Dysmenorrhoea is a symptom associated with the menstrual cycle characterised by lower abdominal and back pain that can be primary or secondary.
Understanding dysmenorrhoea
Dysmenorrhoea is the medical term for period pain, derived from the Greek word ‘dys’ meaning difficult and ‘menorrhoea’ for menstruation. It is considered a symptom rather than a disease itself, and can be an indicator of an imbalance or a possible underlying condition. Dysmenorrhoea can be categorised into two types, primary and secondary dysmenorrhoea. Primary occurs in the absence of a pathological cause, whilst secondary occurs as a result of an underlying pathology.
Dysmenorrhoea is classified as uterine pain around the time of the period and may occur up to 13 days before the period begins. It tends to peak within 24 hours of the period onset, and usually subsides within two or three days after the first day of menstruation (1).
Period pain is experienced by up to 95% of people who menstruate and is often considered a ‘normal’ part of the menstrual cycle, however dysmenorrhoea should not be normalised despite it being a common occurrence (2).
Mild period pain which requires no pain relief nor interferes with daily activities is likely experienced by most menstruating people at some point in their lives. Period pain is often brushed off as something to be ‘put up with’, however when it interferes with day-to-day life or requires pain relief, it should certainly not be the case!
A recent survey of over 42,000 women between the ages of 15–45 looking at the impact of menstrual symptoms on everyday life found that 85% of participants reported experiencing dysmenorrhoea (3).
An earlier questionnaire of 408 young menstruating women reported similar results, with 84.1% of respondents reporting experiencing menstrual pain (4). Of these, 43.1% reported that menstrual pain occurred during every period and 41% during some periods. The authors concluded that a need for medication or inability to function occurred less frequently, being experienced by up to 1 in 4 women. This was defined as distressing menstrual pain involving a need for medication and interruption to usual activities such as absence from school or work , which may be a better description of dysmenorrhoea than just period pain (4).
Other sources suggest that an estimated 5–15% of women who experience primary dysmenorrhoea find that the pain is severe enough to interfere with usual activities and may result in absence from school or work (1).
Herbalists consider period pain which interferes with day-to-day life, or requires pain relief is a sign of imbalance which can be addressed with the support of herbal medicine. Additionally, milder period pain can also be relieved with the support of herbs. Identifying the root cause of dysmenorrhoea and addressing underlying imbalances is considered a vital part of a successful herbal treatment plan.
How does dysmenorrhoea work?
Dysmenorrhoea often occurs due to increased contractions in the uterine wall around the time of menstruation. The function of this contraction is to aid the wall of the womb in shedding its lining (the endometrial lining), which is a natural process of having a period.
During this contraction, blood vessels in the womb can become compressed, which temporarily cuts off the blood supply and subsequently also the oxygen supply. This lack of oxygen in the womb causes the release of chemicals which can also trigger pain.
Furthermore, the body also releases other chemicals called prostaglandins, which encourage more contractions in the womb wall, and can result in an increase in pain (2). Local inflammation or congestion in the pelvic region can contribute to this pain.
Understanding the root
Dysmenorrhoea is classified as primary or secondary and can also be considered spasmodic or congestive in nature.
Primary dysmenorrhoea
Primary dysmenorrhoea is the most common type and is not explained by a specific gynaecological disorder.
It is thought to result from a combination of contractions in the uterine wall, and ischaemia or reduced blood supply to the uterus due to these contractions.
This process of uterine contraction is influenced by prostaglandins, and other inflammatory mediators produced in the uterine wall which arise as a result of local ischaemia.
Prostaglandins are produced naturally in many parts of the body and play a key role in normal body functions as well as defence and repair including inflammation and muscle contraction. During menstruation, prostaglandins are released as the endometrial lining begins to break down, their function here being to stimulate uterine contractions which aid the expulsion of menstrual blood. Higher levels of prostaglandin have been found when women have dysmenorrhoea.
The uterine contractions in primary dysmenorrhoea tend to be too strong and occur too frequently, resulting in increased pain (5).
Due to the role of prostaglandins in promoting uterine contractions, when prostaglandin levels are elevated, this can create a vicious cycle of more contractions, further lack of blood supply, and subsequently more pain (5).
Herbal medicine can help to address imbalances in uterine contractions and prostaglandin levels, and subsequently reduce the symptoms of primary dysmenorrhoea.
Pelvic congestion can also play a role in primary dysmenorrhoea. This may be accompanied by constipation and pain that begins before the flow of menstrual blood has started.
Other factors which may contribute to primary dysmenorrhoea include :
- Passing of menstrual tissue through the cervix (such as clots)
- High levels of prostaglandin F2-alpha in menstrual fluid
- A narrow cervical os (the opening at each end of the cervical canal)
- The position of the uterus (such as retroverted uterus which may point slightly backwards)
- Anxiety (1)
Secondary dysmenorrhoea
Secondary dysmenorrhoea is a symptom linked to an underlying gynaecological condition, or pelvic irregularity.
The most common causes of secondary dysmenorrhoea are:
- Endometriosis (the most common cause)
- Uterine adenomyosis
- Fibroids
Less common causes of secondary dysmenorrhoea include the following:
- Congenital issues
- Ovarian cysts and tumours
- Pelvic inflammatory disease
- Pelvic congestion
- Intrauterine adhesions
- Intrauterine devices (IUDs), particularly copper IUDs
The combination of lifestyle advice and herbal treatment can provide a great deal of support in managing dysmenorrhoea.
Consulting a medical herbalist can be beneficial in supporting both primary and secondary dysmenorrhoea. A herbalist will be able to provide guidance tailored specifically for you. See the resources page for details of where to find a herbalist.
Signs and symptoms
Pain associated with dysmenorrhoea can include:
- Cramping intermittent spasms
- Dull constant ache
- Sharp and throbbing pain
- Pain radiating into back or legs (1)
Some common symptoms which may accompany dysmenorrhoea include:
- Headache
- Nausea
- Constipation or diarrhoea
- Lower back pain
- Urinary frequency
- Vomiting (this is less common)
Some symptoms accompanying period pain may indicate an underlying condition, and it is recommended to consult a GP if you experience any of these symptoms alongside period pain (2):
- Pain during sex
- Irregular periods
- Bleeding in between periods
- A thick or foul-smelling vaginal discharge
Herbal solutions
Herbs can provide a great support for re-establishing balance in the body and provide relief from symptoms of dysmenorrhoea so that it doesn’t interfere with daily life.
There are a number of key approaches which would be included in the treatment of dysmenorrhoea to allow herbs to work holistically within the body to provide the necessary support.
Antispasmodic herbs
Herbs which have an antispasmodic action can help to reduce spasms in the uterine wall, which will reduce the cramping that contributes to the pain in spasmodic dysmenorrhoea. Examples of these include chamomile (Matricaria chamomilla), fennel (Foeniculum vulgare), cramp bark (Viburnum opulus), valerian (Valeriana officinalis), rose (Rosa spp.) and cinnamon (Cinnamomum verum). This antispasmodic action may be beneficial not only in easing the severity of menstrual cramps, but also in helping to break the cycle of strong cramps which stimulates further prostaglandin release and more cramping.
Uterine tonic herbs
Uterine tonic herbs help to tone the uterine muscle and regulate its activity. They encourage more regular and rhythmic muscular contractions in the uterus(5). These include herbs such as angelica (Angelica sinensis), schisandra (Schisandra chinensis) and raspberry leaf (Rubus idaeus).
Herbs which promote circulation
Herbs which promote circulation are helpful in improving the blood flow to the uterus: this can be beneficial in cases of pelvic congestion causing dysmenorrhoea, and when the cramping compromises circulation to the uterus. Herbs such as turmeric (Curcuma longa) and ginger root (Zingiber officinale) help to promote circulation, as well as providing heat from the inside (heat is often helpful in dysmenorrhoea), inhibiting substance-P (a chemical involved in pain perception), and inhibiting prostaglandins (5).
Hormone balancing herbs
Hormone balance can be helpful for dysmenorrhoea since this is believed to indirectly influence prostaglandin levels. Chamomile and green tea (Camellia sinensis) both contain a constituent called apigenin, which inhibits aromatase and prevents excess progesterone and testosterone converting to oestrogen. Agnus castus (Vitex agnus castus) is an example of a hormone balancing herb, and is best taken under the guidance of a herbalist. Further ways to support hormone balance can be found in the holistic solutions section.
Herbs to support healthy liver and digestion
Supporting healthy liver and digestion will ensure the efficient clearance and excretion of hormones from the body. In addition to lifestyle changes (see holistic solutions section), there are herbs which can be helpful in cases of congestive dysmenorrhoea where the liver may benefit from support. Examples include dandelion root (Taraxacum officinale) and barberry (Berberis vulgaris).
Reproductive tonic herbs
Reproductive tonic herbs which specifically target the female reproductive system will help to nourish and restore the function, whilst also providing adaptogenic qualities meaning they help to improve the body’s overall resilience to stress. These herbs can be very beneficial in cases of dysmenorrhoea where stress or anxiety are a factor, either aside from, or as part of the pain being experienced. Two herbs which offer both of these qualities are ashwagandha (Withania somniferum) and shatavari (Asparagus racemosus).
Herbs to treat dysmenorrhoea
Lady’s mantle
Lady’s mantle (Alchemilla vulgaris) has a long history of traditional and folk use for gynaecological conditions, amongst other things it is thought to regulate the menstrual cycle and help ease dysmenorrhoea. Although the mechanisms of action remain unclear, a recent review of literature suggested that it might have a regulatory effect on hormones which has been observed in recent studies on hormone dependent cancer cells (6). This research is based on studies carried out on cancer cell cultures (in vivo), and so is not directly applicable to use in humans, however it is interesting to note that there are possible mechanisms of action being identified which may explain the history of traditional use of lady’s mantle in treating for gynaecological conditions.
Lady’s mantle may be helpful in cases of dysmenorrhoea that are accompanied by heavy menstrual bleeding (menorrhagia), or with endometriosis due to its anti-inflammatory, antioxidant and anti- angiogenesis actions. (7).
Fennel
Fennel (Foeniculum vulgare) is particularly helpful in cases of spasmodic dysmenorrhoea, where there is a sensation of cramping. It has a spasmolytic action, meaning it helps to reduce smooth muscle spasms such as those produced in the uterus responsible for menstrual cramps (7). Fennel is also considered an overall supportive herb for the female reproductive system.
A randomised controlled trial of menstruating women (40 assigned to intervention and control groups) found that participants who took a 30 mg capsule of fennel every four hours for three days prior to menstruation and up to day five, over a three-month time frame, reported a significant decrease in dysmenorrhoea symptoms compared to the control group (8).
Another double-blind placebo-controlled trial of 30 menstruating women who experienced moderate to severe primary dysmenorrhoea were observed for three menstrual cycles and it was found that fennel extract was beneficial as a treatment. During the first cycle no treatment was given, the second cycle mefenamic acid (a medication commonly prescribed for primary dysmenorrhoea) was given, and during the third cycle, a dose of 25 drops of 2% fennel water was given every four hours whilst menstruating. The results revealed that fennel was effective at significantly reducing dysmenorrhoea symptoms compared to no treatment (9). There was a slightly stronger effect recorded with mefenamic acid compared to fennel on days two and three of menstruation, however there was a not a statistically significant difference between effectiveness of the two treatments, suggesting that fennel water is an effective treatment for moderate to severe primary dysmenorrhoea.
Chamomile
Chamomile (Matricaria chamomilla) helps to modulate inflammation, and so may be helpful in cases of dysmenorrhoea when there are signs of prostaglandin imbalance or inflammation. Chamomile also soothes digestive upsets, cramps, or overall tension, so when dysmenorrhoea is accompanied by digestive symptoms such as bloating or bowel cramps, it can be a great aid.
The antispasmodic action of chamomile works on smooth muscle, making it helpful for the digestive tract as well as directly easing uterine cramps. It is also a wonderful herb for relieving anxiety so can be beneficial when this is present along with dysmenorrhoea.
Chamomile can be enjoyed as a simple infusion.
Yarrow
Yarrow (Achillea millefolium) provides many qualities which are helpful in the case of primary dysmenorrhoea, including increasing peripheral vasodilation which helps to improve circulation to the uterus. It is also an anti-inflammatory which can help to minimise inflammatory mediators which may be increased in more debilitating dysmenorrhoea, and it is a spasmolytic which will help to ease uterine contractions.
It also has an antihemorrhagic action, meaning that it helps to reduce bleeding. This means it can be helpful in cases of dysmenorrhoea accompanied by menorrhagia (heavy menstrual bleeding) (7).
A simple herbal infusion of yarrow may be helpful for reducing pain levels in primary dysmenorrhoea, when taken on the first three days of the menstrual cycle.
A randomised, double-blind, placebo-controlled study assessed the effectiveness of yarrow tea on the relief of primary dysmenorrhoea. Participants took 4 g of the dried herb infused in 300 ml of water three times daily, or a placebo teabag on the first three menstrual days for two menstrual cycles. Severity of menstrual pain was rated. The mean change in pain score was significantly greater in the yarrow group after one month, and two months, compared to the placebo group , concluding that yarrow is effective in minimising the pain severity in primary dysmenorrhea (10).
Rose
Rose (Rosa damascena) is an energetically cooling herb, with astringent properties. This makes it helpful in cases of dysmenorrhoea with heavy menstrual bleeding (menorrhagia), and when there may be underlying conditions of either endometriosis or fibroids. It is also helpful for easing anxiety, so can be beneficial in cases of dysmenorrhoea where anxiety is also a feature.
Rose can be enjoyed as a herbal infusion and blends well with chamomile.
Cinnamon
Cinnamon (Cinnamonum spp.) is a warming herb and very helpful in cases of dysmenorrhoea where there is a cold feeling in the body or a desire for heat to be applied such as a hot water bottle. It is particularly helpful in treating pelvic congestion due to its warming effect in the body as it helps to promote circulation and has bitter properties making it helpful when there is sluggish digestion, for example when dysmenorrhoea is accompanied by constipation. Cinnamon is also helpful for relieving the cramps of spasmodic dysmenorrhoea due to its spasmolytic action.
Valerian
Valerian (Valeriana officinalis) is beneficial in cases of dysmenorrhoea accompanied by headaches or anxiety. It helps to relieve menstrual cramps through its spasmolytic action, and relaxes skeletal muscle tension so can be beneficial when muscle tension or tension headaches are also present. Valerian is an excellent nervous system restorative, which will be helpful if there is underlying stress or anxiety accompanying dysmenorrhoea.
Ginger
Ginger (Zingiber officinale) promotes circulation, healthy inflammatory responses, and reduces muscle spasms, making it an excellent herb for helping to ease dysmenorrhoea.. Additionally, its warming effect is helpful in cases of dysmenorrhoea accompanied by a feeling of cold in the body or sensitivity to the cold.
A randomised placebo controlled clinical trial looked at ginger as pain relief for 120 students experiencing moderate to severe dysmenorrhoea. Participants were randomly assigned to a control or placebo group, both of which went through to protocols of treatment each over a one-month timeframe. The first protocol gave 500 mg capsules of ginger or placebo three times per day for two days prior to the period and during the first three days of the period. In the second protocol, these were given only for the first three days of the period. Both protocols showed a significant difference in the severity of pain experienced by participants in the control and placebo groups, and protocol one also showed a significant difference in the duration of pain, but not in the second protocol (11).
These results suggest that ginger taken over a five day period before or during menstruation is effective at reducing the severity and duration of pain experienced in moderate to severe primary dysmenorrhoea.
A recent systematic review and meta-analysis of the efficacy of ginger in the treatment of primary dysmenorrhoea concluded that ginger is a low-cost, easily available treatment option for primary dysmenorrhoea, and potentially as effective as NSAIDs (12).
Turmeric
Turmeric (Curcuma longa) has anti-inflammatory properties, supports effective digestive and liver function due to its bitter properties. It creates heat in the body, making it excellent in cases of dysmenorrhoea accompanied by pelvic congestion, inflammation, and when there is a need to aid the clearance of hormones, and where the application of heat helps to ease symptoms.
According to ayurveda, turmeric helps to stimulate our inner fire (agni), which aids digestive and metabolic processes.
Dandelion root
Dandelion root (Taraxacum officinale) has bitter properties which make it an excellent and effective remedy for promoting liver function and easing constipation. It can be helpful in cases of dysmenorrhoea accompanied by constipation and where there is a need to support hormone clearance and excretion through the liver and bowels.
Shatavari
Shatavari (Asparagus racemosus) is a female reproductive tonic and nervine tonic, meaning that it helps to nourish the tissues and improve the function of these systems, making it a wonderful herb in any case of dysmenorrhoea where stress is also a factor. It is also an adaptogen, which helps to increase the body’s resilience to stress. It is also given as a nutritive tonic for people experiencing fatigue, or anaemia, so can be helpful when either of these accompany dysmenorrhoea (13).
From an Ayurvedic perspective, shatavari is considered to balance hormones, nourish and cleanse the blood and female reproductive organs, providing a sattvic (balancing) quality (14).
Holistic solutions
There are many lifestyle factors and self-care strategies which can have a positive impact on overall health and the following are specific to dysmenorrhoea.
Movement
Moving the body is essential for overall health and helps to avoid stagnation, which can be a causative factor in congestive dysmenorrhoea.
- Exercise promotes circulation not only of the blood, but also of the lymphatic fluid, which plays an important role in immune functions of the body including inflammatory responses. A review of studies looking at exercise for dysmenorrhoea concluded that although the studies available were low quality, the evidence suggested that regularly participating in 45–60 minutes of exercise (regardless of intensity), three times per week or more, seems to provide a clinically significant reduction in the intensity of menstrual pain (15).
- Yoga is considered to have the potential to promote balance in the nervous and endocrine systems (the hormone system of the body), through the practice of asanas (physical postures), and through subtle practices of pranayama (breathing techniques). These harmonising effects on the body and mind can be beneficial in cases of dysmenorrhoea.
- Massage can help to improve circulation and relieve pelvic congestion. This can be self-massage, massage from a friend, or from a massage therapist.
Topical application of heat or herbs
Topical application of heat or herbs can be helpful in easing cases of dysmenorrhoea. These might include:
- Hot water bottle or heat pack
- Castor oil pack
- Warm oil massage with essential oils added to a carrier, such as ginger and lavender
Stress management
Stress management is beneficial for all health conditions since a high percentage of disease can be linked to stress. Stress can have a significant impact on hormones, our article Hormonal health: Stress and immunity goes into more detail on the subject.
Ways to help manage stress include:
- Calming the mind: Overthinking exacerbates stress, simple techniques such as breathing practices or meditation can help to reduce overthinking and therefore stress.
- Yoga: Has been demonstrated as beneficial in reducing stress and anxiety (16).
- Regular exercise: Has been shown to be beneficial for stress reduction.
- Sleep: Regular and sufficient sleep are essential for stress-management and also for maintaining a healthy hormone balance. Read more in Sleep: How it works and herbs to support it.
Relaxation
Relaxation tends to improve people’s ability to cope with pain, and so finding ways to relax may be beneficial, these may include:
- Time in nature
- Meditation
- Yoga nidra
- Resting
- Creativity (art, singing, dancing)
Diet
Food plays an important role in hormone balance, not only for nutrients provided by certain foods and their effect on aiding the liver’s detoxification processes, but also in supporting t regular bowel movements that are an important factor in clearance of excess hormones from the body. Adjustments to diet can also help to reduce inflammation in the body. Including more of these foods can be helpful for managing dysmenorrhoea:
Hormone clearance
- Brassica family vegetables contain nutrients which help the liver’s detoxification process of metabolising oestrogens. These include broccoli, kale, sprouts and cabbage.
- Allium vegetables contain natural anti-oxidants such as quercetin which help the liver to detoxify and reduce the production of oestrogen. These include garlic, onions, chives and leeks.
- Phase II liver detoxification is also aided by the following foods: green vegetables, celery, berries and green tea.
- Using herbs in food can be a great way to promote the metabolism of hormones, the following being beneficial: oregano, thyme, rosemary, sage and turmeric.
- Beetroot is a great source of fibre for healthy bowel movements, and also has anti-inflammatory properties, as well as being a blood tonic.
Anti-inflammatory oils
Excess poor quality oils in the diet can be a contributing factor to inflammation in the body so minimising refined sunflower and rapeseed oil and omega-6 in general, in favour of introducing more omega-3 fatty acids into the body such as coconut oil, hemp seed oil, and extra virgin olive oil.
Final words
The aim of herbal medicine is to get to the root cause of a condition and look at rebalancing the body’s systems to function in a more harmonious way. Each person will experience dysmenorrhoea in a unique way and some herbs can be taken to provide symptomatic relief. However, to really unearth the patterns behind the symptoms and find longer-lasting, sustainable solutions, the guidance of a herbalist is recommended. Consulting a herbalist means they will be able to offer their expertise in formulating treatment to address your specific needs, to re-establish a healthy balance within your body.
References
- MSD Manual Professional Version. Dysmenorrhoea. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/dysmenorrhea?query=dysmenorrhea. Accessed: April 24, 2023
- NHS. Period Pain. https://www.nhs.uk/conditions/period-pain/. Accessed April 24, 2023.
- Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. 2019;220(6):569.e1-569.e7. doi:10.1016/j.ajog.2019.02.048.
- Grandi G, Ferrari S, Xholli A, et al. Prevalence of menstrual pain in young women: what is dysmenorrhea?. J Pain Res. 2012;5:169-174. doi:10.2147/JPR.S30602.
- Tricky R, Women, Hormones and the Menstrual Cycle. 2nd ed. Canberra, Australia: Griffin Press; 2003.
- Tadić MV, Krgović N, Žugić A. Lady’s mantle (Alchemilla vulgaris L., Rosaceae): A review of traditional uses, phytochemical profile, and biological properties. Natural Medicinal Material. 2020;4. DOI: http://dx.doi.org/10.5937/leksir2040066T.
- Bone, K, The Ultimate Herbal Compendium. Warwick, Queensland: Phytotherapy Press; 2007.
- Ghodsi Z, Asltoghiri M. The effect of fennel on pain quality, symptoms, and menstrual duration in primary dysmenorrhea. J Pediatr Adolesc Gynecol. 2014;27(5):283-286. doi:10.1016/j.jpag.2013.12.003.
- Jahromi BN, Tartifizadeh A, Khabnadideh S. Comparison of fennel and mefenamic acid for the treatment of primary dysmenorrhea. International Journal of Gynecology & Obstetrics. 2003;80(2):153-157. https://doi.org/10.1016/S0020-7292(02)00372-7.
- Jenabi E, Fereidoony B. Effect of Achillea Millefolium on Relief of Primary Dysmenorrhea: A Double-Blind Randomized Clinical Trial. Journal of Pediatric and Adolescent Gynecology. 2015;28,5:402-404. https://doi.org/10.1016/j.jpag.2014.12.008.
- Rahnama P, Montazeri A, Huseini HF, Kianbakht S, Naseri M. Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial. BMC Complement Altern Med. 2012;12:92. Published 2012 Jul 10. doi:10.1186/1472-6882-12-92.
- Negi R, Sharma SK, Gaur R, Bahadur A, Jelly P. Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis. Cureus. 2021;13(3):e13743. doi:10.7759/cureus.13743.
- Winston D, Maimes S. Adaptogens, Herbs for strength, Stamina, and Stress Relief. Rochester, Vermont.: Healing Arts Press; 2007.
- Frawley D, Lad V. The Yoga of Herbs. 2nd ed. Twin Lakes: Lotus Light Publications; 2008.
- Armour M, Ee CC, Naidoo D, Ayati Z, Chalmers J, Steel KA, de Manincor M J, Delshad E. Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews Review – Intervention. 2019. https://doi.org/10.1002/14651858.CD004142.pub4. Accessed May 24 2023.
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