Most women report some painful or discomfort with their period. However, some women have killer cramps (the medical term is severe dysmenorrhea) and for many of them life goes on a 3-5 day hold once a month.
Period pain is due to release of a substance called prostaglandins from the lining of the uterus during menstruation. Prostaglandins help the uterus contract (cramp), which is one of the mechanisms used to clot the blood and eventually end the period. Why do some women have more painful periods? Studies tells us some women make more prostaglandins, and most prostaglandins means more pain. Medical conditions, such as endometriosis, muscle spasm in the pelvis, and bladder pain syndrome, can all get worse during the period as hormones have a very complex effect on pain. In addition, prostaglandins make all pain worse (if you cut your hand and poured prostaglandins into the wound it would hurt a lot more). So, if you have a pin condition in the pelvis and your body starts churning out prostaglandins the pain condition may flare.
While many women find period pain improves over time, waiting until your 30s or 40s isn’t exactly a treatment option. So what cam be done to help period pain before then?
Birth control pills are definitely a treatment option (they reduce the amount of prostaglandins released during menstruation) and about 2/3 of women report they improve period pain, however, they don’t work for everyone and some women can’t take them or simply don’t want to take a daily medication for pain that happens 3-7 days a month. Medications like ibuprofen or acetaminophen are also very effective for many women (they block production of prostaglandins).
For a variety of reasons many women ask about natural, which I take to mean non-pharmaceutical, options. Some because that fits in with their personal approach to health care, others because of medication side effects, and some because it is something they can try at home before seeking medical care. (FYI, non-pharmaceutical doesn’t necessarily mean safer or better simply non-pharmaceutical).
The problem is studies on these non-pharmaceutical approaches are far from robust. If this is something you want to try understand that many of the studies have what one might call quality issues (some with serious methodological flaws), so drawing a conclusion is challenging. Retrieving all the studies was a challenge as they were quite old or in obscure journals or in German or all three so I had to rely on the abstracts and summaries from other reviewers (who I really hope read them). Placebo effect is also a big factor and many of the studies didn’t adequately control for the placebo effect (and keep in mind 60% of people can experience a placebo effect). By the way, placebo effect doesn’t mean the response isn’t real it’s just with pain expectation is everything. If you expect/believe you will have pain relief then your brain churns out pain killers.
I’ve left two big ones off the list even though they are really #1 and #2: quitting smoking and maintaining an ideal body weight. They don’t apply to everyone and if they do apply, well, they require a longer term strategy tan everything on the list below. Smoking is a risk factor for painful periods (basically smoking makes everything worse) and fatty tissue increases estrogen (one possible mechanism of painful periods) and increases inflammation (and pain at a cellular level is inflammation).
- Exercise. The original natural therapy, although the evidence for painful periods is low quality (mostly because there are so few studies). However, exercise typically helps most pain syndromes and improves blood flow to the pelvis, and stimulates the release of endorphins (natural pain killers). Anecdotally I have many patients who say exercise really helps. I know it’s hard when you feel crampy and crummy to get motivated (especially if your flow is heavy), also exercising with a pad is a real drag, but the potential benefits are huge. Personally I find after 2-3 minutes of running that I forget about my cramps altogether.
- Ginger capsules for 5 days a month starting 2-3 days before the onset of the period (either 250 mg four times a day or 500-1000 mg twice a day). Ginger may impact inflammation.
- Magnesium, which may work by reducing prostaglandins. A Cochrane review suggests it is more effective than placebo, but the studies are small and old and in German. The dose is typically 360-400 mg a day for 3 days starting 1 day before the onset of bleeding. Magnesium can cause diarrhea so it is important to be mindful of that side effect.
- A TENS unit (transcutaneous electrical stimulation) on the high frequency setting. A TENS unit is small device worn against the skin that delivery an electrical current to the area with pain (not a painful current). The mechanism of action is still not well understood. A TENS doesn’t affect how the uterus contracts but may affect uterine blood flow, stimulate endorphin release, or affect the pain signal going from the uterus to the brain. There are several small studies, but keep in mind it is hard to do sham TENS (you either know it’s on or not) so placebo control is an issue. Understanding these limitations it is possible 40-60% of women may get some benefit. In my experience it’s best to have the sitting determined by an experienced physical therapist. The advantage of a TENS unit is that they are relatively inexpensive and have no risk of side effects and the evidence suggesting they can help is of moderate quality.
- Thiamine supplements (vitamin B1), which may affect prostaglandin production. There is only one study from 1996 using 100 mg a day for 3 months. The author claims an 87% “cure” and another 5% significantly improved. However, one study reporting astronomical cure rates is a condition that is unlikely “cureable” in an obscure journal from 1996 does leave some questions unanswered. The upside is the there is probably little harm to trying three months to see how it works.
- Vitamin E either 500 units a day for 5 days (2 days before onset of bleeding and continuing for 3 days into the menses) or 200 units twice a day for 5 days. Vitamin E is an antioxidant, impacts the immune system and is important for formation of blood cells, but how this affects period pain is unknown. the studies are slightly better quality than some of the others but still small and with issues. There is controversy over safety of vitamin E supplements and taking more that 400 units a day is not recommended. There are a lot of potential safety issues emerging about vitamin E so it’s important to keep in mind these two small studies offered no long-term data on safety.
- Fish oil capsules, 6 g (containing 1,080 mg EPA and 720 DHA) divided into two doses a day or two grams of Krill oil a day. The recommendations are based on three small studies two from 1996 and one from 2003. Again, the general mechanism of action is believed to be anti-inflammatory/reduction in prostaglandins. People say the marine burps from krill oil are less offensive than from fish oil.
- French maritime bark extract (Pycnogenol) 60 mg once or twice a day. There are two studies with just over 150 patients, although only one study used a placebo control. Pycnogenol is also supposed to have anti inflammatory properties.
- Dill capsules 250 mg twice a day for 5 days (starting two days before the onset of bleeding. The placebo was a traditional medication for painful periods, mefanamic acid. Like several of the studies listed above this one was conducted on a university students in Iran, so how generalizeable the results are to other populations is unknown.
- Chocolate chip cookies. Ok, so this isn’t a period pain study (I couldn’t find any studies using chocolate for menstrual pain), it’s a general pain study that found eating a sweet and palatable food (they used chocolate chip cookies) improved pain tolerance for women versus a non sweet food (black olives) and a neutral food (rice cakes). Chocolate chip cookies did not improve pain tolerance for men. Obviously sweeping generalizations about menstrual cramps are not possible with a study of 40 women looking at laboratory induced pain, but it does make one wonder if there is something to those chocolate cravings?
Keep in mind this is all information from lower quality studies and vitamins or herbs are not necessarily safe, especially in mega doses. Even chocolate chip cookies should be ingested in a responsible dosage. All of the non-cookie studies claim effect within 2-3 months, so if trying one of the above therapies is up your alley give it three months maximum and if you are not any better move on to something else. Except exercise, keep that up even if it doesn’t help your cramps.
Hey Dr Gunter! You don’t seem to have a contact listed besides Facebook (which I don’t use) so I’ll just post a comment 🙂 I was curious of your input on: I’ve switched to using menstrual cups over tampons & pads, & I’ve found that since switching my cramps have improved drastically. I thought it was the cup since many women claim the same, but since reading your story debunking toxins in tampons + this + a few of your other posts, I’m thinking the cup had nothing to do with it! I doubt it was placebo since I only heard the improved cramps claims after switching, but thinking back I do know that I picked up magnesium supplements for the first time around the same time since I was deficient. What I’m mainly asking is: Are there any studies or evidence comparing tampons/pads with menstrual cups that look at cramping? and: When it seems like something is causal but it turns out not to be (I hope thats worded ok?), what are some ways that people can figure out what really happened without becoming doctors / scientists / statisticians? The idea that tampons menstrual cups are better for you than tampons is a pretty popular idea, so I know if I hadn’t come across your blog I wouldn’t’ve questioned it; most of the google search results just reinforce that idea.
Thank you! 🙂
My cramps are terrible, i take 5 strong pain killers and need to sleep, even that doesnt help fully because i still wake up from my sleep because of the pain, during my period i get 3 hours of sleep a night and it ruins me, when i was younger i even opted suicide because i could not manage at all, still till today every month i wish for death, i want to try the pill but i havent had time yet, all i can do is get boxes of pain killers to help, maybe once im 40 it will stop, or after a child ive been to doctors and the only thing they can do is prescribe pain killers because theres no way for them to lower my prostaglandins levels, this just sucks, i found a way that helps a little which is to take the first day off from work and take the pain killers and anti inflammatories, with sleep and snacks for when im done vomiting after i wake up with cramps, i dont know if anyone has this problem and i wouldnt wish it on my worst enemy.
Have you tried Aleve aka naproxen sodium? It took me years until I found out this inhibited prostaglandins production. I too suffer from severe cramps like clockwork since puberty. I am now 33. 2 pills a day for the first 2 days resolves all pain.
For some woman natural menstural pads helps too. Like these: https://www.etsy.com/listing/232095899/reusable-cloth-mensural-pads?ref=ss_listing
I eventually figured that since the problem was high levels of prostaglandins (I measured high for testosterone too) then taking a prostaglandins inhibitor such as aspirin for 3-4 days before a period was due was the most effective. Since I always had the classic sugar cravings about 4 days in advance it was very easy to time it despite having irregular periods.
I think if ANY of these or a combination of these dysmenorrhea remedies help than that’s great for the woman suffering. I tried most of these before I got to my hysterectomy. What I did end up using for pain control was: Tylenol, Tylenol #3, ibuprofen, Salponas OTC medicated patches, heating pad and a hot water bottle. Hot baths also helped quite a bit. Nothing helped with the fatigue I experienced and that only seemed to worsen with age.
I tried Vitex (chaste berry herb) (not on your list). I took it faithfully and for a long time and the only thing I got was a very dry mouth.
I tried the B-vitamins to include B-1 and never noticed any difference. Nothing.
I tried Fish Oil and increased the dose twice and even changed brands once. The only thing I got was large multiple bruises all over my body.
I tried aspirin and got an irritated stomach with acid reflux with some bruising.
Vitamin E did nothing for me, along with evening primose oil.
Black cohosh was also equally worthless. I tried both the drops (tincture) and the capsules.
I tried acupuncture and while it worked short-term on some tension headaches I had it did nothing for my dysmenorrhea.
I tried pycnogenol. It was very expensive so I felt very committed to use up the entire bottle. I noticed no change in the pain of my menses but did notice slightly pine-flavored burps.
I tried yoga and belly dancing as far as exercise. Belly dancing was supposed to be especially good. Nope. No change. Nada. And belly dancing can get very aerobic as I certainly sweated a bunch. I also tried swimming, hiking and walking … none of these helped with my dysmenorrhea.
I tried magnesium, two different brands with increased doses. All I ever got was softened stools. I never noticed any change in the pain of my dysmenorrhea and I really, really, really, really, really wanted this one to work.
I tried mefanamic acid (Ponstel) to no avail. I really wanted this to work because this is supposed to be medication that really works for period pain. I also tried Aleve (Naproxen) with no relief. However, when I took Vioxx before they took it off the market, it worked wonders. I cried the day I found out Vioxx was discontinued. Celebrex didn’t work which surprised me because they are in the same class; Celebrex left me with chest pressure and mild facial edema. (I know this mention isn’t under the NATURAL remedies, but I’m merely being complete in what I’ve tried.)
I tried raspberry tea. Nope. Nothing. It simply tasted good and the warming effect on my body was good and the tea was both lovely to look at and smell. I still like raspberry tea.
I tried being a vegetarian for several months and that didn’t help.
I cut out red meat for a FEW years and didn’t drink caffeine. Nope, those didn’t help either.
I cut out alcohol for almost a year and that didn’t help.
I cut out milk and dairy for about one year and that didn’t help although the keratosis piloris on my arms resolved.
I never tried dill capsules or ginger because I didn’t know these things might help. I would have definitely tried them had I known they may have helped my pain. But I’m guessing with my track history these items wouldn’t have helped either.
I never tried a TENS unit and wonder if my insurance company would have ever paid for this. I think this would be worth trying.
Oral contraceptives did diminish the pain occasionally, but not always nor consistently.
I was briefly pregnant for 13 weeks and of course, had no dysmenorrhea during that time and it took another 8 weeks for my period to return after my D&C … so I had 21 weeks free of dysmenorrhea. I never got pregnant again and ended up getting a total hysterectomy June 2014 which has completely resolved my symptoms. Hysterectomy was a last resort for me. I would have gotten a hysterectomy sooner, but I was trying to get pregnant. At age 45 I hung up that hope.
My hysterectomy journey can be found here: https://hysterectomy4dysmenorrhea.wordpress.com
Anyway, I appreciate your article Dr. Gunter and I do hope there are some women who can be helped with these natural remedies. I wish I could have been one of them!
My grandmother, mother, and I all found that our incredibly painful cramps disappeared after having kids. Could be a result of simply getting older, but since we had kids at different ages, I’m inclined to believe something about having kids helped. But so did the pill:) I tried magnesium and vitamin B before the pill. It unsurprisingly just made me poorer. But I suppose not as poor as having kids has…