Reviewed & edited by Dr. Jeffrey C. Lederman, DO, MPH and Julie A. Cerrato, PhD, AP, CYT, CAP
Dysmenorrhea is the medical term for painful menstruation and is a common problem experienced by women in their reproductive years. It can interfere with daily activities and may contribute greatly to absenteeism at school and work for those affected.
Dysmenorrhea may be characterized as two types, primary and secondary. Primary dysmenorrhea is the presence of cramps lower abdominal pain that occurs during a female’s menstrual cycle when there is no other cause for those symptoms. Secondary dysmenorrhea is the presence of the same symptoms but is caused by another medical problem such as endometriosis or uterine fibroids. For both types, hormone- like substances released during a woman’s menstrual cycle called prostaglandins are thought to play an active role. This information here for menstrual cramps natural treatments focuses on primary dysmenorrhea, lower abdominal cramps.
Who Dysmenorrhea Affects
The prevalence of dysmenorrhea in women of reproductive age is between 16 % and 91% and severe symptoms occur in 2%-29%.1 High stress and a family history of dysmenorrhea have each been associated with a worsening of dysmenorrhea. In contrast, age, an increased number of pregnancies, and the use of oral contraceptives have shown to correlate with a decrease, or improvement of dysmenorrhea. Although some research indicates that cigarette smoking, diet, obesity, depression, and abuse may be risk factors for worsening of dysmenorrhea, the evidence is inconclusive.
How Dysmenorrhea Feels
The pain associated with dysmenorrhea is classically considered as “cramps,” however it is often accompanied by back pain, nausea, diarrhea, fatigue, bloating, sluggish digestion, constipation, breast tenderness, lower leg aches and/or headaches. Although some suffers may feel symptoms as periodically intense, many may present with constant, uncomfortable dull aches, exhaustion and malaise. Dysmenorrhea cramps usually occur in the lower abdomen and in the area above the pubic bone. Dysmenorrhea tends to begin one to two days prior to menstrual bleeding or with the onset of menstrual bleeding and then gradually diminishes over 12 to 72 hours.
How Dysmenorrhea is Conventionally Treated
In conventional medicine, a woman’s gynecologist will typically assist in diagnosing and treating an individual’s dysmenorrhea.
Conventional medical treatment of dysmenorrhea aims to reduce the pain associated with discomfort. Initially, the primary treatment is supportive and includes methods to bring heat to the lower abdomen, increase exercise, and reduce stress. However, as the severity of the pain increases, non-steroidal anti-inflammatory (NSAIDS) medication may be used to help alleviate the symptoms. Commonly used NSAIDs include ibuprofen, naproxen, and Aspirin. Prescription strength NSAIDs like diclofenac, etodolac, and celecoxib (Celebrex) are sometimes given when symptoms worsen and can be obtained from a physician.
Hormonal birth control is often the next line of pharmaceutical treatment for dysmenorrhea. This may include birth control pills, vaginal rings, contraceptive implants, hormonal releasing intrauterine devices ( IUDs), injections, or hormonal patches. These agents work by reducing the uterine lining where prostaglandins are produced and, in turn, decreases uterine bleeding or contractions responsible for menstrual pain and cramps. Hormonal birth control has traditionally been a frequent pharmaceutical choice for women not trying to get pregnant. The combination of using NSAIDS and hormonal birth control is also a very common medical plan for reducing dysmenorrhea.
Other potential conventional treatments for dysmenorrhea include medications used to reduce uterine contractions (tocolytics), however there is inconclusive evidence for their overall effectiveness. Examples of these medications include Nitric Oxide, magnesium, calcium channel blockers (i.e., nifedipine), and nitroglycerin. There is also limited evidence to support the use of phosphodiesterase inhibitors like sildenafil (Viagra) and procedures that disrupt pelvic nerves.
After 3-6 months of treatment failure with NSAIDs and hormonal birth control a surgical procedure, often a laparoscopy, may be indicated to look for pelvic pathology like endometriosis in secondary dysmenorrhea. However, many holistic approaches are also available that complement a clinicians’ active and important role in the treatment of dysmenorrhea.
Holistic Healing for Menstrual Cramps
The menstrual discomfort of dysmenorrhea is a significant distraction from normalcy for many women on a monthly basis, interfering with routine activities. Plagued by severe abdominal cramps confounded by migraines, fatigue, bloating and nausea, women often feel incapacitated and unable to function. Many women turn to conventional treatments such as over the counter pain relievers or progress to prescription medication, but there are numerous holistic remedies available to help alleviate symptoms naturally and alternative healing modalities to rectify the underlying cause. Homeopathy, Traditional Chinese Medicine (TCM), Reflexology, Ayurveda, Yoga, Meditation, Aromatherapy, Transcutaneous electrical nerve stimulation (TENS), and Holistic Diet and Lifestyle modifications each offer beneficial therapies for treating dysmenorrhea.
Homeopathic remedies are natural, chemically minute dilutions of various substances used to stimulate the body’s immune system at a low level. This smaller reaction conditions the body to create a gentler reaction to future exposure of the substance. Several homeopathic formulas are available for treating dysmenorrhea and associated menstrual symptoms.
According to Dr. Yukova’s Guide to Homeopathy 2, some homeopathic medicines have a localized action and may provide rapid pain relief such as a reduction in dysmenorrhea cramps. Other remedies, known as constitutional (chronic) homeopathic medicines, target the root of the condition and are focused on eliminating the cause of the dysmenorrhea. Dr. Yukova cites the following formulas as the most common for rapid pain relief of primary dysmenorrhea.
- Belladonna – for relief from sudden onset of intense throbbing pain that worsens from light touch or sudden movements
- Chamomilla – for relief from unbearable pain accompanied by anger or irritation
- Cimicifuga – for relief from pain that is proportional to the flow; ie. whereby increased bleeding results in increased pain; also indicated for shoulder and neck stiffness
- Colocynthis – for relief from intolerable cramps
- Magnesia phosphorica – for relief from cramps relieved by pressure or warmth
- Veratrum album – for relief from severe menstrual cramps accompanied by nausea, vomiting and sweating; heavy flow; fatigue or chills
Two classic constitutional homeopathic remedies for dysmenorrhea include Pulsatilla and Sepia. According to Dr. Nancy Gahles, DC, CCH, RSHom(NA), President of the National Center for Homeopathy (NCH), the plant remedy Pulsatilla has an affinity for the genito-urinary organs, stomach and bowels and may be well-suited for women who suffer from chronic headaches, sinus infections, allergies, discharges, bladder infections, digestive disturbances, ovarian cysts or anxiety. 3
Sepia is derived from cuttlefish ink, and according to Miriam McCrea Malevris, DS Hom. Med., may be useful to treat PMS for women characterized by indifference, irritability or fatigue prior to menses. 4
Treating dysmenorrhea with homeopathic remedies may be a powerful way to improve a woman’s monthly quality of life. As always, please consult a certified homeopathic provider for a proper evaluation and treatment advice.
Traditional Chinese Medicine teaches that after years of stress, insufficient nutrition and irregular lifestyle habits, the body’s natural elements fall out of balance with one another and Nature. TCM supports the notion that order can be restored to the elements by removing energy blockages and redirecting its flow using therapeutic modalities such as acupuncture, acupressure, cupping and herbal treatments.
TCM Herbal Medicine
According to Wei Liu, TCMD, MPH, LAC and Changzhen Gond PhD, MS of the American Academy of Acupuncture and Oriental Medicine (AAOM) 5, pain associated with dysmenorrhea is similar to other forms of pain and can originate from one or the combination of the following: a deficiency of Qi and blood; the retention of heat, dampness or Wind; or an imbalance of the kidney and liver. TCM acknowledges that the pain is only a symptom reflecting a deeper condition, and like most holistic modalities, a practitioner will seek to alleviate the root cause.
TCM treatment of dysmenorrhea, whether via herbal or via hands-on means, ie. acupuncture or acupressure, requires the identification of the type and timing of the pain. Pain may occur days prior to menses, during menses, after menses or a combination of these. In addition, blood color, flow and blood clotting help indicate the specific elemental imbalance.
Two of the most common TCM herbal treatments for dysmenorrhea pain are angelica (Dang Gui) and corydalis tuber (Yan Hu Suo).
- Dang Gui is beneficial for tonifying and harmonizing the blood as it regulates menses and reduces abdominal pain and cramping. Studies with Dang Gui have shown that it interferes with prostaglandin regulating mechanisms, which may account for its successful treatment of dysmenorrhea. 6
- Yan Hu Suo is thought to invigorate the blood and enhance the flow of Qi through the body. Yan Hu Suo contains the alkaloid tetrahydropalmatine (THP), a known sedative and analgesic that may be responsible for alleviating dysmenorrhea pain. 7
According to TCM practitioners from the Yin Yang House Chattanooga Acupuncture and Wellness Center, several formulas are available to treat dysmenorrhea and associated menstrual symptoms. 8
- Ba Zhen Wan – Anemia, Heavy Menstruation, Dysmenorrhea (Cramps), Dizziness, Weakness
- Chai Hu Shu Gan Wan -PMS, Menstrual Pain, Irregular Menstruation, Emotional Stress, Depression, Irritability
- Xiao Yao Wan – Stress, Depression, Anxiety, PMS
- Si Wu Tang Wan- Tonifies and Regulates the Blood, Regulates the Liver
- Fu Fang Dang Gui Wan (Dong Quai Tablet) – Syndromes of qi and blood deficiency; Irregular Menstruation, PMS, Menstrual Pain, Infertility, Fatigue, Memory
- Shao Fu Zhu Yu Wan – Treats Stagnant Qi, Blood Clotting, Abdominal Pain, Dysmenorrhea (Cramps), Fatigue, Weak digestion, Gas, Bloating, Loose stools/Diarrhea, vomiting, gastritis, edem
- Wen Jing Tang Wan- Warms Meridians, Dispels Cold, Nourishes blood to Remove blood stasis
Two of TCM’s most effective therapeutic modalities for treating dysmenorrhea include acupuncture and self-acupressure. Acupuncture accesses sensitive points on the skin’s surface that channel energetic pathways called meridians running throughout the body. The nervous system is particularly accessible to these points and studies have shown that acupuncture drives neurological stimulation of the brain when trying to reduce pain. 9
Acupuncture has been shown as an effective modality for reducing dysmenorrhea pain. 10
Acupressure works with the same system of meridians as acupuncture but does not use needles to stimulate the points. Instead, self-application with fingers or hands may be used to activate the energy at the points and promote self-healing.
Some common Acupuncture or Acupressure points used to treat symptoms of dysmenorrhea include:
GB20 –Headaches, anxiety, insomnia
GB34 – Inflammation, anger, irritation, edema
TW 5 – Migraines, neck stiffness, nausea, diarrhea, constipation
P6- Dizziness, nausea, acid reflux, constipation, headache
SP 6 – Cramps, edema, bloating, menstrual clots, back pain, anxiety and dizziness
SP8 & 9 – Cramps, edema, bloating, menstrual clots
CV4 – Cramps, kidney pain, menstrual clotting/flow
Similar to the TCM modalities of acupuncture and acupressure, the system of reflexology developed by Dr. William H. Fitzgerald, M.D. is based on the Zone Theory that specific points in the hands and feet correspond to areas of the body and can relieve pain when stimulated and massaged. 11 Reflexology has been used successfully to treat dysmenorrhea and was shown to be equally effective as ibuprofen in a trial with 68 university students. 12 Women may choose to get regular reflexology sessions to relieve symptoms during menses and/or have regular sessions prior to their menstrual cycle to prevent pain.
The 5,000 year old medicinal wisdom of Ayurveda from India provides much insight into the treatment of dysmenorrhea. According to the sacred medicine text called the Charaka, imbalances in a woman’s lower abdominal energy, governed by Vata, create pain and discomfort in menstruation. Most often, this imbalance is preceded by faulty dietary and lifestyle habits such as poor nutrition, lack of sleep, stress, fear or anxiety, which build slowly and heighten during menses.
The severe discomfort women experience with dysmenorrhea stems from the pain-inducing hormone-like substances called prostaglandins that are produced by the endometrial cells of the uterine lining shortly prior to menses. During the breakdown of these cells in menstruation, prostaglandins are released locally, constrict the blood vessels, and cause the muscle layer of the uterus to contract, resulting in painful cramps. Some prostaglandins may also enter the bloodstream and cause associated symptoms such as headache, nausea, diarrhea or vomiting. 13
Women who experience dysmenorrhea have been shown to produce higher levels of prostaglandins than those without menses pain. 14 Ayurveda aims to balance these cellular processes responsible for excess prostaglandin synthesis by targeting the misdirected energy, improving digestion and calming the nervous system.
Diet, lifestyle modifications, herbal treatments and body therapies recommended by Ayurveda can be used to identify the root of the woman’s specific energetic imbalance and help restore it. With respect to diet, Ayurveda treats the mind and body by synchronizing both with Nature’s rhythms and emphasizing fresh, whole, seasonal foods.
Fall and Winter seasons particularly upset uterine Vata energy, but can be improved by avoiding certain foods. The energetic Vata imbalance associated with dysmenorrhea is worsened by foods that are cold, dry and rough such as:
- Raw Fruits
- Raw Vegetables
According to Ayurveda, the properties of these foods aggravate the nervous system and create excess gas and dryness in digestion and throughout the body that disturbs the lower abdominal energy. This energy is then free to disrupt other energies including the fire force of Pitta and result in nausea, acid reflux, vomiting and diarrhea. Emotionally, both aggravated Vata and Pitta energy can create additional symptoms associated with dysmenorrhea such as restlessness, sluggishness or fatigue, spaciness, frustration, anger and pain.
To further balance both energies with diet, focus on warm, cooked, wet food that are in season and high fiber foods such as:
- Cooked Vegetables
- Stewed Fruits – Apples, Pears, Prunes
- Brown or Basmati Rice
- Legumes – Kidney beans, Chickpeas, Lentils (up until the last week prior to menses)
Ayurveda also teaches that reducing or avoiding pungent, sour, inflammatory foods and fatty, fried foods will also help pacify the Vata and Pitta energies.
- Nightshades – Tomatoes, Potatoes, Peppers, Eggplant
- Hot Sauces
- Pungent Spices – Chili Powder, Cajun, Paprika
- Meats- Beef, Lamb, Goat, Pork
- Fried Foods: French Fries, Potato/Tortilla Chips, Tempura, Samosas etc.
Lifestyle-wise, Ayurveda emphasizes the importance of structure and even-pacing in daily routines to keep Vata and Pitta energies balanced. Women who experience dysmenorrhea often have busy, hectic, stressful days filled with multi-tasking at work and home. This constant juggling of career and family creates great variability in the daily routine and often leads to missed or late meals, poor nutrition, loss of sleep and challenges in relationships. Ayurveda suggests creating stability through “anchors” in the day such as:
- Regular Meal Times
- Meal Plates that Include all 6 Tastes
- Morning Self-Care Routine
- Evening Bed Time Routine
- Family, Significant Other or Friend Connection Time
- Self-Reflection Time
In addition to diet and lifestyle modifications, several herbal therapies and body treatments are recommended by Ayurveda. Women may not be aware that everyday kitchen spices are herbs that can help improve digestion, relieve constipation or diarrhea and ease pain associated with dysmenorrhea. These include:
- Garlic Powder/Garlic
- Hing (Asafoetida)
Herbal formulas provided by Ayurvedic Practitioners may also help with dysmenorrhea by targeting the urogenital and reproductive systems.
- Some Ayurvedic herbal formulas recommended include:
- Goksura – Restores Energy and Vitality to the Kidneys and Reproductive Organs; Alleviates Menstrual Cramps
- Shatavari- Revitalizes the Reproductive Organs and Balances Hormones
- Amalaki- Removes Excess Heat and Balances Pitta Fire Energy
Balancing the root disturbances of the Vata and Pitta energies with herbs will often target the nervous system and include:
- Shilajit – Draws Out and Removes Deep Toxins from Cells
- Brahmi – Calms Nervous System and Reduces Anxiety
- Shankapushpi – Calms Nervous System and Reduces Anxiety
Soothing Ayurvedic body treatments are available for self-care and at wellness spas/centers to help treat dysmenorrhea and include:
- Abyhanga- Herbal Oil Body Massage
- Shirodhara- Herbal Oil Streaming onto the Forehead
- Svedhana- Steam Box to Eliminate Toxins
Visiting a skilled Ayurvedic Practitioner and an Ayurvedic Wellness Center will significantly assist with reducing or eliminating symptoms of dysmenorrhea.
Yoga is an incredible physical modality that reaches both body and mind when treating numerous conditions and may be especially useful for alleviating dysmenorrhea. A recent study of 113 female medical students with primary dysmenorrhea showed that after just 3 months of yoga postures, 88% reported complete pain relief and 12% reported mild pain,15 supporting this holistic modality as a viable therapy for painful menses.
Women who experience dysmenorrhea may wish to consider a regular, gentle yoga practice to bring stability, calm and comfort to an otherwise stressful life. More specifically, when treating anxiety throughout the month prior to menses, practice yoga poses (asanas) that enhance digestion and elimination, stretch abdominal, hip and back muscles, stimulate the kidney and reduce stress.
Other yogic therapy for anxiety and stress includes restorative poses. Restorative poses are fixed postures that are held for several minutes while adding yogic breath. They are beneficial for reducing stress and pain because they activate the parasympathetic nervous system and relaxing the body while passively stretching tight muscles and facia. These and other yogic asanas also provide significant relief from excess lymphatic fluid/edema in the body’s detoxification system from hormonal fluctuations and menstrual-related swelling.
According to Certified Yoga Teacher Laura Waite 16, the following poses may be used to reduce dysmenorrhea and associated menstrual symptoms:
- Janu Sirsasana (Head-To-Knee Forward Bend) – Stretches the spine, shoulders, hamstrings and groin; calms the brain; reduces anxiety, fatigue, headache and menstrual discomfort
- Ustrasana (Camel Pose) – Stretches the torso, ankles, thighs, deep hip flexors, back and groin; relieves fatigue, anxiety and menstrual discomfort; stimulates the kidneys
- Supta Padangusthasana (Reclining Big Toe Pose) -Stretches the hips, thighs, hamstrings, groin and calves; strengthens knees; relieves back pain, sciatica and menstrual discomfort
In addition to these asanas, Spinal Twists such as Marichyasana III, improve digestion, reduce abdominal gas and bloat and stimulate new blood flow to the principal abdominal organs. Yogic poses that elongate and stretch the spine such as Marjaryasana (Cat Pose), rotate the pelvis and may also alleviate dysmenorrhea cramps. Virasana (Hero Pose) uses the heels of the feet to stimulate two marma points near the sacrum and relieves menstrual cramps.
Leading up to and during menstruation, women may also choose to practice restorative asanas. Restorative yoga postures such as Supta Badha Konasana (Reclining Bound Angle Pose) 17 assist with freeing energy from the pelvic area and stretch the inner thigh and groin areas.
One of the most powerful natural methods shown to reduce pain from dysmenorrhea is the practice of meditation. 18 Centering the mind and aligning it with the body’s needs is thought to create a bridge whereby calming signals can be sent to throughout the nervous system to reduce pain. Several forms of meditation are available to try and include Yogic breathing meditation (pranayama), guided meditation and the Chinese energy meditative practices of Tai Chi and Chi Gong.
Pranayama- Yogic breath meditation focuses on controlling the breath while activating the parasympathetic nervous system. This activation results in a “calm and relax” process that has been shown to lower heart rate and blood pressure, increase respiration and reduce pain. 19 20 21
Two types of pranayama are particularly useful for reducing pain and symptoms associated with dysmenorrhea, Brahmari (Bee Buzzing Breath) and Nadis Shodona (Alternate Nostril Breath).
- Brahmari 22 can be performed to reduce anxiety, treat headaches and quiet the mind
- Nadis Shodona 23 is amazing for balancing the left and right sides of the brain, engaging the parasympathetic nervous system, reducing stress and increasing the flow of energy
Many women may benefit from following a relaxation sequence offered by guided meditation. This form of relaxation uses a voice, often accompanied by music or nature sounds, to walk the woman through a stress-reducing process. A popular guided meditation is the Body Scan method, which consciously identifies certain parts of they body and sends a message for it to relax.
Several meditation phone apps are available to help reduce stress and painful menses such as:
- Simply Being from Meditation Oasis
- The Mindfulness App
- Get Some Head Space
- Meditate (Tibetan Bells)
- Mindfulness Meditation
Chinese Energy Practices
- Tai Chi is an ancient Chinese martial art that has evolved into a modern practice of gracefully balancing and promoting the flow of energy known as “Chi.” According to the Mayo Clinic, this gentler form of tai chi is safe for all ages; pregnant women should consult a physician prior to practice. 24 Tai Chi has been shown to relieve back pain in conditions like fibromyalgia and may be beneficial for back pain associated with dysmenorrhea. 25
- Qi Gong translates to “cultivating vital energy” and can be classified as a martial art, medical therapy or spiritual modality. The gentler forms of Qi Gong practice rhythmic movements that reduce stress, enhance immunity and increase vitality. Qi Gong has also been shown to improve cardiovascular, respiratory, circulatory, lymphatic and digestive functions and according to several independent case studies, may be beneficial for alleviating dysmenorrhea. 26 27
Aromatherapy harnesses the medicinal properties of essential oils extracted from plants and herbs. Many essential oils are available to treat the symptoms of dysmenorrhea and can be applied using various methods such as direct or steam inhalation, oil or lotion massage, shower or baths and aromatic spritzers.* Research has shown that essential oils are effective in reducing dysmenorrhea. 28 The following oils have been known to relieve dysmenorrhea or associated symptoms and are classified according to their therapeutic properties.
Antispasmodic Essential Oils – Relieve smooth muscle menstrual cramps and lower back pain from the uterus during dysmenorrhea 29
- Roman chamomile (Chamaemelum nobile)
- Clary sage (Salvia sclarea)
- Fennel (Foeniculum vulgare var. dulce)
- Geranium (Pelargonium x asperum syn. graveolens)
- Lavender (Lavandula angustifolia)
- Peppermint (Mentha x piperita)
- Rosemary (Rosmarinus officinalis)
Nerve Tonic Essential Oils – Relieves anxiety, stress, anger and fear that precedes dysmenorrhea 29
- Neroli (Citrus aurantium var. amara)
- Patchouli (Pogostemom cablin)
- Lavender (Lavandula angustifolia)
- Geranium (Pelargonium x asperum syn. graveolens)
- Mandarin (Citrus reticulata)
- Ylang Ylang (Cananga odorata)
- Jasmine (Jasminum grandiflorum)
Stimulating & Uplifting Essential Oils – Treats headaches, fogginess, sluggishness and mood 29
- Lemon (Citrus limon)
- Grapefruit (Citrus Paradisi)
- Peppermint (Mentha x piperita)
- Spearmint oil (Mentha spicata)
Digestive Aid Essential Oils – Treats constipation, gas, bloat and diarrhea 29
- Fennel (Foeniculum vulgare var. dulce)
- Ginger (Zingiber officinale)
- Tangerine Citrus reticulata var tangerine) – Constipation
- Lemon (Citrus limon)
- Coriander (Coriandrum sativum)
Application of essential oils requires knowledge of appropriate dilutions in a base lotion or carrier oil such as almond, sunflower, grape seed or jojoba. Oils may also be directly inhaled via adding a few drops to a tissue, bath or shower and breathing the aroma. For safe application of these oils to treat dysmenorrhea, consult an aromatherapist and/or a physician.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation, known as TENS, uses low voltage electric current to relieve pain. A TENS device is thought to work by either the gate control theory of pain whereby stimulating nerves closes a “gate” mechanism in the spinal cord to reduce the sensation of pain and/or by stimulating the production of endorphins that block pain.
TENS units have been used extensively to treat back pain and may work well for women with menstrual cramps and lower back pain. The unit is easy to use, portable, and functions with a small battery-operated device that can be hooked to a belt. Two electrodes that extend from the device attach to the skin and deliver the low voltage electrical current.
TENS treatment may be particularly effective for women suffering from severe dysmenorrhea and can be used alone or in combination with conventional or holistic therapies. A crossover study where women used the TENS unit alone or took ibuprofen for dysmenorrhea showed that the TENS unit itself significantly reduced menstrual pain and also delayed the need for supportive ibuprofen medication by an average of 5.9 hours. 30 To acquire a TENS unit, see a physician as they require a prescription and are contraindicated for women in their first trimester of those with a pacemaker. 31
Holistic Lifestyle Suggestions for Menstrual Cramps
Relaxation & Routine
Both conventional and holistic providers recognize that stress has a large impact on women and greatly contributes to painful menses. According to the Mayo Clinic, mental stress can temporarily alter the function of the hypothalamus, which controls hormones that regulate menses. 32 Moreover, a large study of 388 women examined the link between stress and dysmenorrhea and found that women who reported high stress had twice the risk for dysmenorrhea compared to those who reported low stress. 33
When under continuous stress, women should take time for personal self-care and relief in their everyday lifestyle. Women are often play multiple roles in balancing home, work and family life and place others’ needs above their own. Whether finding time in the day to take a mentally clearing walk, read a book, workout at the gym, visit a spa, meditate or meet with friends and family, a daily stress outlet is paramount for balancing a women’s menstrual cycle.
In addition to a daily stress outlet, consistent morning and night routines and regular meal times are critical for providing stability. Irregular eating habits can disrupt hormone regulation.
Uterine, abdominal and back pain are all difficult conditions associated with dysmenorrhea. The application of heat to the abdomen has been shown to diminish this pain and provide relief and was equally effective as the conventional pain killer ibuprofen. 34 Women may choose to apply heat safely via a hot water bottle, heating pad or take a warm bath or shower.
One of the most powerful holistic lifestyle additions includes regular massage. Massage is an excellent way to move stagnant lymphatic fluid throughout the body which eliminates toxins and inflammatory compounds responsible for pain and congestion.
Conventional, Chinese and Ayurvedic abdominal massage work the belly muscles while moving in the direction of the colon to assist with digestion. Beginning at the lower right quadrant of the abdomen, gently rub in circles upwards to the navel, across the abdomen and down the left side of the abdomen. Combining abdominal massage with heat and essential oils greatly assists in dysmenorrhea pain relief.
Full body massage of any form is a well-known technique for reducing stress and alleviating pain. Since the impact of dysmenorrhea extends beyond abdominal pain, with many women experiencing back and leg pain, headaches and eye tension and overall bloating, massage is an excellent holistic modality for relief.
Holistic Diet and Nutrition for Menstrual Cramps
Diet and nutrition play a significant role in managing dysmenorrhea. Eating healthily can reduce excess toxins stored in fat cells and may dramatically improve menstrual cycles. To balance hormonal changes and inflammatory prostaglandin release during menstruation, women can improve their diets prior to and during menses.
The Alkaline diet suggests that when foods are digested, they have a specific effect on the pH of bodily fluids such as urine. Certain foods are classified as acidic and reduce this pH and others are alkaline and maintain or increase this pH. Acidic foods are considered inflammatory and minerals like calcium are often needed to buffer them. Calcium excreted in the urine as a result of digesting acidic foods is a concern since losing valuable minerals may deplete the body of its stores. Acid-forming foods may be particularly disruptive to a normal menses cycle and avoiding or greatly reducing them may alleviate dysmenorrhea pain.
Highly Acidic Foods to Reduce or Avoid for Dysmenorrhea 35
- Alcohol, Tobacco
- Artificial Sweeteners, White Sugar
- Beef, Lamb, Pork, Veal
- Breads, Biscuits, Crackers, Refined Cereals, Pasta, Flour, White Rice
- Coffee, Soda, Juices
- Pastries, Cookies, Cakes, Ice Cream, Jams, Jellies
- Fermented Foods- pickles, white vinegar, miso
- Processed Vegetable Oils, Salad Dressings, Margarine
- Fatty, Fried Foods- French Fries, Burgers, Chips, Doughnuts, etc.
When dealing with hormone fluctuations and inflammation associated with uterine lining shedding, women may choose to adopt an alkaline diet full of fresh fruits, vegetables, whole grains, and legumes while reducing fatty and sugary foods. In addition, foods low in fat and rich in soluble and insoluble fiber have been shown to significantly reduce estrogen levels 36 and can help prevent digestive problems like constipation and diarrhea that often accompany menses.
Alkaline Foods to Increase for Dysmenorrhea 37
- Fresh & Cooked Vegetables: Alfalfa Grass, Barley Grass, Artichokes, Asparagus, Bok Choy, Brussels Sprouts, Cauliflower, Cabbage, Celery, Cilantro, Cucumber, Dandelion, Jicama, Kale, Lamb’s Lettuce, Leeks, Mustard Greens, Peas, Sea Vegetables, Spinach, Zucchini, Broccoli, Beets, Carrots, Rutabaga, Sweet Potatoes, Squash Pumpkins, Turnips, Kohlrabi
- All Fruit, Especially Avocados
- Lima Beans, Green Beans
- Lentils, Navy Beans
- Buckwheat, Kamut, Spelt, Millet, Barley
- Fennel Seeds, Cumin Seeds, Sunflower Seeds, Pumpkin Seeds, Flax Seeds
- Almonds, Brazil Nuts, Cashews, Hazelnuts, Macadamia, Pine Nuts, Pistachios, Walnuts
Aggravating Foods & Allergens
Certain foods may increase mucous and congestion in the body that may cause sluggish digestion, bloating, fatigue and heavy periods. Others may induce inflammation or an allergic reaction in the gut or skin.
- Fatty, fried foods are culprits for several medical conditions and are highly inflammatory. Damaging blood vessels, increasing cholesterol and regulating estrogen are just some of the ways these foods can result in painful menses. Avoid or significantly reduce these foods in the diet to help alleviate dysmenorrhea.
- Refined sugar is another well-known inflammatory food that should be avoided on a daily basis and especially during menses. Women may wish to have natural sweeteners such as raw honey, unprocessed maple syrup or small amounts of unrefined sugar called sucanat to avoid exacerbation of menstrual symptoms.
- Dairy is considered a congestive food and may worsen dysmenorrhea. Calcium, however is beneficial for reducing muscle cramps. Adding non-dairy sources of calcium such as fresh leafy greens like kale, collards and turnip greens, broccoli and cabbage like bok choy, legumes like white beans and black-eyed peas, nuts like almonds, seeds like sesame and ocean seaweed may greatly reduce dysmenorrhea and associated digestive problems such as bloating, constipation and diarrhea.
- Red Meat and egg yolks are foods that may exacerbate dysmenorrhea. Both are high in an inflammatory compound called arachidonic acid (AA), activated by a decline of progesterone. 38 A diet low in AA and high in omega-3 foods may significantly reduce dysmenorrhea.
- Magnesium is vital mineral that has been shown to reduce key cell compounds in the body’s inflammatory processes. Preliminary research with magnesium supplements has shown some efficacy in reducing dysmenorrhea by decreasing prostaglandin F 2 alpha. 41 Sufferers of dysmenorrhea may wish to speak with a physician about whether magnesium supplements are appropriate for them. *
- Vitamin E. A study from 2005 using vitamin E supplementation for women with dysmenorrhea showed a reduction in severity and duration of pain and the amount of menstrual blood loss, making it a potential pain-relief treatment. 42
- Omega-3s, commonly present in fish and flax seed oils, are anti-inflammatory compounds capable of reducing pain. Studies using omega-3 supplements to treat dysmenorrhea have shown a reduction in symptoms and the ability to decrease pain medication such as ibuprofen. 43
- Calcium supplements are thought to help reduce menstrual pain. Early studies showed that calcium channel blockers helped free calcium and relieve uterine contractions, thus lessening menstrual pain. 44 According to the University of Maryland, more recent research indicates that calcium citrate supplements may work by helping to maintain muscle tone and may be more useful when consistently taken prior to menses.
- Ginger Root has been used in TCM and Ayurveda for thousands of years for its anti-nausea and anti-inflammatory properties. Recent evidence showed that ginger root was as effective as mefenamic acid and ibuprofen on treating pain in women with primary dysmenorrhea. 45
- Chamomile or Mint Tea are both home remedies that have been used to reduce menstrual pain, but may become part of the mainstream treatment for dysmenorrhea. Peppermint contains antispasmodic compounds and its essential oil has proven effective in reducing spasms during colonoscopy and upper gastrointestinal endoscopy procedures. 46 And,recent research with chamomile reveals that drinking chamomile tea led to high levels of glycine, a chemical that relieves muscle spasms and may relax the uterus. 47
- Cramp Bark (Viburnum opulus) and Black haw (Viburnum prunifolium) are two well-known antispasmodic herbs that may be extremely useful for treating dysmenorrhea. The first is native to Europe and Asia and the latter is found in North America. Both have the ability to relax smooth muscle and are recommended by doulas like Dalene Barton to treat uterine menstrual cramps. 48
Products for Relieving Menstrual Cramps
Hot Water Bottle
Updated: November 2014
- Hong Ju, Mark Jones, and Gita Mishra. The Prevalence and Risk Factors of Dysmenorrhea. Epidemiol Rev (2014) 36 (1): 104-113 first published online November 26, 2013 doi:10.1093/epirev/mxt009
- Proctor M, Farquhar C. Diagnosis and Management of Dysmenorrhoea. BMJ. 2006; 332:1134-1138.
- Durain D. Primary dysmenorrhea: assessment and management update. J Midwifery Womens Health. 2004;49:520-528.
- Thomas M, Lunden T, Bjork J, Lundstrom- Lindsbedt V. Pain and discomfort in primary dysmenorrhea is reduced by pre-emptive acupuncture or low frequency TENS. Eur J Phys Med Rehabil 1995; 5: 71–6.
- Penland J, Johnson P, et al. Dietary calcium and manganese effects on menstrual cycle symptoms. Am J Obstet Gynecol . 1993;168:1417-1424.