We do not know why menstruation is uncomfortable at all, or why it is much more painful for some women than for others and varies so much from month to month.
Occasionally, severe menstrual pain indicates the presence of endometriosis (a condition in which uterine tissue is growing in places other than the uterus) or uterine fibroids (benign tumors in the uterus), but in most cases no such identifiable abnormality can be found. Natural substances known as prostaglandins seem to play a central role in menstrual pain, but the details of the many interactions are scarcely understood, and the available treatments are not specific in their action.
Anti-inflammatory drugs such as ibuprofen usually relieve menstrual pain substantially. However, their blood-thinning effects can increase menstrual flow. Oral contraceptive treatment can also help over the long term, although its success is not guaranteed.
Treatment
Principal Proposed Treatments for Dysmenorrhea:
There is some evidence that the supplements fish oil, magnesium, and vitamin E
may help reduce menstrual pain.
Fish Oil: Appears to Relieve Cramps
It is believed that the omega-3 fatty acids in fish oil may help relieve
dysmenorrhea by affecting the metabolism of prostaglandins and other factors
involved in pain and inflammation.
In a 4-month study of 42 young women aged 15 to 18, half the participants
received a daily dose of 6 g of fish oil, providing 1,080 mg of EPA (eicosapentaenoic
acid) and 720 mg of DHA (docosahexaenoic acid) daily. After 2 months, they were
switched to placebo for another 2 months. The other group received the same
treatments in reverse order. The results showed that these young women
experienced significantly less menstrual pain while they were taking fish oil.
Another double-blind study followed 78 women, who received either fish oil, seal
oil, fish oil with vitamin B12 (7.5 mcg daily), or placebo for three full
menstrual periods. Significant improvements were seen in all treatment groups,
but the fish oil plus B12 proved most effective, and its benefits continued for
the longest time after treatment was stopped (3 months). The researchers offered
no explanation why B12 should be helpful.
For more information, including dosage and safety issues, see the full fish oil
article.
Vitamin E
One study suggests that vitamin E may be helpful for the treatment of
dysmenorrhea. In this double-blind, placebo-controlled trial, 100 young women
complaining of significant menstrual pain were given either 500 IU vitamin E or
placebo for five days. Treatment began two days before and continued for three
days after the expected onset of menstruation While both groups showed
significant improvement in pain over the two months of the study, (presumably
due to the power of placebo), pain reduction was greater in the treatment group
as compared to the placebo group.
Magnesium
Preliminary studies suggest that magnesium supplementation may be helpful for
dysmenorrhea. 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 prostaglandin
F2 alpha, a hormone-like substance involved in pain and inflammation.
Similarly positive results were seen in a double-blind placebo-controlled study
of 21 women.
For more information, including dosage and safety issues, see the full magnesium
article.
Other Proposed Treatments for Dysmenorrhea:
One small but carefully conducted double-blind trial suggests that making sure
to get enough calcium and manganese may help control symptoms of menstrual pain.
The herb cramp bark has traditionally been used to relieve menstrual pain.
Unfortunately, it has not received any significant scientific attention.
Herbs with possible anti-inflammatory properties may be helpful as well,
including bromelain, turmeric, and white willow. Other potentially helpful
treatments include black cohosh, Coleus forskohlii, dong quai, and manganese.