Medicine does not know why menstruation is uncomfortable, or why it is much more uncomfortable for some women than for others, or from month to month.
Occasionally, severe menstrual pain indicates the presence of endometriosis (a condition in which uterine tissue is growing in places other than the uterus) or uterine fibroids (benign tumors in the uterus). In most cases, no identifiable abnormality can be found. Natural substances known as prostaglandins seem to play a central role in menstrual pain, but their detailed actions are not fully understood. Anti-inflammatory drugs such as ibuprofen and naproxen relieve pain and reduce levels of some prostaglandins. These drugs are the mainstay of conventional treatment for menstrual pain. Oral contraceptive treatment may also help.
The omega-3 fatty acids in fish oil are thought to have anti-inflammatory effects. Omega-3 may relieve dysmenorrhea by affecting the metabolism of prostaglandins and other factors involved in pain and inflammation.1
In a 4-month study of 42 young women ages 15 to 18, half the participants received a daily dose of 6 g of fish oil, providing 1,080 mg of EPA (eicosapentaenoic acid) and 720 mg of DHA (docosahexaenoic acid) daily.2 After 2 months, they were switched to placebo for another 2 months. The other group received the same treatments in reverse order. The results showed that these young women experienced significantly less menstrual pain while they were taking fish oil.
Another double-blind study followed 78 women, who received either fish oil, seal oil, fish oil with vitamin B12 (7.5 mcg daily), or placebo for three full menstrual periods.3 Significant improvements were seen in all treatment groups, but the fish oil plus B 12 proved most effective, and its benefits continued for the longest time after treatment was stopped (3 months). The researchers offered no explanation why B 12 should be helpful.
For more information, including dosage and safety issues, see the full Fish Oil article.
In a double-blind, placebo-controlled trial, 100 young women complaining of significant menstrual pain were given either 500 IU vitamin E or placebo for 5 days.12 Treatment began 2 days before and continued for 3 days after the expected onset of menstruation. While both groups showed significant improvement in pain over the 2 months of the study (due to the power of placebo), pain reduction was greater in the treatment group than the placebo group.
In another study performed in Iran, 278 adolescents with dysmenorrhea were given either placebo or 200 IU of vitamin E twice daily on the same schedule as above.18 Again, vitamin E proved more effective than placebo.
It is not clear how vitamin E could affect menstrual pain.
For more information, including dosage and safety issues, see the full Vitamin E article.
Preliminary studies suggest that magnesium supplementation may be helpful for dysmenorrhea. A 6-month, double-blind, placebo-controlled study of 50 women with menstrual pain found that treatment with magnesium significantly improved symptoms.9 The researchers reported evidence of reduced levels of prostaglandin F 2 alpha, one of the prostaglandins involved in menstrual pain.
Similarly positive results were seen in a double-blind, placebo-controlled study of 21 women.10
For more information, including dosage and safety issues, see the full Magnesium article.
A double-blind study of 43 women found some evidence that acupuncture can be effective for control of menstrual pain.14 In addition, a controlled study of 61 women evaluated the effects of a special garment designed to stimulate acupuncture points related to menstrual pain.15 Unfortunately, researchers chose to compare treatment to no treatment, rather than to placebo treatment. For this reason, the results (which were positive) mean little. In a review of 30 controlled trials, researchers were unable to draw conclusions about the effectiveness of acupuncture and similar treatments for menstrual pain due to widespread study design problems.24
A review 6 randomized trials compared acupressure and acupuncture to no treatment and sham treatment. The trials evaluated the effects of these interventions on pain reduction in 457 women with dysmenorrhea. Acupressure and acupuncture were associated with pain reduction compared to no treatment, but when compared to sham treatment, there were no significant differences.28
A randomized trial of 66 women with primary dysmenorrhea showed improvement in pain scores with 16 twice-weekly acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) compared to sham AL-TENS.27
A more recent systematic review included 42 acupuncture and acupressure trials involving 4,640 women. Acupuncture was associated with pain relief when compared to no or standard treatment, sham acupuncture/accupressure, anti-inflammatory drugs (NSAIDs) and traditional Chinese herbs. Some of the trials showed significant pain relief, while others were more mixed. Despite successes, there is not enough quality evidence to definitively include acupuncture/accupressure as standard treatment. The trials were inconsistent and had several biases that affect outcomes. Researchers found enough weaknesses in the trials to recommend the need for more high-quality studies.29
The herb cramp bark has traditionally been used to relieve menstrual pain. Unfortunately, it has not received any significant scientific attention. Numerous other herbs and supplements have been suggested for menstrual pain relief, including boswellia, bromelain, Coleus forskohlii, dong quai, turmeric, and white willow. However, there is no reliable scientific support for these treatments.
One study has been reported as finding the herb fennel helpful for menstrual pain; however, a close look at the study shows that it merely found fennel less effective than the drug mefenamic acid.13 The study did not have a placebo control group. For this reason, it is quite possible that the relatively mild benefits seen in the fennel group simply reflect the placebo effect. Another study of fennel also failed to use a placebo.21
Some pain relief successes were reported with the herbal supplements ginger, valerian, dill seed powder, and fenugreek. Supplements were taken during menstrual cyles and compared to placebo. The review included 27 randomized trials with 3,101 women. Although pain relief was consistent with the 4 supplements, there were biases in the trials that affect the end results. At this time, there is not enough evidence to say these herbs work.30
In one study, aromatherapy massage with lavender, rose, and clary sage reduced menstrual pain to a greater extent than massage with an almond oil placebo.20 One seemingly substantial double-blind study reported benefits with guava leaf .22 However, researchers resorted to a form of statistical analysis that makes the results relatively unreliable.
A 2008 review of 39 randomized controlled trials involving a total of 3,475 women, researchers concluded that the use of traditional Chinese herbal medicine shows some promise in for the treatment of menstrual pain. However, firm conclusions were not possible due to the wide variability of study design and herbs used, as well as the poor quality of many of the studies.23
Sericite is a mineral that emits far infrared rays, which subtly warms tissue and locally increases blood flow. In one study, researchers randomized 104 women with menstrual cramps to wear a heated sericite belt or a placebo belt for 3 menstrual cycles.26 The evidence suggests that the sericite belt may be a useful treatment for menstrual cramps.
Various herbs and supplements may interact adversely with drugs used to treat dysmenorrhea. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.
1. Harel Z, Biro FM, Kottenhahn RK, et al. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. 1996;174:1335-1338.
2. Harel Z, Biro FM, Kottenhahn RK, et al. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. 1996;174:1335-1338.
3. Deutch B, Jorgensen EB, Hansen JC. Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B 12 (fish oil or seal oil capsules). Nutr Res. 2000;20:621-631.
9. Seifert B, Wagler P, Dartsch S, et al. Magnesium—a new therapeutic alternative in primary dysmenorrhea [translated from German]. Zentralbl Gynakol. 1989;111:755-760.
10. Fontana-Klaiber H, Hogg B. The therapeutic effects of magnesium in dysmenorrhea [in German; English abstract]. Schweiz Rundsch Med Prax. 1990;79:491-494.
11. Penland J, Johnson P, et al. Dietary calcium and manganese effects on menstrual cycle symptoms. Am J Obstet Gynecol. 1993;168:1417-1424.
12. Ziaei S, Faghihzadeh S, Sohrabvand F, et al. A randomized placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea. BJOG. 2001;108:1181-1183.
13. Namavar Jahromi B, Tartifizadeh A, Khabnadideh S.Comparison of fennel and mefenamic acid for the treatment of primary dysmenorrhea. Int J Gynaecol Obstet. 2003;80:153-157.
14. Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstet Gynecol. 1987;69:51-56.
15. Taylor D, Miaskowski C, Kohn J. A randomized clinical trial of the effectiveness of an acupressure 357 device (Relief Brief) for managing symptoms of dysmenorrhea. J Alt Compl Med. 2002;8:357-370.
16. Hondras MA, Long CR, Brennan PC. Spinal manipulative therapy versus a low force mimic maneuver for women with primary dysmenorrhea: a randomized, observer-blinded, clinical trial. Pain. 1999;81:105-114.
17. Sampalis F, Bunea R, Pelland MF, et al. Evaluation of the effects of Neptune Krill Oil on the management of premenstrual syndrome and dysmenorrhea. Altern Med Rev. 2003;8:171-179.
18. Ziaei S, Zakeri M, Kazemnejad A, et al. A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. BJOG. 2005;112:466-469.
19. Eccles NK. A randomized, double-blinded, placebo-controlled pilot study to investigate the effectiveness of a static magnet to relieve dysmenorrhea. J Altern Complement Med. 2005;11:681-687.
20. Han SH, Hur MH, Buckle J, et al. Effect of aromatherapy on symptoms of dysmenorrhea in college students: a randomized placebo-controlled clinical trial. J Altern Complement Med. 2006;12:535-541.
21. Modaress Nejad V, Asadipour M. Comparison of the effectiveness of fennel and mefenamic acid on pain intensity in dysmenorrhoea. East Mediterr Health J. 2006;12:423-427.
22. Doubova SV, Morales HR, Hernandez SF, et al. Effect of a Psidii guajavae folium extract in the treatment of primary dysmenorrhea: A randomized clinical trial. J Ethnopharmacol. 2006 Oct 13. [Epub ahead of print]
23. Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database of Systematic Reviews. 2008;CD005288.
24. Yang H, Liu CZ, Chen X, et al. Systematic review of clinical trials of acupuncture-related therapies for primary dysmenorrhea. Acta Obstet Gynecol Scand. 2008;87:1114-1122.
26. Lee C, Roh J, Lim C, Hong J, Lee J, Min E. A multicenter, randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of a far infrared-emitting sericite belt in patients with primary dysmenorrhea. Complementary Therapies in Medicine. 2011;19(4):187-193.
27. Wu LL, Su CH, Liu CF. Effects of noninvasive electroacupuncture at Hegu (LI4) and Sanyinjiao (SP6) acupoints on dysmenorrhea: a randomized controlled trial. J Altern Complement Med. 2012;18(2):137-142.
28. Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review. J Physiother. 2014;60(1):13-21.
29. Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. Acupuncture for dysmenorrhoea. Cochrane Database Syst Rev. 2016;4:CD007854.
30. Pattanittum P, Kunyanone N, Brown J, Sangkomkamhang US, Barnes J, Seyfoddin V, Marjoribanks J. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev. 2016;3:CD002124
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 7/19/2016
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