Dysmenorrhea

In a double-blind trial, supplementation with 500 IU of vitamin E per day for two months, beginning two days before menstruation and continuing for three days after the onset of menstruation, was significantly more effective than a placebo at relieving menstrual pain.²⁰ Similar benefits were seen in four-month double-blind trial using 400 IU per day, beginning two days before the expected start of menstruation and continuing through the first three days of bleeding.²¹

Açaí is reported to be a traditional remedy for dysmenorrhea. There is preliminary evidence that anthocyanins from bilberry, some of which are also found in açaí, may help with dysmenorrhea symptoms.²² However, there have been no clinical trials investigating açaí’s effect on dysmenorrhea.

Black cohosh has a history as a folk medicine for relieving menstrual cramps. Black cohosh can be taken in several forms, including crude plant, 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.²³ The best researched form provides 1 mg of deoxyactein per 20 mg of extract. Tinctures can are also used (2–4 ml three times per day).²⁴ The Commission E Monograph recommends black cohosh be taken for up to six months, and then discontinued.²⁵

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 application of the whole herb is 300–1,000 mg. Blue cohosh is generally used in combination with other herbs. Women of childbearing 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.²⁶

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 supplementation was reported to reduce pain during menses in one double-blind trial,²⁷ though another such study found that it relieved only premenstrual cramping, not pain during menses.²⁸ Some doctors recommend calcium supplementation for dysmenorrhea, 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 maximum of 2,000 mg per day).

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. Research from animal studies shows that cramp bark blocks spasms of smooth muscle.³¹ Cramp bark is traditionally prepared by placing two teaspoons of the dried bark into a cup of water and bringing it to a boil; it is then simmered gently for 10 to 15 minutes. The tea may be drunk three times per day.³² Alternatively, 4–8 ml of tincture may be used three times per day.

Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.³³

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 (2–5 ml three times per day). The dried root may also be used (1–2 grams three times daily). It is typically taken in combination with other herbs supportive of the female reproductive organs.

Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.³⁴

Some practitioners report success using topical progesterone cream for dysmenorrhea.³⁵ To date, this approach lacks sufficient research.

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.

In a double-blind trial, adolescents living in India who were suffering from dysmenorrhea took 100 mg of vitamin B1 (thiamine) per day for three months. Eighty-seven percent of those treated experienced marked relief of dysmenorrhea symptoms.³⁶ However, vitamin B1 deficiency is relatively common in India, whereas it is rare in the Western world, except among alcoholics. It is not known whether vitamin B1 supplementation would relieve dysmenorrhea in women who are not B1 deficient.

Clinical reports from Germany have suggested that vitex may help relieve different menstrual abnormalities associated with premenstrual syndrome, including dysmenorrhea.³⁸ These studies used 40 drops of a liquid preparation that delivers the equivalent of 40 mg of the dried berries of the plant.