Menstrual Pain

Dysmenorrhea is pain associated with menstruation. Primary dysmenorrhea affects young women in their teens and early twenties. Pain usually begins a day or two before menstrual flow and may continue through the first two days of menstruation. Discomfort tends to decrease over time and after pregnancy. Secondary dysmenorrhea is caused by underlying physical problems.

Signs and Symptoms

Symptoms and degree of pain vary but may include the following.

• Abdominal cramping or dull ache that moves to lower back and legs
• Heavy menstrual flow
• Headache
• Nausea
• Constipation or diarrhea
• Frequent urination
• Vomiting (not common)

What Causes It?

Primary dysmenorrhea is caused by the following.

• Strong uterine contractions stimulated by increased production of the hormone prostaglandin by the lining of the uterus (endometrium)
• Anxiety and stress
• Blood and tissue being discharged through a narrow cervix
• Displaced uterus
• Lack of exercise

Secondary dysmennorhea can be caused by the following.

• Endometriosis (inflammation of the lining of the uterus)
• Blood and tissue being discharged through a narrow cervix
• Uterine fibroid or ovarian cyst
• Infections of the uterus
• Pelvic inflammatory disease (PID)
• Intrauterine device (IUD)

What to Expect at Your Provider's Office

A pelvic examination may include an internal examination laparoscopy and ultrasound. You may need a Pap test or D&C to analyze tissue. Blood and urine samples may be required.

Treatment Options

Treatment Plan

Sometimes a specific disease causes dysmenorrhea. Your health care provider will want to first treat the disease. He or she also may suggest drugs that reduce the painful symptoms. Some women find exercise and relaxation therapies helpful.

Drug Therapies

Prescription

• Gonadotropin-releasing hormone (GnRH) or oral contraceptives—reduce symptoms; various side effects
• Antibiotics—cure PID
• Estrogen or oral progestins—reduces endometriosis; for example norethindrone taken for one year reduces symptoms for 80 percent of patients; be sure to discuss possibly serious side effects with your provider
• Diuretics—for swelling; various side effects

Over the Counter

• Anti-inflammatory agents— reduce symptoms; for example ibuprofen (800 mg to start; then 400 mg to 600 mg every 6 hours)

Complementary and Alternative Therapies

Dysmenorrhea may be effectively treated with nutritional support and mind-body techniques such as meditation yoga tai chi and exercise.

Nutrition

• Increase intake of essential fatty acids which are found in cold-water fish nuts and seeds. Reduce intake of saturated fats (meat and dairy products). Eliminate refined foods sugar dairy products and methylxanthines (coffee and chocolate). Increase intake of fresh fruits and vegetables proteins and whole grains.
• Magnesium (400 mg per day) with B₆ (100 mg per day) throughout cycle to promote hormone production and induce relaxation. Can be used at higher doses during your period (magnesium up to 600 mg per day and B₆ up to 300 mg per day) for pain relief.
• Vitamin E (400 to 800 IU per day) to improve blood supply to muscles
• B-complex (50 to 100 mg per day) to reduce the effects of stress
• Omega-3 oils such as flax seed evening primrose or borage oil (1 000 to 1 500 mg one to two times per day) to reduce inflammation and support hormone production
• Niacinamide (50 mg twice a day) to reduce pain. Begin seven days before your period until the end of flow. Add rutin (60 mg per day) and vitamin C (300 mg per day) to increase effects.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers; 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Chaste tree (Vitex agnus-cactus) and black cohosh (Cimicifuga racemosa) 30 drops each twice a day to reduce dysmenorrhea.
• Red raspberry (Rubus idaeus) tea strengthens uterine tissue.
• Tea of chamomile (Matricaria recutita) and ginger root (Zingiber officinalis) can help reduce ovarian cyst pain.
• Tinctures of cramp bark (Viburnum opulus) black cohosh Jamaican dogwood (Piscidia erythrina) and wild yam (Dioscorea villosa) can be used together in equal parts to relieve pain and cramping. Use 20 drops every half hour for four doses then as needed up to eight doses per day for seven days.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

The following methods can relieve pelvic pain.

• Castor oil pack. Apply oil directly to skin cover with a clean soft cloth (for example flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results use three consecutive days in one week.
• Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for three minutes then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day three to four days per week.

Acupuncture

Dysmenorrhea may respond to acupuncture particularly for pain relief.

Massage

Therapeutic massage is helpful in reducing the effects of stress.

Following Up

If your symptoms change or treatment does not help tell your provider.

Special Considerations

Avoid caffeine alcohol and sugar prior to onset of your period.

Supporting Research

Batchelder HJ Scalzo R. Allopathic specific condition review: dysmenorrhea. The Protocol Journal of Botanical Medicine. 1995;1(1).

Berkow R ed. The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway NJ: Merck Research Laboratories; 1992.

Branch WT Jr. Office Practice of Medicine. 3rd ed. Philadelphia Pa: WB Saunders Company; 1994.

Penland JG Johnson PE. Dietary calcium and manganese effects on menstrual cycle symptoms. Am J Obstet Gynecol. 1993;168:1417–1423.

Werbach MR. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing Inc; 1987.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.