Dysmenorrhea, or painful menstruation, 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 commonly a result of endometriosis, 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 month.¹

Nutritional supplements 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 40 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.⁷ In a follow-up study of 220 women, 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.⁸ Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. The effect of 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 was reported to reduce pain during menses in one double-blind trial,⁹ though another such study found that calcium relieved only premenstrual cramping and not pain during menses.¹⁰ Some doctors recommend calcium, 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 total of 2,000 mg per day).

Long ago, vitamin B1 (thiamine) was linked to inflammation of pelvic nerves, a condition that can accompany dysmenorrhea. In 1996, as a result of this link, researchers from India gave 556 adolescents with dysmenorrhea 100 mg of vitamin B1 per day for three months in a double-blind trial.¹² A remarkable 87% were cured with this treatment. However, thiamine deficiency in India is relatively common, but is rare in the Western world except in alcoholics. Therefore, the dramatic relief experienced by Indian adolescents might not occur in women in this society were they to supplement with thiamine.

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 analgesic and sedative effects. Painful menstruation responded favorably to the administration of THP.¹³ For an analgesic 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 1:2 extract.

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. It has been shown to block smooth muscle spasms in experiments.¹⁴ To use this herb, place two teaspoonfuls of the dried bark into a cup of water and bring to a boil; simmer gently for ten to fifteen minutes. This may be drunk three times per day.¹⁵ Alternatively, 4–8 ml of tincture can be used three times per day.

Black cohosh has a history as a folk medicine for relieving menstrual cramps. Black cohosh can be taken in several forms, including crude, 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.¹⁶ The best researched form provides 1 mg of deoxyactein per 20 mg of extract. Tinctures can be taken at 2–4 ml three times per day.¹⁷ Black cohosh can be taken for up to six months, and then it should be discontinued.¹⁸

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 dose of the whole herb is 300–1,000 mg. Blue cohosh is generally used in combination with other herbs. Women of child-bearing 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.¹⁹

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 in the amount of 2–5 ml three times per day. The dried root may be used at 1–2 grams three times daily. It is almost always taken in combination with other herbs supportive of the female reproductive organs, particularly vitex.

Yarrow was used traditionally to treat inflammation in a number of conditions, especially in female reproductive system. The German Commission E monograph suggests 4.5 grams of yarrow daily or 3 teaspoons of the fresh pressed juice.²⁰ A tea can be prepared by steeping 1–2 tsp (5–10 grams) of yarrow in 1 cup (250 ml) boiling water for ten to fifteen minutes. Three cups a day can be drunk. If tincture is preferred, 3–4 ml can be taken three times per day. The tea, or cloths dipped in the tea, can be used topically as needed.

Dong quai is a traditional Chinese herb that may also ease dysmenorrhea. The powdered root can be used in capsules, tablets, tinctures, or as a tea. Many women take 3–4 grams per day.

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.

Chaparral is another herb that has been used historically for dysmenorrhea, although it should only be used topically.

Other integrative therapies that may be helpful: Relaxation techniques have been used with some success to alleviate dysmenorrhea in some young women. According to one study, the symptoms of menstrual cramps, nausea, irritability, and poor concentration greatly improved after twenty-minute relaxation sessions twice per week.²¹

Acupuncture may be a useful therapy in the treatment of dysmenorrhea. An uncontrolled study reported that 42 of 49 women treated for dysmenorrhea with acupuncture had complete cessation of pain for three consecutive menstrual periods.²² Other uncontrolled studies have demonstrated similar results. ^{23 24 25} A placebo-controlled study 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.²⁶ A small controlled trial using TENS (transcutaneous electrical nerve stimulation) units to stimulate acupuncture points compared a placebo pill with one 30-minute treatment with TENS. 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.²⁷ More controlled trials are needed to determine whether acupuncture is a useful treatment for dysmenorrhea.

Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.

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