Primary dysmenorrhea, also known as menstrual pain, 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
Abdominal cramping or dull ache that moves to lower back and
Heavy menstrual flow
Constipation or diarrhea
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
Lack of exercise
Secondary dysmenorrhea 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.
Your provider may suggest the following drugs.
Anti-inflammatory agents such as ibuprofen (800 mg to start; 400 to
600 mg every six hours).
Gonadotropin-releasing hormone (GnRH) or oral
Antibiotics will cure PID
Estrogen or oral progestins (for example, norethindrone for 12 months
brings relief in 80 percent of patients; however, there may be side
Complementary and Alternative Therapies
Dysmenorrhea may be effectively treated with nutritional support and
mind-body techniques such as meditation, yoga, tai chi, and exercise.
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
B-complex (50 to 100 mg per day) to reduce the effects of
Essential fatty acids (Omega-3 and Omega 6 oils such as flaxseed,
evening primrose, or borage oil) to reduce inflammation and/or support hormone
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 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
Red raspberry (Rubus idaeus) tea strengthens uterine
Tea of chamomile (Matricaria recutita) and ginger root
(Zingiber officinale) can help reduce ovarian cyst pain.
Tinctures of cramp bark (Viburnum opulus), black cohosh,
Jamaica dogwood (Piscidia piscipula), 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.
There have been few studies examining the effectiveness of specific
homeopathic remedies. A professional homeopath, however, may recommend one or
more of the following treatments for menstrual pain based on his or her
knowledge and clinical experience. Before prescribing a remedy, homeopaths take
into account a person's constitutional type. In homeopathic terms, a person's
constitution is his or her physical, emotional, and intellectual makeup. An
experienced homeopath assesses all of these factors when determining the most
appropriate remedy for a particular individual.
Belladonna — for acute menstrual pain
that often resembles labor pains; pain is often described as sharp, throbbing
pressure in the pelvis accompanied by heavy bleeding; pain may extend to the
back and is generally tends to worsen with walking or moving
Chamomilla — for menstrual pain with
mood changes including irritability and anger; pain may occur after bouts of
anger and be relieved by warmth; the individual may have the sensation of a
weight on her pelvis
Cimicifuga — for pains that move from
one side of the abdomen to the other and that are worsened by movement
Colocynthis — for sharp pains
accompanied by anger and irritability
Lachesis — for pain and pressure that
extend to the back; symptoms tend to worsen at night
Magnesia phos — for cramps or sharp,
shooting pains that are relieved by warmth, pressure, and bending forward
Nux vomica — for cramping pains that
extend to the lower back; these pains are often accompanied by nausea, chills,
irritability, and a sensitivity to light, noise, and odors
Pulsatilla — for menstrual pains
accompanied by irritability, moodiness (including feelings of sadness),
dizziness, fainting, nausea, diarrhea, back pain, and headaches; there may be
more pain when there is no menstrual flow
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.
The National Institutes of Health recommend acupuncture as either a
supplemental or alternative treatment for dysmennorhea. This recommendation is
supported by a well-designed trial involving 43 women with dysmenorrhea. Women
treated with acupuncture showed a dramatic reduction in both pain and the need
for pain medication
Acupuncture has become a popular treatment for dysmenorrhea. Acupuncturists
treat people with dysmenorrhea based on an individualized assessment of the
excesses and deficiencies of qi located in various meridians. In the case of
dysmenorrhea, a qi deficiency is usually detected in the liver and spleen
meridians. Moxibustion (a technique in which the herb mugwort is burned over
specific acupuncture points) is often added to enhance needling treatment, and
qualified practitioners may also recommend herbal or dietary
Chiropractors report that some people with dysmenorrhea may benefit from
spinal manipulation (particularly in areas that supply sensory and motor
impulses to the uterus and lower back). Studies of women with a diagnosis or
history of primary dysmenorrhea have found that spinal manipulation improves
symptoms, but no more effectively than sham manipulation. Sham manipulation
refers to maneuvers that shift soft tissues surrounding the bone but to not
actually adjust the spine or joint. Sham manipulation has been compared to
placebo because both procedures look and feel the same. Interestingly, however,
experts are now questioning whether sham is a fair placebo because the massage
quality of the manipulation may also have a beneficial
Therapeutic massage is helpful in reducing the effects of
If your symptoms change, or treatment does not help, tell your
Avoid caffeine, alcohol, and sugar prior to onset of your
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Review Date: August 1999
Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Pamela Stratton, MD, Chief, Gynecology Consult Service, National
Institute of Child Health and Human Development, National Institutes of Health,
Bethesda, MD; Joseph Trainor, DC, (Chiropractic section October 2001)
Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc,
(Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New
York, NY; Leonard Wisneski, MD, FACP, George Washington University, Rockville,
MD; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and
Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu,
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