Disclaimer: I am not a medical professional. If you suffer from painful periods or chronic pelvic pain, please consult a medical professional. The information in this post stems personal experience. Every case of dysmenorrhea is individual and therefore manifests differently. Ultimately, you have to do what is best for you and your body.
I hunched over in pain, trying to hold back the urge to either vomit or faint. I felt as if a knife had plunged into the right side of my pelvis and was slowly twisting. My clammy skin and slumped posture caused my classmates to gaze at me in concern and confusion. I reasoned to myself that if I could get through this class, I could skip my run and go directly home to nap. Or maybe I should have run before to temporarily numb the pain with endorphins? Did I bring enough Midol to make it through a run? Unfortunately, this wasn’t an out of the ordinary experience for me – and perhaps you’ve experienced painful periods as well.
The medical term for painful periods is dysmenorrhea. Dysmenorrhea includes pelvic pain, abdominal cramping, lower back pain, hip pain, headaches, nausea, and lightheadedness during menstruation. For some women, GI distress and diarrhea can accompany the pain, as can mood swings and heavy bleeding. These aren’t merely minor nuisance of PMS cramps. Advil and Midol only make a dent in the severity of the pain. Basic activities – from attending work or school to normal daily runs – are disrupted.
We read articles discussing amenorrhea (loss of period) from running, which is something female runners must be aware of and prevent. We also see more knowledge is being shared about how to train around a normal menstrual cycle. But what about when you suffer from dysmenorrhea? I often felt like I couldn’t find answers and would be frustrated at the lack of information.
I suffered from dysmenorrhea from when my period started in middle school. My periods were irregular, unpredictable, and painful. I’d suffer from both GI distress and pelvic pain so much that I’d contemplate staying home from school, which was not normal for a school-loving bookworm such as myself. The symptoms worsened with each year.
Then at 17, I lost my period without any change in exercise, eating, or weight – I wasn’t even running yet. I was diagnosed with non-insulin resistant lean PCOS with low progesterone, swallowed large progesterone pills to force my body to have a period, and then was put on medication to balance my hormones.
Yet the pain continued through my late teens and 20s, even though my medication was so I only got 3-4 periods per year. Mood swings, stabbing pain in my pelvis, low back pain, and a general sense of fatigue would render me feeling like a shell of myself for several days. I have a get-it-done mentality, so I persisted in class, work, and training as best as I could even with the pain.
Eventually, my doctors suspected based on my symptoms and family history that I had endometriosis, a condition in which uterine lining grows and attaches outside of the uterus, thus causing painful periods. While they didn’t confirm it via laparoscopic surgery, they adjusted my medication to prevent both pain and symptoms from worsening. The decision wasn’t based on running – it was based on health and quality of life – but it certainly did help with running. I still have bouts of pelvic pain, but nothing as severe or frequent.
(Edited to add: In December of 2017, I had a laparoscopy that was negative for endometriosis and removed two adhesions that were causing GI issues and chronic pelvic pain. My doctor now suspects that my painful periods are related to hormonal issues and long, irregular cycles.)
My dysmenorrhea was a disruption to my otherwise active lifestyle, even when I only had 3-4 periods per year. I wanted to spend all day in bed and I struggled to motivate myself. I stuck to the treadmill to have a bathroom nearby and would drug myself with Advil and Midol first (which wasn’t always the best idea for my stomach). But I needed to run. Running reduced the pain, even if just temporarily, leveled my mood swings, and kept me from feeling like my body was broken.
Painful periods are a reality for many women, and the causes can range from the individual person to a chronic condition such as endometriosis. The severity can range as well, but what marks dysmenorrhea as different from normal menstrual cramps is that the pain is significant enough to disrupt your normal routine. Running can seem near impossible at times when you have dysmenorrhea, but most female runners find that the movement and endorphins reduce the pain, even if just for a few hours. The following tips are based on what worked for me when running with dysmenorrhea.
Please do know that this is non-medical advice from the perspective of a coach and runner who experienced dysmenorrhea. This is training advice, not advice on how to treat dysmenorrhea as a whole. Every case of dysmenorrhea is individual and will be treated different medically – so how I am treated medically may be very different than how you manage the pain.
Talk to Your Doctor
There are two different types of dysmenorrhea: primary (no underlying cause) and secondary (underlying cause). You may just get bad cramps as part of PMS and menstruation – or you may be suffering from endometriosis, pelvic inflammatory disease, or another health issue. I honestly thought painful periods were normal until I talked to my doctor about them.
Talk to your doctor so they can help you and check for underlying causes. If they determine that it is primary dysmenorrhea, then you can have peace of mind and learn how to alleviate the pain. If they find an underlying cause, then you can discuss treatment options to ensure that your overall health and fertility do not suffer.
Properly Warm Up Before Your Run
Going from curled up in a ball on the sofa to trying to run isn’t conducive to a good run, regardless of whether or not you are on your period. A warm up will improve mobility in your joints, increase blood flow to your muscles, and mentally help you transition from rest to running. The light movement may also help reduce the pain of cramps before you start to run. Warm up with few minutes of easy walking followed by some dynamic stretches.
Treat Your Period as Cutback Week
Cutback weeks occur every 3-4 weeks when training for a race. Mileage, intensity, or both are reduced in order to let the body recover so that it can adapt and you can continue to train hard and improve.
Women with normal periods will find cutback weeks are ideal before their periods. During your luteal phase (from ovulation to right before menstruation, the change in hormones make female runners more sensitive to heat and more prone to dehydration or electrolyte imbalance. Once menstruation begins, hormone levels drop and the body is better able to regulate the core temperature and balance fluids.
However, for women with dysmenorrhea, the week encompassing the days before the period through the first few days of menstruation are ideal for a cutback week. Despite the drop in hormones, the pain of dysmenorrhea and the possible accompanying GI distress can make running difficult. Even if you do run, you likely won’t feel up to running a hard interval workout. By reducing mileage, intensity, and even frequency, you can both aid your body in recovery from training while managing your pain. Training should fit your life – including your cycle.
Within that cutback week, adjust the training days themselves to accommodate how you feel. You may find that the severity of pain requires rest of the first day of your period, and then you can do easy runs the remainder of the week – so plan accordingly and be rearrange your training schedule in that week. If you have a running coach, communicate to her the need to adjust training that week so she can help you.
Particularly if you have secondary dysmenorrhea from endometriosis or a similar inflammatory condition, high levels of inflammation and stress can make dysmenorrhea worse. My worst bouts of dysmenorrhea coincided with applying to grad schools and other stressful times in life. You also battle fatigue during this time, which can hinder recovery from a hard run. Scaling back your training will help, as you emphasizing recovery.
Be sure to get enough sleep (you may find you need even more during your period). Choose anti-inflammatory foods such as blueberries and tart cherry juice and be sure to eat within that vital 30-60 minute recovery window after a run. Spend time foam rolling, doing yoga or Pilates, or add in an extra day of rest or light cross-training.
Dehydration and electrolyte imbalance can cause cramping – and the last thing you want on top of pelvic pain is more cramps. Drink plenty of water and choose sugar-free electrolyte beverages (as long as the sugar substitute is not irritating to your stomach).
Take Care of Your Gut
If dysmenorrhea coincides with GI distress, avoid foods that can trigger stomach upset. Common culprits include dairy, cruciferous vegetables, beans, excessive caffeine, and sugary treats, although the exact irritants vary from individual to individual. Do not use this time to experiment with new fuel on your long runs – stick to the fuel that your gut has been trained to digest.
NSAIDs will relieve some pain, but they can also upset an empty stomach during exercise and cause GI distress. Be sure to eat a bland snack such as a banana or piece of toast before a run to keep your stomach settled. Be careful to not take too many NSAIDs (which trust me, is tempting when a normal dosage doesn’t make a difference), especially if GI distress is a symptom of your dysmenorrhea. You can take other types of painkillers such as acetaminophen, which won’t irritate your stomach as much.
Be Kind to Your Body
Heed your body’s signals. Let yourself miss a run if you need to. Some days, running will feel good, but some days you may find that the pain is too severe to run. Don’t force it. Take your runs at an easy to moderate effort and don’t force speedwork that week.
Most of all, keep things in perspective. Dysmenorrhea can strain one’s relationship with her body; I often felt angry at my body and emotional about the pain. One of the best things about running is that it can foster a positive relationship with your body. Even if you run less on your period because of the pain, focus on what your body can do in running.
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