Primary dysmenorrhea, also known as menstrual pain, affects young women in their teens and early twenties. Pain usually begins a day or two before menstrual flow, and may continue through the first two days of menstruation. Discomfort tends to decrease over time and after pregnancy. Secondary dysmenorrhea is caused by underlying physical problems.

Symptoms and degree of pain vary, but may include the following.

• Abdominal cramping or dull ache that moves to lower back and legs
• Heavy menstrual flow
• Headache
• Nausea
• Constipation or diarrhea
• Frequent urination
• Vomiting (not common)

Primary dysmenorrhea is caused by the following.

• Strong uterine contractions stimulated by increased production of the hormone prostaglandin by the lining of the uterus (endometrium)
• Anxiety and stress
• Blood and tissue being discharged through a narrow cervix
• Displaced uterus
• Lack of exercise

Secondary dysmenorrhea can be caused by the following.

• Endometriosis (inflammation of the lining of the uterus)
• Blood and tissue being discharged through a narrow cervix
• Uterine fibroid or ovarian cyst
• Infections of the uterus
• Pelvic inflammatory disease (PID)
• Intrauterine device (IUD)

A pelvic examination may include an internal examination, laparoscopy, and ultrasound. You may need a Pap test or D&C to analyze tissue. Blood and urine samples may be required.

Your provider may suggest the following drugs.

• Anti-inflammatory agents such as ibuprofen (800 mg to start; 400 to 600 mg every six hours).
• Gonadotropin-releasing hormone (GnRH) or oral contraceptives
• Antibiotics will cure PID
• Estrogen or oral progestins (for example, norethindrone for 12 months brings relief in 80 percent of patients; however, there may be side effects).

Dysmenorrhea may be effectively treated with nutritional support and mind-body techniques such as meditation, yoga, tai chi, and exercise.

• Increase intake of essential fatty acids, which are found in cold-water fish, nuts, and seeds. Reduce intake of saturated fats (meat and dairy products). Eliminate refined foods, sugar, dairy products, and methylxanthines (coffee and chocolate). Increase intake of fresh fruits and vegetables, proteins, and whole grains.
• Magnesium (400 mg per day) with B6 (100 mg per day) throughout cycle to promote hormone production and induce relaxation. Can be used at higher doses during your period (magnesium up to 600 mg per day, and B6 up to 300 mg per day) for pain relief.
• Vitamin E (400 to 800 IU per day) to improve blood supply to muscles
• B-complex (50 to 100 mg per day) to reduce the effects of stress
• Essential fatty acids (Omega-3 and Omega 6 oils such as flaxseed, evening primrose, or borage oil) to reduce inflammation and/or support hormone production
• Niacinamide (50 mg twice a day) to reduce pain. Begin seven days before your period until the end of flow. Add rutin (60 mg per day) and vitamin C (300 mg per day) to increase effects.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Chaste tree (Vitex agnus-cactus) and black cohosh (Cimicifuga racemosa), 30 drops each, twice a day, to reduce dysmenorrhea.
• Red raspberry (Rubus idaeus) tea strengthens uterine tissue.
• Tea of chamomile (Matricaria recutita) and ginger root (Zingiber officinale) can help reduce ovarian cyst pain.
• Tinctures of cramp bark (Viburnum opulus), black cohosh, Jamaica dogwood (Piscidia piscipula), and wild yam (Dioscorea villosa) can be used together in equal parts to relieve pain and cramping. Use 20 drops every half hour for four doses, then as needed up to eight doses per day for seven days.

There have been few studies examining the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for menstrual pain based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Belladonna — for acute menstrual pain that often resembles labor pains; pain is often described as sharp, throbbing pressure in the pelvis accompanied by heavy bleeding; pain may extend to the back and is generally tends to worsen with walking or moving
• Chamomilla — for menstrual pain with mood changes including irritability and anger; pain may occur after bouts of anger and be relieved by warmth; the individual may have the sensation of a weight on her pelvis
• Cimicifuga — for pains that move from one side of the abdomen to the other and that are worsened by movement
• Colocynthis — for sharp pains accompanied by anger and irritability
• Lachesis — for pain and pressure that extend to the back; symptoms tend to worsen at night
• Magnesia phos — for cramps or sharp, shooting pains that are relieved by warmth, pressure, and bending forward
• Nux vomica — for cramping pains that extend to the lower back; these pains are often accompanied by nausea, chills, irritability, and a sensitivity to light, noise, and odors
• Pulsatilla — for menstrual pains accompanied by irritability, moodiness (including feelings of sadness), dizziness, fainting, nausea, diarrhea, back pain, and headaches; there may be more pain when there is no menstrual flow

The following methods can relieve pelvic pain.

• Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth (for example, flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results use three consecutive days in one week.
• Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for three minutes, then in cold water for one minute. Repeat this three times to complete one set. Do one to two sets per day three to four days per week.

The National Institutes of Health recommend acupuncture as either a supplemental or alternative treatment for dysmennorhea. This recommendation is supported by a well-designed trial involving 43 women with dysmenorrhea. Women treated with acupuncture showed a dramatic reduction in both pain and the need for pain medication

Acupuncture has become a popular treatment for dysmenorrhea. Acupuncturists treat people with dysmenorrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of dysmenorrhea, a qi deficiency is usually detected in the liver and spleen meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is often added to enhance needling treatment, and qualified practitioners may also recommend herbal or dietary treatments.

Chiropractors report that some people with dysmenorrhea may benefit from spinal manipulation (particularly in areas that supply sensory and motor impulses to the uterus and lower back). Studies of women with a diagnosis or history of primary dysmenorrhea have found that spinal manipulation improves symptoms, but no more effectively than sham manipulation. Sham manipulation refers to maneuvers that shift soft tissues surrounding the bone but to not actually adjust the spine or joint. Sham manipulation has been compared to placebo because both procedures look and feel the same. Interestingly, however, experts are now questioning whether sham is a fair placebo because the massage quality of the manipulation may also have a beneficial effect.

Therapeutic massage is helpful in reducing the effects of stress.

If your symptoms change, or treatment does not help, tell your provider.

Avoid caffeine, alcohol, and sugar prior to onset of your period.

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