Painful menstruation is the leading cause of lost time from school and work among women in their teens and 20s. “Dysmenorrhea” (the medical term for pain during menstruation that interferes with daily activities) affects about 25% of women, and about 65-90% of adolsecent girls. It has also been linked with reduced performance & attention span, and poor quality sleep. There are many theories about how to prevent or reduce menstrual pain. Unfortunately most theories have only received preliminary research (if that), and few conclusions can be drawn. A lot more research is needed. Truestar Health has reviewed a number of studies on menstrual pain relief/prevention and has concluded that there is: (a) reliable and relatively consistent scientific data indicating that magnesium supplements are beneficial, (b) contradictory, insufficient, or preliminary studies indicating that Vitamin B3 (niacin) and Vitamin E supplements may be beneficial, and (c) little scientific support indicating that fish oil and calcium supplements are beneficial.
Acetaminophen / Paracetemol – Studies have shown that this does reduce period pain (when compared with a placebo), however NSAIDS work better.
NSAIDs (taken regularly on the day before menstruation & then continued regularly for the first 2-3 days of menstruation). Anti-inflammatory drugs such as ibuprofen, naproxen, and mefenamic acid relieve pain and reduce levels of some prostaglandins. Various studies report successful pain relief in 64 to 100 percent of subjects.A review was conducted of data from 73 trials carried out in 18 different countries. The review shows that all NSAIDs (except aspirin) are very effective for treating period pain compared with placebo. The review also provides some evidence that NSAIDs are significantly more effective than paracetamol, though there were only three relevant studies. Unfortunately NSAIDs were shown to carry a significantly increased risk of adverse effects compared to placebo (adverse effects can include indigestion, headaches, and drowsiness). For best results it is recommended that the first dose should be taken as soon either pain or bleeding starts (perhaps even on the day before menstruation is due), and that medication should be continued at regular intervals over the first 2-3 days of menstruation.
Magnesium, 360 mg daily for 3 days (beginning on the day before menstruation starts). A 6-month, double-blind, placebo-controlled study of 50 women with menstrual pain found that treatment with magnesium significantly improved symptoms. The researchers reported evidence of reduced levels of one of the prostaglandins involved in menstrual pain. Similarly positive results were seen in a double-blind, placebo-controlled study of 21 women.
Niacin (B3) (200mg daily throughout menstrual cycle, then 100mg every 2-3 hours during menstrual pain) – In a 1952 study (involving 40 participants) the niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle (they then took 100 mg every two or three hours while experiencing menstrual cramps). A follow-up study in 1954 produced similar results. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.
Fish Oil (6000mg daily throughout menstrual cycle) – omega-3 fatty acids affect the metabolism of prostaglandins. One study found that taking approximately 6000mg of fish oil daily throughout one’s cycle resulted in a 37% decrease in menstrual pain for the participants. A few other studies have indicated similar results.
Ginger (500mg three times a day, for 2 days before and 3 days after menstruation starts) – One study found ginger was as effective as mefenamic acid and ibuprofen in relieving pain in women with primary dysmenorrhea. The study was conducted in 2006-2007 on 150 university students. The students were divided into three groups – one group took 250mg of Ginger rhizome (Zingiber officinale), another group took 250 mg mefenamic acid, and the third group took 400 mg ibuprofen – all groups stuck to the same schedule (taking the doses 4 times a day for three days from the start of 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. A second study tested 120 students, divided into two groups (ginger and placebo). The students received 500 mg capsules of either ginger root powder or placebo three times a day (some received it from the onset of menstruation, and others received it for 2 days prior to menstruation as well). The results of this study showed that menstrual pain was significantly less severe for the ginger group compared to the placebo groups (regardless of whether the doses were taken prior to, or at the onset of, menstruation). The results also showed that the duration of pain was less for the ginger group compared with the placebo group – but only for the students who started their doses for 2 days prior to menstruation.
Vitamin E (500 IU daily for 2 days before and 3 days after menstruation starts) – In one study, 100 young women took either 500 IU of vitamin E or placebo for 5 days (2 days before and 3 days after their periods started). Those who took vitamin E reported less pain than those who took placebo. In another trial (double-blind, placebo-controlled) 100 young women took either 500 IU vitamin E or placebo for 2 days before and 3 days after the expected onset of menstruation. Over the 2 months of the study pain reduction was greater in the treatment group than the placebo group.
Calcium – Inconclusive. In theory calcium deficiency may result in increased period pain (because 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, though another such study found that it relieved only premenstrual cramping, not pain during menstruation. It has been recommended that 1,000mg/daily is taken throughout the month, and 250-500mg every four hours during cramping (up to a maximum of 2,000 per day).
Avoidance of Alcohol – In theory alcohol consumption could increase menstrual pain, however there has been little or no research done to test this theory. It is known that alcohol depletes stores of certain nutrients and alters the metabolism of carbohydrates—which in turn might worsen muscle spasms. It is also known that alcohol can also interfere with the liver’s ability to metabolize hormones. In theory this might result in elevated estrogen levels, increased fluid and salt retention, and heavier menstrual flow, however no research has been conducted on this.
Avoidance of Caffeine – Avoiding caffeine is one theory about how to reduce menstrual pain, however it remains largely or entirely un-researched. Caffeine constricts your blood vessels and raises tension levels, and in theory this may lead to more severe menstrual pain.
Hot water bottle or heat pad – Scientists from University College London have found that heat treatment works by blocking pain messages to the brain. Menstrual period pain is caused by a temporary reduction in blood flow to organs, causing local tissue damage and activating pain receptors. The heat doesn’t just provide comfort and have a placebo effect – it actually deactivates the pain at a molecular level in much the same way as pharmaceutical painkillers work. The scientists found that if warmth over 40 degrees Celsius is applied to the skin near to where internal pain is felt, it switches on heat receptors at the site of injury. These heat receptors in turn block the effect of chemical messengers that cause pain to be detected by the body. However unfortunately researchers found that heat can only provide temporary relief.
Viagra – Researchers from Penn State College of Medicine studied 25 women between the ages of 18 and 35 who suffered from menstrual cramps. Some of the women were issued a dose of sildenafil citrate, while others were given a placebo. The women who took the sildenafil citrate reported significantly greater pain relief than those who didn’t take it. The findings are still preliminary, and the study needs to be repeated several times to confirm the findings.
Spinal Manipulation – A large controlled clinical trial over two months compared a series of treatments of spinal manipulation to the low back and pelvis to a series of sham manipulations (that were designed to be ineffective). However there was no difference between the groups in reported pain relief.
Hormonal IUD: Research indicates that a hormonal n intrauterine device (IUD) – “Mirena” – can reduce dysmenorrhea by as much as 50 percent, however the Copper IUD has no effect.
Hormonal birth control pill – Women usually have significantly less dysmenorrhea after using a hormonal birth control treatment for two to three months. Women who take a hormonal birth control treatment continuously often have intermittent light bleeding or spotting, especially during the first two to three months of treatment; this usually declines with time. When bleeding occurs, it is usually lighter and associated with less severe cramping compared to before the treatment.
Surgical options — At least two surgical procedures have been developed to treat dysmenorrhea. Both of these surgeries involve cutting or destroying the uterine nerves, which prevents the transmission of pain signals. However, no surgery has been shown to provide long-term relief of pain and surgery may be associated with complications. These may be related to regrowth of nerves or pain signals being transferred by alternate routes. As a result, surgical treatments for dysmenorrhea are not generally recommended
Acupuncture – In a review of 30 controlled trials, researchers were unable to draw conclusions about the effectiveness of acupuncture and similar treatments for menstrual pain due to widespread study design problems.
Exercise – There is fairly strong evidence that (a) exercise increases blood circulation, which helps muscle cramps to go away, and (b) exercise lowers stress (and evidence indicates that stress is associated with increased menstrual pain). Therefore in theory exercise is supposed to reduce dysmenorrhea. However the actual research results are inconclusive. Some preliminary studies indicate that exercise may reduce menstrual pain, however other studies do not. One study in the UK (involving almost 600 university students) did not find any association between the total amount of exercise (done throughout the menstrual cycle) and the severity of period pain the participants experienced. However it is noted that the researchers in that study did not assess at what time in their menstrual cycle the women tended to exercise, and whether exercise at specific times in their cycle (e.g. during menstruation) had an effect on period pain.A review of a number of studies on the relationship between exercise and period pain concluded, “It has been widely claimed that exercise is beneficial to dysmenorrhea, yet solid evidence is lacking. [Most studies] showed decreased prevalence and/or improved symptomatology with exercise. However, controlled longitudinal studies involving women with confirmed primary dysmenorrhea who are sufficiently blinded to the study objectives are necessary before a definite relationship between exercise and dysmenorrhea can be established.”