta,
- brown rice,
- wholemeal bread,
- cereal flakes
should be the basis of the diet. They are a good source of dietary fiber, which reduces the body’s inflammatory state and regulates gastrointestinal motility. Additionally, it binds cholesterol, lowers post-meal glucose and insulin levels, and provides a feeling of fullness. Dietary fiber is also found in vegetables, fruits, and legume seeds. To increase fiber intake, it is important to remember proper hydration to avoid constipation.
Fruits and Vegetables
Fruits and vegetables should be an essential element of the daily diet. They contain vitamins and minerals that can help maintain health. Many studies indicate that a diet rich in fruits and vegetables is associated with lower levels of inflammatory markers in the blood. The World Health Organization (WHO) recommends consuming at least 400 g of fruits and vegetables daily. It is also essential to consume different color groups of fruits and vegetables because each color exhibits other properties:
- Red fruits and vegetables, such as tomatoes, strawberries, and red beans, are rich in vitamin C, vitamin A, potassium, and antioxidants.
- Yellow/orange fruits and vegetables, including carrots, peaches, pumpkins, and pineapple, are also rich in vitamin C, A, and potassium. They can also strengthen the immune system and improve vision.
- Mushrooms, bananas, onions, and other white fruits and vegetables are suitable for the heart and help control cholesterol levels.
- Green color indicates a lot of potassium protecting the heart and vitamin K, which supports blood clotting. Green fruits and vegetables also help maintain healthy vision and strong bones and teeth. Dark green leafy vegetables have the highest concentration of antioxidants and fiber.
- Blue-purple fruits and vegetables, including favorites like cranberries, purple grapes, raisins, and eggplant, improve urinary tract health and memory function and promote healthy aging.
Meat is often associated with cardiovascular diseases, primarily due to its fat content, incredibly saturated fat. Excessive consumption of saturated fatty acids promotes the release of inflammatory proteins like cytokines in the body. This can trigger inflammation, increasing the risk of cardiovascular diseases and metabolic syndrome. However, this does not mean that one should completely abstain from meat as it is a source of high-quality protein. However, lean meat (chicken, turkey) should be chosen and replaced with red meat (pork), which should be as infrequent in the diet.
Products to Avoid During Painful Menstruation
Studies  suggest that sugar intake is linked to the incidence of painful menstruation. Sugar induces chronic low-grade inflammatory states. A systematic review from 2018  cited several studies linking higher dietary sugar intake – especially from sweetened beverages – to chronic inflammation. Those on a high-sugar diet have higher blood levels of inflammatory markers, including C-reactive protein.
Excessive salt intake can also be another cause of pain during menstruation. An excess of salt in the diet increases fluid retention, which can cause edema. Edema can enhance feelings of fullness and discomfort in the abdominal area, which can be more noticeable during menstruation. Therefore, one should stay within the recommended daily salt intake of 5g. 
Saturated fatty acids from sources other than dairy can also intensify menstrual pains by stimulating the production of prostaglandins. High intake of fatty acids causes severe constriction of vessels and uterine muscle cramps. High intake of saturated fatty acids contributes to an increase in the concentration of “bad cholesterol.” These molecules have atherosclerotic action, causing atherosclerotic plaque formation in the blood vessels and increasing the risk of cardiovascular diseases. 
The reaction to caffeine is varied and may depend on individual predispositions. In some women, caffeine intake can help alleviate menstrual pain, while it may exacerbate symptoms in others. Caffeine blocks a hormone that can constrict blood vessels (present in the uterus), slowing blood flow. Therefore, drinking large amounts of coffee, especially during menstruation, may worsen cramps. 
Alcohol consumption is one of many factors that can cause an increase in the level of prostaglandins in the body. This can lead to more painful menstrual cramps. Frequently reaching for alcohol can disrupt the gut microbiota, disturbing the balance between good and bad bacteria and causing excessive growth of bacteria in the gastrointestinal tract. Both factors contribute to intestinal inflammation. Even moderate alcohol consumption can contribute to inflammation as organs process and eliminate toxins. It is crucial to be aware of the potential risks associated with drinking alcohol. Persistent low-grade inflammation can contribute to several serious health problems. 
Ingredients that Alleviate Menstrual Pain According to Studies
More and more studies  show the positive impact of daily intake of Omega-3 fatty acids in reducing symptoms of painful menstruation. By acting as an anti-inflammatory, they soothe pain symptoms and contribute to a reduction in the dosage of pain medication. The referenced study observed a positive effect with constant supplementation of 500 mg of Omega-3 for at least two months. Their action is probably effective through the impact on the metabolism of prostaglandins and other factors responsible for pain and inflammation.
Good sources of omega-3 fatty acids include:
- flaxseed oil;
- walnuts and the oil extracted from them.
According to the current recommendations of the National Institute of Public Health and the European Society of Cardiology (ESC), fish should be consumed twice a week, including at least once oily sea fish. If we cannot consume the recommended amount of fish per week, omega-3 supplementation should be considered. For this purpose, it is best to contact a doctor who will collect the appropriate interview and establish a supplementation dose. 
Vitamin E reduces the formation of prostaglandins by inhibiting the release of arachidonic acid. Studies  indicate a positive effect of vitamin E in alleviating pain associated with painful menstruation. The suggested dose of vitamin E for supplementation to relieve menstrual pain ranges from 200 to 400 mg per day.
It can primarily be found in:
- olive oil;
- almonds, sunflower oil;
- sprouts and cereal grain embryos;
- brussels sprouts;
- black currant.
Vitamin D supplementation inhibits the expression of several essential genes involved in the prostaglandin pathway. This reduces their biological activity, reducing pain in women taking vitamin D.
Vitamin D is mainly synthesized through skin contact with the sun. However, sun exposure alone is not enough to cover the total recommended dose in our latitude. Therefore, the National Center for Nutrition Education recommends supplementing with 2000 units of vitamin D for an adult throughout the year. 
Zinc has antioxidant and anti-inflammatory properties, affecting the reduction of prostaglandin synthesis. This improves circulation in the endometrium. It also plays a role in regulating chronic inflammatory states by reducing inflammatory cytokines. Zinc supplementation lessens pain and acts as a protective factor for uterine muscle cells. 
Zinc can be found in products such as:
- yellow cheese;
It is worth mentioning that animal protein enhances the absorption of zinc.
Olive oil contains monounsaturated fats, which have anti-inflammatory effects. It positively impacts health and the body’s ability to cope with pain.
Studies  indicate olive oil affects oxytocin receptors, reducing uterine contractions. It has an effect similar to ibuprofen and can alleviate painful menstruation.
In oil and tablet forms, fennel seems effective in treating menstrual pain by reducing the amount of prostaglandins in the blood. Fennel contains various chemical compounds, including essential oils, phenols, and flavonoids, with anti-inflammatory and antispasmodic actions. 
Does a higher BMI cause more painful periods?
Due to numerous macronutrients, excess fat tissue stimulates it to release inflammatory solid mediators. These changes cause a gradual development of an inflammatory state and increase oxidative stress. It is also associated with increased production of prostaglandins in overweight and obese women. High levels of prostaglandins cause uterine ischemia and induce uterine muscle contractions, which in turn cause pain. 
The anti-inflammatory diet is derived from the Mediterranean diet, considered the healthiest nutritional model in the world. It focuses on fresh fruits and vegetables, good sources of antioxidants. Antioxidants are molecules in food that help remove free radicals from the body. Free radicals are natural by-products of some processes occurring in the body, including metabolism. However, external factors, such as stress, can increase the number of free radicals in the body. Free radicals can lead to cell damage, which increases the risk of inflammation and can contribute to various diseases. [15,20]
Which foods are good sources of antioxidants and antioxidants?
Vegetables and fruits: a wide variety, including various colors, to increase nutrient content.
Plant-based protein sources: legumes, soy, nuts, and seeds. More fatty fish and some lean animal protein.
Carbohydrates: high fiber content, reduced refined carbohydrates, avoiding highly processed food.
Fats: Cold-water fish are one of the highest sources of omega-3 fatty acids, especially salmon, sardines, and anchovies. Olive oil is an additional source of fat. Avoid trans fats, which are pro-inflammatory.
Spices: turmeric, garlic, ginger.
Beyond dietary food choice patterns, how food is consumed affects its inflammatory state and nutritional value. Eating slowly, mindfully, and in smaller amounts can reduce the impact of the inflammatory state on the body. Portion control and smaller meals reduce hyperglycemia and, in the long run, obesity – both factors reduce systemic inflammatory conditions. 
Painful menstruation is a troublesome issue many women struggle with. Studies show that implementing an anti-inflammatory diet reduces menstrual pains positively. Additionally, some dietary components exhibit actions similar to pain relievers. This is good news for those who struggle with severe aches and must resort to pain relief medications. The anti-inflammatory diet should not only be adopted during menstruation but should be a long-term solution. Such a nutritional model provides the body with all necessary vitamins and minerals and prevents the development of inflammatory conditions.
Frequently Asked Questions:
It is best to avoid high-fat, highly processed foods with high salt.
Omega-3 acids, vitamins E, Zinc, olive oil, and fennel are soothing.
During menstruation, it is best to opt for unprocessed food, such as fresh vegetables and fruits, fish, and whole grain products, following the principle of the anti-inflammatory diet.
The best solution is water—drinking plenty of it makes cramps less frequent and less painful. You can also drink herbal teas, e.g., chamomile, which is soothing.
Flaxseed oil is a good source of omega-3, which is involved in alleviating painful menstruation.
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Clinical Dietitian, Psychodietitian, Food Technologist. Advocate for building a healthy relationship with food, without categorizing products as “good” or “bad”. Main areas of interest: brain-gut axis, probiotics, SIBO, eating disorders. Privately, a lover of cooking and true crime podcasts.