Introduction

Brief overview of menstrual cramps

Menstrual cramps occur during the shedding of the uterine layer (menstruation). Every month, the uterus lines itself with extra cells in preparation for pregnancy. When pregnancy does not occur, these extra cells are shed, resulting in a “bleed”. During this phase, the uterus can contract to help shed the lining. These uterine contractions can restrict blood flow, reducing oxygen supply and causing pain.¹

Peppermint as a natural remedy

Peppermint is a common herb consumed widely across the world for both its medicinal and flavouring purposes. Peppermint is a valuable natural remedy because of its wide variety of forms (such as teas, oils, and extracts), its numerous proven and potential medicinal benefits, and its easy accessibility. Peppermint has been shown to help ease symptoms of: gastritis, flatulence, dyspepsia, intestinal colic, enteritis, spasms of the bile duct, gallbladder, and gastrointestinal (GI) tract, and biliary disorders.² However, much of these benefits are only proven anecdotally, with the medicinal applications of peppermint largely under-researched by modern evidence-based scientific research.²

Understanding menstrual cramps

Causes and symptoms

Painful periods (dysmenorrhea), typically characterised by menstrual cramps, are sorted into primary and secondary types. Primary dysmenorrhea refers to recurrent painful periods with no identifiable cause, whilst secondary dysmenorrhea refers to painful periods which have an identifiable cause (e.g., endometriosis). Unfortunately, experiencing pain or discomfort during menstruation is common, with around 80% of people experiencing period pain at some point in their lives. It is most common to experience discomfort and pain at the start of menstruation, due to the contraction of the uterus during this phase. 

The NHS lists common symptoms of painful periods as:

• Abdominal pains occurring before or at the start of your period
• Stomach cramps which may extend to your back and thighs
• Sharp pains or dull aches in your abdominal region
• Pain beginning several days before your period or at its onset
• Pain typically lasting up to three days
• Pain that can impact your daily activities

However, if you are experiencing pain that is intense or noticeably worse than normal, and taking painkillers has not relieved the pain, please seek help through NHS online, requesting an urgent GP appointment or calling 111.

Conventional western treatments

There are a variety of home remedies and accessible medications to help manage painful periods. Some of the most common are:

• Gentle exercise like yoga, swimming or walking
• Massaging the stomach and back
• Warm baths or showers
• Heat pads or hot water bottles on your tummy
• Painkillers like paracetamol or ibuprofen

While cost effective and accessible, these interventions may not reduce intense pains. If you are regularly experiencing any of the following please contact your GP:

• Pain during sex or when peeing or defecating
• Bleeding in-between periods
• Periods more painful, heavier, or irregular than normal periods
• Period pain which is significantly impacting your daily life

Your GP will investigate these symptoms and advise you on treatment options. Common treatment options are:

• Anti-inflammatory medications (e.g., naproxen, flurbiprofen, or mefenamic acid)
• A TENS machine—a device which uses electrical impulses to alleviate pain
• Contraceptive methods (e.g., the pill, implant or injection), as they thin the womb lining, leading to lighter periods and reduced pain
• If period pain persists, your GP may refer you to a specialist, such as a gynaecologist

This is a brief outline of the most common “conventional” treatments available. However, many other options can help alleviate symptoms of painful periods, such as herbal remedies like peppermint.

Peppermint and its properties

Peppermint overview

Peppermint is an aromatic herb belonging to the Lamiaceae (Labiatae) family, and is a hybrid between spearmint (Mentha spicata L.) and water mint (Mentha aquatic L.).^3,4 It has been widely embraced for its medicinal properties across many cultures and continents.⁵ Peppermint offers a range of health benefits, serving to ease digestive discomfort, relieve headaches, and provide respiratory relief.⁶ Peppermints natural anti-inflammatory and muscle relaxant properties make it a popular choice for managing conditions such as irritable bowel syndrome (IBS), indigestion, and tension headaches.

In the realm of women's health, peppermint has gained attention for its potential in relieving menstrual cramps.⁷ As a natural remedy, peppermint offers a holistic approach, appealing to those seeking alternatives to conventional medications.

Properties of peppermint

Peppermint has demonstrated relevant properties for alleviating symptoms of painful menstruation, including anti-inflammatory, anti-nociceptive, and muscle-relaxant effects. 

Anti-inflammatory:

Inflammation is often regarded as a fundamental and significant initial response that contributes to the development of various chronic diseases.⁶ Peppermint has been shown to contain compounds that interfere with molecular processes involved in inflammation, producing anti-inflammatory effects.^8,5

Anti-nociceptive:

Peppermint contains compounds that help reduce pain by interacting with the body’s natural pain management and relief systems, one of which is the opioid system. This system regulates how pain signals are processed, sometimes blocking them before they reach the brain, which prevents painful stimuli from being understood as pain. Substances that work by interfering with pain signalling are known as anti-nociceptive agents. Research shows that peppermint’s pain-relieving effects may be caused by anti-nociceptive properties of peppermint, through interacting with the body's opioid system.⁹

Muscle-relaxant:

Peppermint's muscle relaxant properties have a solid foundation, supported by evidence dating back to 1988.^10,2 Research demonstrates that peppermint has the ability to induce muscle relaxation by disrupting the process of muscle contraction, causing a relaxation effect.

Potential benefits for relieving menstrual cramps

Peppermint showcases a spectrum of medicinal advantages, including its ability to reduce inflammation, relax muscles, and relieve pain through anti-nociceptive properties. These effects can help alleviate common issues experienced during painful periods, such as inflammation and strong uterine contractions. Therefore, utilising peppermint as a treatment proves doubly beneficial, as it not only targets potential underlying causes, such as inflammation and muscle tension, but it also directly alleviates the pain associated with them. 

How does peppermint do this?

Firstly, the muscle relaxant properties help to prevent overly tight contractions of the uterus, improving blood flow and reducing cramping. Secondly, it may reduce inflammation and contraction of the uterus caused by inflammatory agents (prostaglandins), which are thought to be greater in those suffering from dysmenorrhea.¹ Thus, reducing inflammation may reduce the severity of cramps and pain in those affected by painful periods. Finally, peppermint’s anti-nociceptive properties block pain signals, thus reducing the perception of pain, even if cramps and contractions remain.

Though the precise mechanisms behind peppermint's therapeutic effects aren't fully understood or easily observed, a preliminary study indicates its potential in alleviating the signs and symptoms of dysmenorrhea.⁷ This effect appears comparable to that of Mefenamic Acid, a commonly prescribed anti-inflammatory painkiller for managing painful or heavy periods, yet peppermint has fewer reported side effects.⁷ While the research is promising, further studies are required to better determine and characterise the effects of peppermint as a treatment for dysmenorrhea and menstrual cramps.

Ways to use peppermint for menstrual cramp relief

Peppermint is consumed in two main forms. Firstly, a tea or similar beverage can be brewed using the physical plant, usually the leaves. Secondly, the plant's oils can be extracted to produce a concentrated format, which can be consumed in various forms, such as capsules, topical ointments, or aromatherapy. If you observe negative side effects consult a doctor. If you experience severe side effects, they could be life threatening if left untreated. cease consumption immediately, and call a doctor or 111.

Peppermint tea

Preparation and consumption

Simply take a handful of leaves (fresh or dried) and steep in hot water for several minutes, or use a teabag purchased from a local shop. Drink as a normal tea.

Frequency and dosage

Everybody is different, if you don’t like the taste try steeping (soaking) for a shorter time or using fewer leaves. With limited scientific literature regarding peppermint tea, there is no defined dosage, so try different concentrations and steeping times, monitor yourself for side effects and improvements, and adjust accordingly. As cramps often preclude the start of a period, try drinking the tea regularly in the lead up to your period.

Peppermint oil

Peppermint oil can be purchased in capsule format from places such as pharmacies. The NHS recommends taking one to two capsules, three times a day, an hour before meals. You should consult a medical professional before you start taking it, or if you are planning to take it for an extended period (two weeks or more), as it can be unsafe for some individuals (e.g., those with a history of allergic reactions to peppermint oil or other medications, or if you are pregnant). Side effects like heartburn, indigestion, and itching or irritation around your bottom are common. If you observe severe side effects, such as an allergic reaction, muscle shaking, or an itchy skin rash, stop taking peppermint oil and call your doctor or 111. 

Peppermint essential oils can be used topically or as part of aromatherapy. The oils are usually concentrated and require dilution with a carrier oil to prevent irritation when applied topically to the affected areas (e.g., massaging into the tummy). 

Summary

Menstrual cramps and the associated pain are common occurrences for those who menstruate, making accessible and effective methods, which alleviate their severity, crucial for enhancing quality of life. While many medications exist to help with cramps or period pain, they can be expensive, require prescriptions, and have unwanted side effects. Natural and accessible remedies, such as peppermint, which has scientifically proven benefits for reducing cramps and pain, are therefore worth investigating. If you are considering regular peppermint use for menstrual cramps or other reasons, consult a health professional first to reduce the risks of side effects.