Medicine does not know why menstruation is uncomfortable, or why it is much more uncomfortable for some women than for others, or 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). In most cases, no identifiable abnormality can be found. Natural substances known as prostaglandins seem to play a central role in menstrual pain, but their detailed actions are not fully understood. Anti-inflammatory drugs such as ibuprofen and naproxen relieve pain and reduce levels of some prostaglandins. These drugs are the mainstay of conventional treatment for menstrual pain. Oral contraceptive treatment may also help.

Principal Proposed Natural Treatments

There is some evidence that the supplements fish oil, magnesium, and vitamin E may help reduce menstrual pain.

The omega-3 fatty acids in fish oil are thought to have anti-inflammatory effects. Omega-3 may relieve dysmenorrhea by affecting the metabolism of prostaglandins and other factors involved in pain and inflammation.1

In a 4-month study of 42 young women ages 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.2 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.3 Significant improvements were seen in all treatment groups, but the fish oil plus B 12 proved most effective, and its benefits continued for the longest time after treatment was stopped (3 months). The researchers offered no explanation why B 12 should be helpful.

Krill oil, another source of omega-3 fatty acids, might be helpful as well.17

For more information, including dosage and safety issues, see the full Fish Oil article.

In a double-blind, placebo-controlled trial, 100 young women complaining of significant menstrual pain were given either 500 IU vitamin E or placebo for 5 days.12 Treatment began 2 days before and continued for 3 days after the expected onset of menstruation. While both groups showed significant improvement in pain over the 2 months of the study (due to the power of placebo), pain reduction was greater in the treatment group than the placebo group.

In another study performed in Iran, 278 adolescents with dysmenorrhea were given either placebo or 200 IU of vitamin E twice daily on the same schedule as above.18 Again, vitamin E proved more effective than placebo.

It is not clear how vitamin E could affect menstrual pain.

For more information, including dosage and safety issues, see the full Vitamin E article.

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.9 The researchers reported evidence of reduced levels of prostaglandin F 2 alpha, one of the prostaglandins involved in menstrual pain.

Similarly positive results were seen in a double-blind, placebo-controlled study of 21 women.10

For more information, including dosage and safety issues, see the full Magnesium article.

A double-blind study of 43 women found some evidence that acupuncture can be effective for control of menstrual pain.14 In addition, a controlled study of 61 women evaluated the effects of a special garment designed to stimulate acupuncture points related to menstrual pain.15 Unfortunately, researchers chose to compare treatment to no treatment, rather than to placebo treatment. For this reason, the results (which were positive) mean little. In a review of 30 controlled trials, researchers were unable to draw conclusions about the effectiveness of acupuncture and similar treatments for menstrual pain due to widespread study design problems.24

A smaller, but more recent systematic review from 2011 included 6 acupuncture trials involving 673 women and 4 acupressure trials involving 271 women.25 Acupuncture was associated with pain relief when compared to a placebo (sham) control, anti-inflammatory medication (NSAIDs) and Chinese herbs. Similarly, acupressure was associated with symptom improvement when compared to a placebo control. As in previous reviews, however, researchers found enough weaknesses in the trials to recommend the need for more high-quality studies.

Other Proposed Natural Treatments

One small double-blind trial suggests that making sure to get enough calcium and manganese may help control symptoms of menstrual pain.11

The herb cramp bark has traditionally been used to relieve menstrual pain. Unfortunately, it has not received any significant scientific attention. Numerous other herbs and supplements have been suggested for menstrual pain relief, including boswellia, bromelain, Coleus forskohlii, dong quai, turmeric, and white willow. However, there is no reliable scientific support for these treatments.

One study has been reported as finding the herb fennel helpful for menstrual pain; however, a close look at the study shows that it merely found fennel less effective than the drug mefenamic acid.13 The study did not have a placebo control group. For this reason, it is quite possible that the relatively mild benefits seen in the fennel group simply reflect the placebo effect. Another study of fennel also failed to use a placebo.21

In one study, aromatherapy massage with lavender, rose, and clary sage reduced menstrual pain to a greater extent than massage with an almond oil placebo.20 One seemingly substantial double-blind study reported benefits with guava leaf .22 However, researchers resorted to a form of statistical analysis that makes the results relatively unreliable.

A 2008 review of 39 randomized controlled trials involving a total of 3,475 women, researchers concluded that the use of traditional Chinese herbal medicine shows some promise in for the treatment of menstrual pain. However, firm conclusions were not possible due to the wide variability of study design and herbs used, as well as the poor quality of many of the studies.23

According to one small double-blind study, use of magnet therapy (applying the magnets to the pelvic area) might improve menstrual pain.19

A controlled study failed to find chiropractic spinal manipulation helpful for menstrual pain.16

Sericite is a mineral that emits far infrared rays, which subtly warms tissue and locally increases blood flow. In one study, researchers randomized 104 women with menstrual cramps to wear a heated sericite belt or a placebo belt for 3 menstrual cycles.26 The evidence suggests that the sericite belt may be a useful treatment for menstrual cramps.

Herbs and Supplements to Use Only With Caution

Various herbs and supplements may interact adversely with drugs used to treat dysmenorrhea. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.