Study: Can Air Pollution Make Periods More Painful?

For people who experience painful periods, that time of the month can be excruciating and disruptive. While there can be many contributing factors to painful periods, one recent study suggests that air pollution may be making yours worse.

Researchers from China Medical University Hospital in Taiwan examined whether living in areas of increased levels of nitric oxides, nitric oxide, nitrogen dioxide, and carbon monoxide was linked to more painful periods. In Taiwan, levels of air pollutants are significantly higher in cities than they are in the countryside.

The study suggests that the link does exist. These findings were published in the Frontiers in Public Health journal in mid-June.

Does Air Pollution Make Periods Worse?

Researchers included 296,078 female participants in this study, and, of those, 12,514 participants had a diagnosis of dysmenorrhea.

There are two different forms of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea. Both forms were included in the research.

Primary dysmenorrhea, according to the American College of Obstetricians and Gynecologists (ACOG), is "the cramping pain that comes before or during a period," and the pain usually subsides after the first few days. This is because the uterus lining is shed.

Secondary dysmenorrhea is when an underlying disorder in or near the reproductive organs is causing the pain, and this often lasts more than the first couple of days. Some conditions that cause secondary dysmenorrhea include:

• Endometriosis
• Fibroids
• Adenomyosis
• Crohn's disease
• Urinary disorders

Some people with primary dysmenorrhea may develop secondary dysmenorrhea. "Let's say you have a 22-year-old with primary dysmenorrhea, and they have infertility, and you end up doing a diagnostic laparoscopy, and they end up having endometriosis," G. Thomas Ruiz, MD, the OB/GYN lead at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, tells Verywell. Ruiz explained that this person would no longer now have primary dysmenorrhea, as there is now an underlying disorder.

The study suggests that people who live in areas in Taiwan with more air pollution had more painful periods. In fact, the risk of developing dysmenorrhea was up to 33 times higher among women and girls who lived in areas with the highest levels of air pollutants compared to others living in areas with better air quality.

Limitations of the Research

However, the experts who spoke to Verywell for this piece raise issues with how the researchers would be able to control for other factors, like how people who live in cities may have better access to medical care.

"I'm just always wondering can you really control for urbanization, and can you really control for access to doctors because maybe if you live in the city, you see more doctors so you're more likely to get diagnosed with dysmenorrhea," Sophia Yen, MD, MPH, the co-founder and CEO of Pandia Health and clinical associate professor at Stanford University School of Medicine, tells Verywell.

Ruiz thinks that, in order for more evidence to support the claim that air pollution could contribute to dysmenorrhea, different studies using different populations would need to replicate the same or similar results.

"They try to make an argument for socio-economic conditions, but how do you separate one thing from the next and say it's just certain pollutants in the air?" he asks. Ruiz says that he would not recommend that someone move away from a city to help manage their painful periods.

If air pollution affect's someone's mental health, this could indirectly lead to air pollution affecting periods, as emotional stress can make periods more painful. "I wouldn't say it's necessarily specific to period pain but definitely, when you're talking about pain in general, it absolutely can be confounded or exacerbated by your emotional situation," Yen says.

How Air Pollution Can Affect Your Health

"Absolutely pollution is bad, and absolutely pollution could have an effect on prostaglandin E, [which triggers muscles in your uterus to contract during periods] but this paper hasn't proven that," Yen says.

While more research is needed to better understand the relationship between air pollution and dysmenorrhea, air pollution has been linked to other different health conditions, too.

The National Institute of Environmental Health Sciences shared that these include:

• Respiratory diseases: Air pollution has been linked to the development of asthma and chronic obstructive pulmonary disease.
• Cardiovascular diseases: Fine particle matter can impair blood vessel function.
• Cancers: Occupational exposure to benzene, an industrial chemical, and a component of gasoline, can cause leukemia.

Managing Painful Periods

For people who experience painful periods, there are different health treatments that they can pursue to try and prevent or lessen dysmenorrhea's effects on their life.

"With the new hormonal treatment birth control, the IUD with hormone implant ... any of these methods can make your periods go away, and many of them at the very least can make them lighter," Yen says.

Taking time to exercise may also be useful for some people in managing their painful periods.

"Diet and exercise is a good way to manage pain without even taking nonsteroidal [medication]," Ruiz says. "Someone who does moderate to vigorous exercise will usually have less pain, and we think it has to do with elevations and circulating endorphins."

The American College of Obstetricians and Gynecologists also recommends that people take NSAIDs for one or two days after their period pain starts. In addition to seeing a doctor, pursuing alternative therapies like acupuncture, acupressure, and nerve stimulation therapies may be useful in managing dysmenorrhea.