Menstrual Cramps, use of vitamins, herbs, and dietary supplements, natural treatment
January 25 2016 by Ray Sahelian, M.D.

Menstrual periods usually last a few days, but periods as short as two days or as long as seven may be normal. Menstrual flow is usually heaviest in the first two days. Most women have some occasional pain or discomfort during their period. Typical symptoms include cramps, headache, nausea, backache, and fatigue. Menstrual cramps are most often felt in the lower abdomen but may also occur in the lower back or spread down the legs. The medical term is dysmenorrhea.
   Menstrual cramps affect as many as 50 percent of women of reproductive age and between 60 percent to 80 percent of teenaged girls.

Natural menstrual cramp remedy, home remedies
A heating pad or hot water bottle may offer some relief. Walk or exercise regularly. Follow a healthy diet like whole grains, fruits, and vegetables, and plenty of cold water fish like salmon, halibut, and sardines. Reduce sugar and caffeine intake. Practice relaxation techniques like meditation or yoga. You may also consider aromatherapy which may help ease menstrual cramp pain in some women.

Menstrual cramp relief with supplements
Vitamin E may provide relief for some women with menstrual cramps. It is doubtful, though, that vitamin E would provide relief for those with severe discomfort.
Fennel is an herb that could be helpful.
Ginger has been tested and found to be of benefit.
Krill oil has been found to be helpful for menstrual cramps. Perhaps fish oils would also be helpful.

Fennel herb
Comparison of fennel and mefenamic acid for the treatment of primary dysmenorrhea.
Int J Gynaecol Obstet. 2003.
To compare the effect of Foeniculum vulgare variety dulce (Sweet Fennel) vs. mefenamic acid for the treatment of primary dysmenorrhea. A cohort of seventy women, 15-24 years old from a local university and high-school, who complained of dysmenorrhea were enrolled in this study. Ten cases were excluded due to evidence of secondary dysmenorrhea. The remaining 60 patients were graded mild, moderate and severe on the basis of a verbal multidimensional scoring system. Thirty patients with mild dysmenorrhea were also excluded from the study. Each of the 30 cases with moderate to severe dysmenorrhea was evaluated for three cycles. In the first cycle no medication was given (control cycle), in the second cycle the cases were treated by mefenamic acid (250 mg q6h orally) and in the third cycle, essence of Fennel's fruit with 2% concentration (25 drops q4h orally), was prescribed at the beginning of the cycle. These cycles were compared day by day for the effect, potency, time of initiation of action and also complications associated with each treatment modality, by using a self-scoring system. Intensity of pain was reported by using a 10-point linear analog technique. Statistical analyses were performed by the independent sample t-test, paired t-test and repeated measurement analysis method. In the study group the mean age of menarche was 12.5+/-1.3 years, the mean duration of menstruation was 6.6 days with the mean cycle days of 27. The findings observed during menses were as follows: headache in 26%, nausea in 63%, vomiting in 23%, diarrhea in 33%, fatigue in 93.3% and leaving the daily tasks undone was reported in 86% of the cases. Both of the drugs effectively relieved menstrual pain as compared with the control cycles. The mean duration of initiation of action was 67 min for mefenamic acid and 75 min for fennel. The difference was not statistically significant. Mefenamic acid had a more potent effect than fennel on the second and third menstrual days, however, the difference on the other days was not significant. No complication was reported in mefenamic acid treated cycles, but five cases (16.6%) withdrew from the study due to fennel's odor and one case (3.11%) reported a mild increase in the amount of her menstrual flow. The essence of fennel can be used as a safe and effective herbal drug for primary dysmenorrhea, however, it may have a lower potency than mefenamic acid in the dosages used for this study.

Ginger herb
J Altern Complement Med. 2009. Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea.
This was a double-blind comparative clinical trial. Participants were 150 students (18 years old and over) with primary dysmenorrhea from the dormitories of two medical universities who were alternately divided into three equal groups. Students in the ginger group took 250 mg capsules of ginger rhizome powder four times a day for three days from the start of their menstrual period. Members of the other groups received 250 mg mefenamic acid or 400 mg ibuprofen capsules, respectively, on the same protocol. A verbal multidimensional scoring system was used for assessing the severity of primary dysmenorrhea. Severity of disease, pain relief, and satisfaction with the treatment were compared between the groups after one menstruation. At the end of treatment, severity of dysmenorrhea decreased in all groups and no differences were found between the groups in severity of dysmenorrhea, pain relief, or satisfaction with the treatment. Ginger was as effective as mefenamic acid and ibuprofen in relieving pain in women with primary dysmenorrhea. Further studies regarding the effects of ginger on other symptoms associated with dysmenorrhea and efficacy and safety of various doses and treatment durations of ginger are warranted.

J Pak Med Assoc. 2013. The effect of ginger for relieving of primary dysmenorrhoea. 70 female students of the university with primary dysmenorrhoea were randomly divided in to two equal groups and were given either placebo or ginger in capsule form for 3 days in first menstruation cycles. They graded the severity of their pain using a visual analogue scale.  Compared with the baseline, the decrease in the visual analogue scores of post-therapy pain in the ginger group was significantly greater than that for placebo group. In the ginger group, 29 (82.85%) subjects reported an improvement in nausea symptoms, compared with 16 (47.05%) in the placebo group. Ginger is effective in minimising the pain severity in menstrual cramps.

Vitamin E
The study, of teenage girls in Iran, found that those who took vitamin E starting two days before their periods suffered far less cramping than their peers who used only standard pain medication. After four months, the girls who took vitamin E had cramps for less than two hours, on average, during their periods. That compared with 17 hours for those who did not take the vitamin. Dr. Saeideh Ziaei and her colleagues at Tarbiat Modarres University in Tehran report the findings in the British Journal of Obstetrics and Gynaecology. Common menstrual cramps, or primary dysmenorrhea, are thought to result from the release of hormone-like substances called prostaglandins. Prostaglandins cause the uterus to contract in order to expel the uterine lining, resulting in menstrual blood flow. Vitamin E, by acting on two enzymes in the body, can inhibit the formation of prostaglandins -- and, potentially, menstrual cramps, according to Ziaei and her colleagues. To investigate, the researchers randomly assigned 278 girls, 15 to 17 years old, with primary menstrual cramps to take either vitamin E or an inactive placebo pill. Girls in the vitamin E group took 200 milligrams (mg) of the vitamin twice a day, starting two days before they expected their periods and continuing through the third day of menstruation.] Both groups were allowed to take ibuprofen if they needed to. After four months, girls in the vitamin E group showed a sharp reduction in the number of hours they suffered menstrual cramps each month. Few -- 4 percent -- reported using ibuprofen, compared with 89 percent of girls in the placebo group. Girls in both groups tended to say their periods got lighter during the study period, but the change was greater in the vitamin group. The dose of vitamin E used in the study -- 200 mg twice a day -- is significantly higher than the recommended daily intake of 20 mg, but still well within the range that experts consider unlikely to cause adverse effects. U.S. health officials set the "upper tolerable intake level" for vitamin E at 1,000 mg per day. "The use of vitamin E for menstrual cramps  in adolescent women is attractive," Ziaei's team writes, "because of the marked effect we have demonstrated, coupled with the absence of significant side effects from vitamin E at therapeutic doses." British Journal of Gynecology, 2005.

Chinese herbs for menstrual cramps
A study with 3,500 women in several countries supports the use of Chinese herbs in offering relief from menstrual. In many cases, the Chinese herbs worked better than drugs or acupuncture. Xiaoshu Zhu from the Center for Complementary Medicine Research at the University of Western Sydney and his fellow researchers gave women herbal concoctions to treat their menstrual cramp symptoms. Some of these herbs include Chinese angelica root (danggui), Szechuan lovage root (chuanxiong), red peony root (chishao), white peony root (baishao), Chinese motherwort (yimucao), fennel fruit (huixiang), nut-grass rhizome (xiangfu), liquorice root (gancao) and cinnamon bark (rougui).

Zhongguo Zhong Yao Za Zhi. 2013 June. Effects and safety of varying doses of guizhi fuling capsule in patients with primary dysmenorrhea: a multi-center, randomized, double-blind, placebo-controlled clinical study. The efficacy of Guzhi Fuling (high- and low-dose) displays certain dosage-effect relationship. Among these group, no serious adverse event was reported. Guizhi Fuling capsule at high or low dose significantly relieves the pain, improves symptoms, reduces the duration of pain, and has a better overall treatment effect and long-term treatment effect in patients with primary dysmenorrhea.

Evid Based Complement Alternat Med. 2015. Efficacy of Acupuncture versus Combined Oral Contraceptive Pill in Treatment of Moderate-to-Severe Dysmenorrhea: A Randomized Controlled Trial. This open-label randomized controlled trial was designed to compare the efficacy of acupuncture and combined oral contraceptive pill in treating moderate-to-severe primary menstrual cramps. Mefenamic acid was prescribed as a recue analgesic drug with both groups. Response rates following both interventions at the end of the study were not statistically different. Acupuncture commonly caused minimal local side effects but did not cause any hormone-related side effects as did contraceptives. In conclusion, acupuncture is an alternative option for relieving menstrual cramps, especially when oral contraceptive use is not a favorable choice.

What causes menstrual cramps?
These symptoms are caused by the normal contraction of the uterus. Like all muscles, the uterus contracts and relaxes. Most of the time women are unaware of these contractions. During menstruation uterine contractions are much stronger and it is these strong contractions that are most likely to be painful. Uterine contractions are caused by prostaglandins, and there is a good possibility that dietary manipulation can influence the types of prostaglandins that are formed.

Women who started smoking at a young age may be at increased risk for chronic, severe menstrual pain, Tobacco Control, news release, Nov. 17, 2014.

Standard medical menstrual cramps treatment
Ibuprofen and naproxen sodium are common over-the-counter medications that can help relieve menstrual cramps. NSAIDs, the class of painkillers that includes ibuprofen and naproxen seems to work well against menstrual cramps, and may be more effective than acetaminophen, also known as the product name Tylenol. Cochrane Database of Systematic Reviews, 2010.

Natural menstrual cramps treatment questions
Are you familiar with these herbs and nutrients being helpful for menstrual cramps: saw palmetto, lipoic acid, or curcumin? What about endometriosis?
   I have not seen research regarding these herbs and menstrual cramps.
Endometriosis article has some good information.

I simply want to know if maca herb is a good natural treatment for women who suffer from cramps due to their period?
   I have not seen human studies regarding the use of maca herb as a natural treatment for menstrual cramps.

Would you have a proven formula of herbs that can stop excess menstrual bleeding? My wife has had a condition for many years and conventional gynecologists only know about birth control, depo provera shots, and cutting you open as the solution. My wife if familiar with Chinese herbs so no problem there. We are really seeking a proven formula that can stop the bleeding quickly. This goes on for weeks and with clots as well. Local herb practitioners that we have tried have not been able to come up with the right formula. We once had a good doctor that understood the problem and was able to come up with some herbs that worked, but she was in the LA Chinatown and there was a language barrier that proved difficult to overcome.
    I am not familiar with an effective herbal formula that works for excessive menstrual bleeding.

I am amazed and wanted to share with you that I have suffered from painful menstrual cramps since the birth of my second child 13 years ago. Last month I was confined to bed with Thermacare and Advil. I heard CoQ10 increased energy & metabolism & played a roll in a friends weightloss so I thought I'd give it a try. I've taken about a weeks worth of 1oomg CoQ10, I've had more energy, more focus, can run in the cold without my asthma acting too badly and NO MENSTRUAL CRAMPS!

I have experienced painful cramps at menstruation for about 8 years now and have been vegan for 10 years. I recently read a study that showed the effect of omega-3s on prostaglandins- the hormones that cause cramps. I began taking between 420-640mg of algal DHA about 3 months ago. I noticed some alleviation of the cramps, but more annoyingly, a major increase in hormonal moodiness- unusual and irrational sadness, jealousy and grouchiness. Do you think the DHA is affecting my other sex hormones (estrogen, progesterone, testosterone)? Do you think I should also be supplementing with EPA and/or vitamin E?
   It's difficult to say, perhaps it may be a good idea to take the combination of EPA and DHA rather than the latter alone.