Painful menstrual cramps, also known as dysmenorrhea, are experienced by more than 50 percent of women. The degree of pain is variable and can be described in a bell curve distribution—for some the pain is hardly noticeable, for others it is severe, and for the majority the pain is somewhere in between.
what is dysmenorrhea?
what symptoms are associated with dysmenorrhea?
The constellation of symptoms can include:
gynecologic: focal cramping or pain in the lower abdomen, pelvis, lower back, and legs
gastrointestinal: nausea, vomiting, and diarrhea
generalized: fatigue or weakness, headache, mood changes
how is dysmenorrhea categorized?
is the pain produced directly from the uterus and NOT from other pathology. This pain usually lasts one to three days, starting just before menstrual flow begins. Cramps are usually worse as an adolescent and lessen with time, especially after childbirth
dysmenorrhea occurs due to causes other than ordinary menstruation. This pain usually arises years after menarche (your very first period) and tends to worsen over time if left untreated
what causes primary dysmenorrhea?
Prostaglandins (PGE2 and PGF2 alpha) are released by the breakdown of endometrial (the lining of the uterus) cells, and cause pain:
by inducing vasoconstriction (constriction of blood vessels) and
local hypoxia (decreased oxygen), through directly irritating nerves and via stimulating uterine contractions.
what are risk factors?
getting your first period (menarche) earlier than age 11
high levels of stress
increased body mass
how is it treated?
Prostaglandin inhibitors (such as NSAIDs including Motrin) are an important option in treating primary dysmenorrhea.
what are the causes of secondary dysmenorrhea?
pelvic inflammatory disease and other sexually transmitted infections (STIs)
fibroids (myomata uteri)
cervical stenosis, imperforate hymen, and other congenital anomalies
how is the cause of dysmenorrhea identified?
the following can be used to identify the underlying cause
personal and family history
cervical cultures for gonorrhea and chlamydia
in certain situations the following might be indicated
management of dysmenorrhea
therapy for dysmenorrhea will depend on the underlying cause.
non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) or naproxen (Aleve) counter the production of prostagladins which is the cause primary dysmenorrhea. NSAIDs will reduce menstrual flow as well as pain.
hormonal birth control
hormonal birth control options will decrease the amount of menstrual flow as well as pain
birth control pills
hormonal IUDs (Mirena, Kyleena)
hormonal implant (Nexplanon)
hormone injection (depo-provera)
diet & lifestyle modifications
increase aerobic exercise
use a heating pad across the pelvis or lower back
avoid caffeine, sugar and alcohol
for secondary dysmenorrhea, the underlying cause should be treated. For instance, some functional ovarian cysts will respond to hormonal therapy such as OCPs, while other cysts such as endometriomas may require surgical excision. Chlamydia and gonorrhea require antibiotic therapy for both the patient and any potentially exposed partners. In the most extreme cases, removal of the uterus, fallopian tubes and/or ovaries is usually an effective option.
alternative options for treating dysmenorrhea
derived from fish oil at a dose of 2 grams per day has been shown to be effective in several studies. Omega-3 fatty acids are the precursor of the potent anti-inflammatory and vasodilating eicosanoids. This conversion requires niacin, magnesium, vitamin B6, vitamin C, and zinc. Omega-6 fatty acids are the basis for producing pro-inflammatory vasoconstrictor eicosanoids. Increasing the proportion of omega-3 to omega-6 reduces inflammation and improves vascular flow, reducing tissue hypoxia.
Beneficial eicosanoid precursors can be found in black currant oil, evening primrose oil, pumpkin, and flax seeds.
2,500 international units (IUs) daily for five days, overlapping the time of pain, has also been shown to be effective
was found to be more effective than placebo in a 2001. Magnesium is a muscle relaxant, helping to diminish uterine contractility as a source of pain, as well as improving vascular flow. Magnesium glycinate at 400 milligrams is helpful when taken once to twice daily starting several days before menses starts through the end of flow.
at high doses (50,000 IUs weekly) has been shown to be useful in treating dysmenorrhea, but additional studies evaluating the efficacy of vitamin D have not been as convincing.
vitamin B1 (thiamine)
at a dose of 100 milligrams daily has been shown to be effective in a randomized controlled study in a group of 500 Indian women.
acts in a multitude of beneficial ways to reduce dysmenorrhea. It increases insulin sensitivity, thus reducing inflammation. It reduces the volume of menstrual flow. It is an anti-spasmodic. It also improves circulation, thus reducing tissue hypoxia.
has been found to have a substantial impact on menstrual pain. Two components in ginger, the gingerols and gingerdiones, inhibit leukotriene and prostaglandin synthesis, thus decreasing pain. One study evaluated a dose of 500 mg three times daily for five days, beginning two days prior to the onset of flow. Another study used 250 mg four times daily for three days beginning on the first day of flow. Ginger was as or more effective than placebo as well as NSAIDs with the added bonus of diminishing nausea.
is an anti-inflammatory agent as well as an analgesic when taken systemically. Both effects are very useful in the treatment of dysmenorrhea. CBD is also an anxiolytic. Anxiety is a risk factor for primary dysmenorrhea, and is also a result of cyclic pain, the anticipation of pain produces anxiety.
diet & lifestyle
low-fat vegan diet
a low-fat vegan diet has been shown to significantly reduce pain for many women
eliminates all animal fats and nearly all vegetable oils.
emphasizes plant-based foods, rich in fiber
a low-fat, high-fiber diet can reduce estrogen levels by about 20 percent.
Since estrogen is responsible for growth of endometrium, less estrogen equates with less endometrium, less menstrual flow and less prostaglandin production.
The high amount of vegetable fibers assists in estrogen metabolite elimination. Improved bowel elimination also prevents reabsorption via the enterohepatic circulation.
Paleo or Mediterranean diet
inflammation is the hallmark of dysmenorrhea Paleo and Mediterranean style diets are known to be anti-inflammatory
high amounts of vegetables
low in sugars and other carbohydrates
reduced or eliminated dairy and gluten
use of healthy oils such as avocado and olive oils, and use of nuts and seeds.
the Standard American Diet (or SAD) is high in processed sugary foods, animal fats from industrialized animals, and refined vegetable oils
these "foods" are known to be highly inflammatory
Aerobic exercise is anti-inflammatory, improves circulation, improves anxiety and depression, improves bowel function and estrogen metabolite elimination, and results in an outpouring of endogenous endorphins, our own natural pain relievers.
Similarly, orgasms have been promoted to have similar effects as exercise with the added benefit of directly increasing uterine circulation.
Stress management is an integral part of treating women with dysmenorrhea, as their cyclic pain will surely contribute to angst and further dysfunction. Meditation, yoga, prayer, mindful awareness, and other stress-reduction efforts are an essential part of caring for women in pain.