Painful Menstruation

Painful Menstruation (Dysmenorrhea): Overview

Dysmenorrhea is the medical term for painful periods or menstrual cramps.  The majority of women are thought to experience some degree of dysmenorrhea.

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Dysmenorrhea is either primary or secondary.

Incidence; Causes and Development

Primary dysmenorrhea frequently affects women in their teens and early 20s, who have never had a baby.

The symptoms are caused by prostaglandin, a natural hormone produced by cells in the uterine lining.  The level of prostaglandin increases in the second half of the menstrual cycle.  When a woman's period begins, the cells in the uterine lining release prostaglandin as they are shed.  Women with severe primary dysmenorrhea have significantly higher prostaglandin levels in their menstrual fluid than do other women.  Usually the symptoms do not last very long – one or two days, but rarely longer.

Secondary dysmenorrhea is caused by a variety of uterine conditions.  Women who suffer from it tend to be older than those with primary dysmenorrhea.

Signs and Symptoms

In cases of primary dysmenorrhea, no disease or other medical cause can be found for the pain and other symptoms, which may include backache, diarrhea, dizziness, headache, nausea, vomiting, and a feeling of tenseness.

Treatment and Prevention

Secondary dysmenorrhea.  On physical exam and/or ultrasound, if everything is normal, the doctor might recommend prostaglandin-inhibiting medications such as aspirin, ibuprofen, or naproxen.  The birth-control pill is sometimes recommended, as it stops ovulation and decreases prostaglandin levels.

In cases of secondary dysmenorrhea, dilation and curettage (D&C) may be recommended to open the cervix and remove tissue for microscopic testing.  Once the reason for your secondary dysmenorrhea has been found, your doctor will be able to discuss an appropriate treatment with you.  You might also be advised to use prostaglandin-inhibiting drugs or the birth-control pill to relieve symptoms.

Signs, symptoms & indicators of Painful Menstruation (Dysmenorrhea):

Symptoms - Reproductive - Female Cycle

Risk factors for Painful Menstruation (Dysmenorrhea):



Endometriosis is the most common cause of menstrual cramps.


Low Adrenal Function / Adrenal Insufficiency

Dysmenorrhea caused by ovarian dysfunction may disappear when low doses of cortisol are used to improve adrenal influence on ovarian function. [The Safe Uses of Cortisol, William Mck. Jefferies, MD 1996, p.157]


EFA (Essential Fatty Acid) Type 3 Requirement

In a double-blind placebo-controlled study among a group of girls suffering from dysmenorrhea, it was found that the symptoms could be significantly reduced by dietary supplementation with omega-3 fatty acids.  This particular study used fish oil. [ American Journal of Obstetrics & Gynecology, April 1996;174(4): pp.1335-1338]

Tumors, Benign

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Painful Menstruation (Dysmenorrhea) suggests the following may be present:


Tumors, Benign

Ovarian Cysts

Ovarian cysts can cause symptoms resembling painful menstrual periods when the cyst grows to a larger size.

Recommendations for Painful Menstruation (Dysmenorrhea):

Botanical / Herbal


Marijuana is being used to treat menstrual cramps. [Grinspoon, L., and Bakaler, J.B. "Marijuana as Medicine." Journal of the American Medical Association 1995; 273(23): pp1875-76.]

Digestive Aids


Bromelain at 250 to 500mg can be taken 3 to 4 times per day on an empty stomach.  Fish oil and bromelain make a powerful anti-inflammatory combination.



Anti-inflammatories such as Motrin, while useful for the management of acute pain, do little to deal with any underlying causes.


Aerobic Exercise

Regular exercise can help minimize pain and cramping.



Menstrual cramps, irritability, fatigue, depression, and water retention have been lessened with magnesium, usually given along with calcium and often with vitamin B6.  Magnesium is often at its lowest level during menstruation.  In acute cases, magnesium and vitamin B6 intravenously can stop the cramping.  Restoring magnesium sufficiency by consistent supplementation can work to prevent this problem.


Essential Fatty Acids

Long-term improvement may be gained by promoting the build up of anti-inflammatory prostaglandins with Omega-3 fatty acids or fish oil.  Six grams of fish oil per day (or about 1,000mg of eicosapentanoic acid, 700mg of docosahexaenoic acid) can be taken every day for 2 or 3 cycles and then reduced, or taken for a total of 14 days starting 10 days before your period.


Vitamin B1 (Thiamine)

In a well-designed controlled trial of 556 girls with moderate to severe menstrual cramping, vitamin B1 (100mg daily by mouth) for 3 months produced startling results.  87% were cured, 8% were almost completely relieved, while only 5% were not benefited at all. [ Indian J Med Res May, 1996;103: pp.227-31]

Vitamin E

Supplementation with vitamin E (500 IU per day) from 2 days before menstrual onset through the third day of bleeding, for two consecutive menstrual cycles, reduced pain in a placebo-controlled trial of 100 young women with primary dysmenorrhea. [BJOG 2001;108(11): pp.1181-3]

Another study used vitamin E successfully at a dosage of 75-400 IU tid. [Butler & McKnight. Lancet 1: pp.844-47, 1955]

Inositol Hexaniacinate

There is evidence that niacin may be beneficial for the treatment of dysmenorrhea.  Hudgins reported on a group of 80 women suffering from painful menstrual cramps who were supplemented with 100mg niacin twice daily, beginning 7 to 10 days before the onset of menses and then every 2 to 3 hours during heavy cramps.  90% of participants experienced significant relief.  It should be noted that the dosage required during heavy cramping is high enough to cause unpleasant side effects and that it would seem that the use of flush-free niacin (inositol hexaniacinate) might be indicated.  In addition, the inositol would provide lipotropic effects.  Lipotropic agents help in the metabolism of hormones by the liver, important for the prevention of PMS.

Vitamin B3 (Niacin)

Niacin (and possibly flush-free niacin) at 100mg every 2 to 3 hours in acute cases has been used.

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