Dysmenorrhea

Dysmenorrhea refers to painful uterine cramping associated with menses (monthly periods). In addition to lower pelvic discomfort, women may also experience low back pain, radiation of pain to the anterior thighs, nausea, vomiting, diarrhea, headache, and various other symptoms starting 1 to 3 days before the onset of menses and typically lasting through the first few days of bleeding. Primary dysmenorrhea refers to pain that is not associated with other, obvious pelvic disease and typically begins when a girl first begins to experience periods. Secondary dysmenorrhea is associated with another diagnosis (e.g. cervical stenosis, endometriosis) and typically has a later onset, usually after the age of 20 years.1

Estimates of the percentage of women affected by dysmenorrhea range from 16% to 90% but most reliable estimates place the number at about 75%. Being overweight appears to significantly affect the likelihood and duration of painful cramping. Smoking has been associated with prolonged pain, and although alcohol consumption does not increase the probability of painful cramping, it seems to increase the duration and severity of cramping in women with dysmenorrhea.

The pathogenesis of primary dysmenorrhea seems to involve elevated levels of prostaglandins (lipid compounds that have hormone-like effects) in response to the rise and fall of progesterone that occurs after ovulation. In women with dysmenorrhea, excessive elevation of prostaglandins, specifically prostaglandin F2α and prostaglandin E2α, leads to uterine hypercontractility; painful cramping; and other prostaglandin-related symptoms such as nausea, vomiting, and diarrhea.

Evidence for exercise as a treatment modality for dysmenorrhea has been mixed and limited in quality.2 Early studies indicated that the type of exercise was less important than the desire to alleviate symptoms with exercise.3 However, more recent evidence has supported the use of both aerobic and stretching exercise regimens.4 Tobacco and alcohol use have been associated with worse symptoms of dysmenorrhea. At RMRM, patients are typically counseled on this and supported in addressing unhealthy use of these substances.

The release of arachidonic acid (a fatty acid present in cell membranes) from the membranes of cells of the uterus leads to an increase in proinflammatory prostaglandins. Omega-6 fatty acids are precursors to arachidonic acid, and our consumption of omega-6 compared with omega-3 fatty acids has greatly increased over the past century. An anti-inflammatory diet can change the ratio of omega-6 to omega-3 polyunsaturated fatty acids in our bodies and may thereby modulate the levels of prostaglandins, inflammation, and painful uterine contractions.

Magnesium has been found to be beneficial in the treatment of cardiac arrhythmias, severe asthma, migraine, dyspepsia, and constipation. Its role in dysmenorrhea may be related to its effect on intracellular calcium concentration,5 a reduction in prostaglandin synthesis,6 or its muscle relaxant properties. A series of small studies (n = 21 to 24) in 1988 compared various permutations of vitamin B6 versus magnesium versus vitamin B6 and magnesium versus placebo. The results revealed that vitamin B6 was better than placebo and a combination of vitamin B6 and magnesium at decreasing pain scores and the number of ibuprofen tablets used.7

One of the largest double-blind, placebo-controlled studies investigating the effect of a nutritional supplement on dysmenorrhea was a trial of vitamin B1. This crossover trial involved 556 Indian adolescents who were randomized to receive either 100 mg of vitamin B1 daily for 90 days, followed by placebo for 60 days or placebo for 60 days, followed by 100 mg of vitamin B1 daily. In both groups, complete resolution or significant improvement in pain did not occur until the participants had received thiamine for at least 30 days. “Cure” rates by the end of the trial were approximately 90% in both groups.8

An Iranian blend of highly purified extracts of saffron, celery seed, and anise (SCA by Gol Daro Herbal Medicine) was compared with mefenamic acid (an NSAID) and placebo for effectiveness in alleviating symptoms of dysmenorrhea in 163 women 18–30 years old. SCA, at 500 mg three times daily, was found to be more effective than placebo and NSAIDs. At 250 mg three times daily, it was found to be effective in decreasing menstrual pain intensity and duration. All agents were taken for 3 days at the start of the menstrual cycle. No side effects were noted.9

At RMRM, we’d be happy to further discuss all that regenerative therapies have to offer for addressing dysmenorrhea.

  1. S.D. Harlow, M. Park: A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol.103:1134-1142 1996
  2. J. Brown, S. Brown: Exercise for dysmenorrhea. Cochrane Database Syst Rev. (2)2010CD004142
  3. J.W. Hubbell: Specific and non-specific exercises for the relief of dysmenorrhea. Res Q. 20:378-386 1949
  4. F. Vaziri, A. Hoseini, F. Kamali, et al.: Comparing the effects of aerobic and stretching exercises on the intensity of primary dysmenorrhea in the students of universities of Bushehr. J Fam Reprod Health. 9 (1):23-28 2015
  5. H.P. Zahradnik, M. Breckwoldt: Drug therapy of dysmenorrhea. Gynakologe. 21(1):58-62 1988
  6. J. Sanfilippo, T. Erb: Evaluation and management of dysmenorrhea in adolescents.Clin Obstet Gynecol. 51:257-267 2008
  7. M. Proctor, P. Murphy: Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. (2)2001 CD002124
  8. L.B. Gokhale: Curative treatment of primary (spasmodic) dysmenorrhoea. Indian J Med Res. 103:227-231 1996
  9. K. Nahid, M. Fariborz, G. Ataolah, et al.: The effect of an Iranian herbal drug on primary dysmenorrhea: a clinical controlled trial. J Midwifery Womens Health. 54:401-404 2009