Also indexed as: Menstrual Cramps, Painful Menstruation
A woman’s monthly cycle may include several days of pain
and discomfort due to cramps, also known as dysmenorrhea. How do you find relief? According to
research or other evidence, the following self-care steps may be helpful:
- Mix in magnesium
- Take a supplement containing 360 mg a day of this essential
mineral to help keep uterine muscles relaxed
- Don’t forget the fish oil
- Take a supplement containing 1,800 mg a day of EPA and DHA to help
prevent menstrual symptoms
- Take vitamin E in advance
- To help prevent severe pain, take 400 to 600 IU of vitamin E a day
for five days, beginning two days before menstruation
- Make an appointment with an acupuncturist
- See a qualified practitioner to find out if treatments may relieve
- Try spinal manipulation
- Visit a chiropractor or other licensed practitioner trained in
this technique to see if it reduces painful symptoms
- Make time for a checkup
- See your healthcare provider to find out if your dysmenorrhea
could be caused by a treatable medical condition
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full dysmenorrhea article for
more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
Dysmenorrhea is painful menstruation. It is classified as either primary or secondary.
Primary dysmenorrhea generally occurs within a couple of years of the first menstrual period.
The pain tends to decrease with age and very often resolves after childbirth. Secondary
dysmenorrhea is menstrual pain caused by another condition, commonly endometriosis. It starts later in life and tends to
increase in intensity over time.
As many as half of menstruating women are affected by dysmenorrhea, and of these, about 10%
have severe dysmenorrhea, which greatly limits activities for one to three days each
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What are the symptoms?
Dysmenorrhea includes symptoms of abdominal bloating, frequent and intense cramps, pain below the waistline, or a dull ache that may
radiate to the lower back or legs. There may also be symptoms of headache, nausea, diarrhea or constipation, frequent urination, and, occasionally,
vomiting. The symptoms usually occur just before or during the menstrual period.
Over-the-counter treatment includes pain medications, such as ibuprofen (Advil®, Motrin®, Midol
PMS®), naproxen (Aleve®), and acetaminophen (Tylenol®).
Prescription strength nonsteroidal
anti-inflammatory drugs (NSAIDs) including
celecoxib (Celebrex®), ibuprofen
(Motrin®), diclofenac (Voltaren®),
ketoprofen (Orudis®), and mefenamic acid
(Ponstel®) might be necessary for pain relief. Birth control pills (Ortho-Novum®,
Mircette®, Loestrin®, Triphasil®) may be used to suppress ovulation. The
anti-estrogen drug danazol (Danocrine®) and progestins are also occasionally used. Severe
cases involving nausea and vomiting might require the use of prochlorperazine (Compazine®) or promethazine (Phenergan®).
Dietary changes that may be helpful
Some physicians advise that alcohol should be avoided by women experiencing menstrual pain,
because it depletes stores of certain nutrients and alters the metabolism of
carbohydrates—which in turn might worsen muscle spasms. Alcohol can also interfere with
the liver’s ability to metabolize hormones. In theory, this might result in elevated
estrogen levels, increased fluid and salt retention, and heavier menstrual flow.
Lifestyle changes that may be helpful
Many women feel the need to lie still while experiencing menstrual cramps, while others
find that exercise helps relieve the pain of dysmenorrhea. This variation from woman to woman
may explain why some researchers report that exercise makes symptoms worse,2 though
most studies report that exercise appears helpful.3
Vitamins that may be helpful
The niacin form of vitamin B3 has been
reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200
mg of niacin per day throughout the menstrual cycle. They then took 100 mg every two or three
hours while experiencing menstrual cramps.4 In a follow-up study, this protocol was
combined with 300 mg of vitamin C and 60 mg of
the flavonoid rutin per day, which resulted in
a 90% effectiveness for relieving menstrual cramps.5 Since these two preliminary
studies were published many years ago, no further research has explored the relationship
between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten
days before the onset of menstrual flow.
In theory, calcium may help prevent
menstrual cramps by maintaining normal muscle tone. Muscles that are calcium-deficient tend to
be hyperactive and therefore might be more likely to cramp. Calcium supplementation was
reported to reduce pain during menses in one double-blind trial,6 though another
such study found that it relieved only premenstrual cramping, not pain during
menses.7 Some doctors recommend calcium supplementation for dysmenorrhea,
suggesting 1,000 mg per day throughout the month and 250–500 mg every four hours for
pain relief, during acute cramping (up to a maximum of 2,000 mg per day).
Like calcium, magnesium plays a role in
controlling muscle tone and could be important in preventing menstrual cramps.8
9 Magnesium supplements have been reported in preliminary and double-blind European
research to reduce symptoms of dysmenorrhea.10 11 12 In one
of these double-blind trials, women took 360 mg per day of magnesium for three days beginning
on the day before menses began.13
Diets low in omega-3 fatty acids (EPA and
DHA) have been associated with menstrual pain.14 In one double-blind trial,
supplementation with fish oil, a good source
of omega-3 fatty acids, led to a statistically significant 37% drop in menstrual symptoms. In
that report, adolescent girls with dysmenorrhea took an unspecified amount of fish oil that
provided 1,080 mg of EPA and 720 mg of DHA per day for two months to achieve this
result.15 A double-blind trial found that the same amount of EPA and DHA plus 7.5
mcg per day of vitamin B12 led to a greater than 50% decrease in menstrual symptoms, but a
group taking only fish oil did not obtain as much relief.16 Six grams of fish oil
per day provides the approximate levels of EPA and DHA used in these trials.
In a double-blind trial, adolescents living in India who were suffering from dysmenorrhea
took 100 mg of vitamin B1 (thiamine) per day
for three months. Eighty-seven percent of those treated experienced marked relief of
dysmenorrhea symptoms.17 However, vitamin B1 deficiency is relatively common in
India, whereas it is rare in the Western world, except among alcoholics. It is not known
whether vitamin B1 supplementation would relieve dysmenorrhea in women who are not B1
In a double-blind trial, supplementation with 500 IU of vitamin E per day for two months, beginning two days
before menstruation and continuing for three days after the onset of menstruation, was
significantly more effective than a placebo at relieving menstrual pain.18 Similar
benefits were seen in four-month double-blind trial using 400 IU per day, beginning two days
before the expected start of menstruation and continuing through the first three days of
Some practitioners report success using topical progesterone cream for dysmenorrhea.20 To
date, this approach lacks sufficient research.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Corydalis contains several alkaloids, and
one called tetrahydropalmatine (THP) is considered to be the most potent. In laboratory
research, THP has been shown to exhibit a wide number of pharmacological actions on the
central nervous system, including pain-relieving and sedative effects.21 According
to a secondary reference, painful menstruation responded favorably to the administration of
THP.22 For a pain-relieving effect, the recommended amount for the crude dried
rhizome is 5–10 grams per day. Alternatively, one can take 10–20 ml per day of a
Cramp bark (Viburnum opulus) has been a favorite traditional herb for menstrual
cramps, thus its signature name. Cramp bark may help ease severe cramps that are associated
with nausea, vomiting, and sweaty chills. Research from animal studies shows that cramp bark
blocks spasms of smooth muscle.23 Cramp bark is traditionally prepared by placing
two teaspoons of the dried bark into a cup of water and bringing it to a boil; it is then
simmered gently for 10 to 15 minutes. The tea may be drunk three times per day.24
Alternatively, 4–8 ml of tincture may be used three times per day.
Açaí is reported to be a
traditional remedy for dysmenorrhea. There is preliminary evidence that anthocyanins from
bilberry, some of which are also found in açaí, may help with dysmenorrhea
symptoms.25 However, there have been no clinical trials investigating
açaí’s effect on dysmenorrhea.
Black cohosh has a history as a folk
medicine for relieving menstrual cramps. Black cohosh can be taken in several forms, including
crude plant, dried root, or rhizome (300–2,000 mg per day), or as a solid, dry powdered
extract (250 mg three times per day). Standardized extracts of the herb are available, though
they have primarily been researched for use with
menopausal women suffering from hot flashes. The recommended amount is 20–40 mg
twice per day.26 The best researched form provides 1 mg of deoxyactein per 20 mg of
extract. Tinctures can are also used (2–4 ml three times per day).27 The
Commission E Monograph recommends black cohosh be taken for up to six months, and then
Blue cohosh, although unrelated to black
cohosh, has also been used traditionally for easing painful menstrual periods. Blue cohosh,
which is generally taken as a tincture, should be limited to no more than 1–2 ml taken
three times per day. The average single application of the whole herb is 300–1,000 mg.
Blue cohosh is generally used in combination with other herbs. Women of childbearing age using
this herb should cease using it as soon as they become pregnant—the herb was shown to cause heart
problems in an infant born following maternal use of blue cohosh.29
False unicorn was used in the Native
American tradition for a large number of women’s health conditions, including painful
menstruation. Generally, false unicorn root is taken as a tincture (2–5 ml three times
per day). The dried root may also be used (1–2 grams three times daily). It is typically
taken in combination with other herbs supportive of the female reproductive organs.
Dong quai has been used either alone or in
combination with other Traditional Chinese
Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams
per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and
four other herbs and has been found to effectively reduce symptoms of cramping and pain
associated with dysmenorrhea.30
Vervain is a traditional herb for
dysmenorrhea, however there is no research to validate this use. Tincture has been recommended
at an amount of 5–10 ml three times per day.
Clinical reports from Germany have suggested that vitex may help relieve different menstrual
abnormalities associated with premenstrual syndrome, including dysmenorrhea.31
These studies used 40 drops of a liquid preparation that delivers the equivalent of 40 mg of
the dried berries of the plant.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
Relaxation techniques have been used with some success to alleviate dysmenorrhea in some
young women. According to one preliminary study, the symptoms of menstrual cramps, nausea,
irritability, and poor concentration greatly improved after 20-minute relaxation sessions
twice per week.32
Acupuncture may be a useful therapy in the
treatment of dysmenorrhea. A preliminary trial reported that 86% of women treated with
acupuncture for dysmenorrhea had complete cessation of pain for three consecutive menstrual
periods.33 Other preliminary trials have demonstrated similar results.34
35 36 A controlled clinical trial reported 91% efficacy with acupuncture
compared to 36.4% efficacy with sham acupuncture (using fake acupuncture points) and 18%
efficacy in an untreated control group.37 A small trial compared a 30-minute TENS
(transcutaneous electrical nerve stimulation) treatment to stimulate acupuncture points with a
placebo pill for dysmenorrhea. There was a large placebo effect in this study, and pain relief
over the next several hours was not significantly better in the treatment group compared to
placebo.38 More controlled trials are needed to determine whether acupuncture is a
useful treatment for dysmenorrhea.
Spinal manipulation has been investigated
as a treatment for dysmenorrhea. One small preliminary study reported improvement in symptoms
measured by a questionnaire.39 A controlled clinical trial compared a single
treatment of spinal manipulation to the low back and pelvis to a sham manipulation that was
designed to be ineffective. Women receiving real manipulation reported twice as much relief as
those receiving sham treatment.40 A recent, larger trial repeated the above study,
testing a series of treatments over two months. Women reported less pain from both real and
sham treatment, but there was no difference between the groups.41 Whether there is
a real benefit from spinal manipulation for women with dysmenorrhea remains unclear at this
1. Galeao R. La dysmenorrhee, syndrome multiforme. Gynecologie
1974;25:125 [in French].
2. Metheny WP, Smith RP. The relationship among exercise, stress, and
primary dysmenorrhea. J Behav Med 1989;12:569–86.
3. Bolomb LM, Solidmum AA, Warren MP. Primary dysmenorrhea and physical
activity. Med Sci Sports Exerc 1998;30:906–9 [review].
4. Hudgins AP. Am Practice Digest Treat 1952;3:892–3.
5. Hudgins AP. Vitamins P, C and niacin for dysmenorrhea therapy.
West J Surg 1954;Dec:610–1.
6. Penland J, Johnson P. Dietary calcium and manganese effects on
menstrual cycle symptoms. Am J Obstet Gynecol 1993;168:1417–23.
7. Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and
the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet
8. Durlach J. Neuromuscular and phlebothrombotic clinical aspects of
primary magnesium deficiency. Z Ernahrungswiss 1975;14:75–83 [in French].
9. Martignoni E, Nappi G, Facchinetti F, Gennazzani AR. Magnesium in
gynecological disorders. Gyn Endocrinol 1988;2(Suppl 2):26 [abstract].
10. Benassi L, Barletta FP, Baroncini L, et al. Effectiveness of
magnesium pidolate in the prophylactic treatment of primary dysmenorrhea. Clin Exp Obstet
11. Fontana-Klaiber H, Hogg B. Therapeutic effects of magnesium in
dysmenorrhea. Schweiz Rundsch Med Prax 1990;79:491–4 [in German].
12. Seifert B, Wagler P, Dartsch S, et al. Magnesium—a new
therapeutic alternative in primary dysmenorrhea. Zentralbl Gynakol
1989;111:755–60 [in German].
13. Fontana-Klaiber H, Hogg B. Therapeutic effects of magnesium in
dysmenorrhea. Schweiz Rundsch Med Prax 1990;79:491–4 [in German].
14. Deutch B. Menstrual pain in Danish women correlated with low n-3
polyunsaturated fatty acid intake. Eur J Clin Nutr 1995;49:508–16.
15. Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with
omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J
Obstet Gynecol 1996;174:1335–8.
16. Deutch B, Jørgensen EB, Hansen JC. Menstrual discomfort in
Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil
capsules). Nutr Res 2000;20:621–31.
17. Gokhale LB. Curative treatment of primary (spasmodic) dysmenorrhoea.
Indian J Med Res 1996;103:227–31.
18. Ziaei S, Faghihzadeh S, Sohrabvand F, et al. A randomised
placebo-controlled trial to determine the effect of vitamin E in treatment of primary
dysmenorrhoea. Br J Obstet Gynaecol 2001;108:1181–3.
19. Ziaei S, Zakeri M, Kazemnejad A. A randomised controlled trial of
vitamin E in the treatment of primary dysmenorrhoea. BJOG 2005;112:466–9.
20. Hudson T. Natural progesterone: Clinical indications in women’s
health. Townsend Letter for Doctors and Patients 1999;Dec:140–3.
21. Zhu YP. Chinese Materia Media: Chemistry, Pharmacology, and
Applications. Australia: Harwood Academic Publishers, 1998, 445–8.
22. Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology, and
Applications. Australia: Harwood Academic Publishers, 1998, 445–8
23. Nicholson JA, Darby TD, Jarobe CH. Viopudial, a hypotensive and
smooth muscle antispasmotic from Viburnum opulus. Proc Soc Exp Biol Med
24. Hoffmann D. The Holistic Herbal. Forres, Scotland: The
Findhorn Press, 1986, 88.
25. Colombo D and Vescovini R: Controlled clinical trial of
anthocyanosides from Vaccinium myrtillus in primary dysmenorrhea. G Ital Obstet
26. Murray MT. The Healing Power of Herbs. Rocklin, CA: Prima
Publishing, 1995, 376.
27. Bradley PR, ed. British Herbal Compendium, vol 1.
Bournemouth, Dorset, UK: British Herbal Medicine Association, 1992, 34–6.
28. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete
Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative
Medicine Communications, 1998, 90.
29. Jones TK, Lawson BM. Profound neonatal congestive heart failure
caused by maternal consumption of blue cohosh herbal medication. J Pediatr
30. Kotani N, Oyama T, Hashimoto H, et al. Analgesic effect of a herbal
medicine for treatment of primary dysmenorrhea—a double-blind study. Am J Chinese
31. Loch E, Böhnert KJ, Peeters M, et al. The treatment of menstrual
disorders with Vitex agnus-castus tincture. Der Frauenarzt
1991;32:867–70 [in German].
32. Ben-Menachem M. Treatment of dysmenorrhea: A relaxation therapy
program. Int J Gynaecol Obstet 1980;17:340–2.
33. Yuqin Z. A report of 49 cases of dysmenorrhea treated by acupuncture.
J Tradit Chin Med 1984;4:101–2.
34. Xiaoma W. Observations of the therapeutic effects of acupuncture and
moxibustion in 100 cases of dysmenorrhea. J Tradit Chin Med 1987;7:15–7.
35. Chuang Z. Treatment of 32 cases of dysmenorrhea by puncturing hegu
and sanyinjiao acupoints. J Tradit Chin Med 1990;10:33–5.
36. Lin L. Literature research on point injection with Chinese Angelica
liquor. J Tradit Chin Med 1998;18:308–12.
37. Helms JM. Acupuncture for the management of primary dysmenorrhea.
Obstet Gynecol 1987;69:51–6.
38. Lewers D, Clelland JA, Jackson JR, et al. Transcutaneous electrical
nerve stimulation in the relief of primary dysmenorrhea. Phys Ther
39. Thomason PR, Fisher BL, Carpenter PA, Fike GL. Effectiveness of
spinal manipulative therapy in treatment of primary dysmenorrhea: a pilot study. J Manip
Physiol Ther 1979;2:140–5.
40. Kokjohn K, Schmid D, Triano J, Brennan P. The effect of spinal
manipulation on pain and prostaglandin levels in women with primary dysmenorrhea. J Manip
Physiol Ther 1992;15:279–85.
41. 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;81:105–14.