Dysmenorrhea: A Global Perspective on Natural Approaches -

Dr. Nyarai Paweni, MSM, ND
@DrNyarai

Dysmenorrhea is common place for women around the globe. Women with regular menstrual cycles will bleed every month, a total of 12-13 times a year. If there is pain for 1, 2, 3 or more days of that menstrual period that can add up to at least 1 full month every year of being in pain, according to one study by Thirza I. J. Hillen. The societal impact includes limiting school, work and leisure activities. It is estimated that dysmenorrhea causes approximately 45% restricted school (or work) activities and 48% restricted sports activities for 1-2 days each month.

What is Dysmenorrhea?

Pain associated with menstruation
The most commonly reported menstrual disorder
Tends to start the first 6 – 12 months, with the majority starting within first 2 years after menarche
More than half of women who menstruate have some pain for 1-2 days/each month
Primary – pain with menses “menstrual cramps”
Secondary – disorder in reproductive system, later onset worsens over time, including strong association with inflammatory conditions

Menses pain results in decreased blood flow to the muscles, decreased oxygen, ischemia, and spasm and is exuberated by an imbalance of prostaglandins – mainly high PGE2 and PGF2-alpha and vasopressin production initiated when progesterone levels fall at the cycle’s end. Dysmenorrhea is not associated with income, education however BMI (Body Mass Index) may be a possible factor in some patients.

Associated Symptoms

Headaches/migraines
Back pain
Fatigue
Mood changes
Nausea/vomiting
Diminished appetite
Declining mental focus/clarity
Sweating
BM changes – constipation/diarrhea

Conventional Treatments

Current conventional/allopathic treatment options tend to focus on reducing the symptoms and invariably include:

OTC analgesics
Sedatives
Antispasmodics
Prostaglandin inhibitors
Uterine contraction inhibitors
NSAIDs
Vasopressin antagonists
Ovulation inhibitors/OPCs
Bed rest, local heat therapy
Surgical intervention
Psychotherapy

Traditional Chinese Medicine

Considerations from a TCM Perspective:

Dysmenorrhea is the result of chronic imbalances in the flow of qi and blood
Liver qi deficiency, excess, or stagnation, which result in a significant effect on menstrual flow and are a source for painful periods
Spleen qi imbalance – reflective in digestive disturbances and sugar cravings
Kidney qi imbalance, which tends to be responsible for ovulation

In reviewing the research that provides a global overview of how women in different cultures have treated dysmenorrhea naturally, one notices that in many countries, traditional medicine is an ancient and common practice. This practice continues today as the effectiveness of some of therapies have been proven for the treatment of numerous conditions. Many even influence current herbal approaches. While this review is not comprehensive, it may provide other options and suggestions worth trying should you, or your patient, be experiencing this chronic monthly pain/discomfort.

Another study by Antonino Lasco et. Al, Archives of Intern Med is titled “Improvement of Primary Dysmenorrhea Caused by a Single Oral Dose of Vitamin D.” This randomized, double-blind, placebo-controlled study of 40 women, aged 18 to 40 years, evaluated the effect of a single-loading oral dose of cholecalciferol (300 000 IU) 5 days prior to menses. The results are as follows:

Significant decrease in pain shown in the vitamin D group compared with the placebo group (P < .001) over the 2-month duration of our study.
The greatest increase of pain was seen in women with severe pain at the baseline in the vitamin D group (r = −0.76; P < .001).
Vitamin D receptors are abundant on the human uterus and in immune system cells. Vitamin D reduces the synthesis of PGs and may also have a beneficial effect in the uterus.

Herbs

The Journal of Alternative & Complementary Medicine published a study on “The Effect of Aromatherapy on Symptoms of Dysmenorrhea” by Sun-Hee Han, et al. 67 females with a mean age of 20.6 were included in this randomized placebo-controlled clinical trial. The study involved topically applying 2 drops of lavandula officinalis (lavender), 1 drop of Salvia sclarea, (clary sage) and 1 drop of Rose centifolia (rose) in 5 cc of almond oil for 15 minutes as an abdominal massage. Massage is thought to enhance essential oil penetration into the skin. The following are benefits and results of this aromatherapy treatment:

Herbal Benefits: Lavender is an analgesic, sedative, anticonvulsant; Clary Sage is an anticonvulsant, menstrual regulator, and estrogen action supporter; Rose alleviates uterine problems.
Findings: Effective in decreasing the severity of menstrual cramps from 7.40 to 4.26 (on a 10-point scale) after aromatherapy on the 10-point VAS. Effective on females with menstrual cramping greater than 6 on 10-point scale. (Placebo received only almond oil and control group nothing.)
Recommendations: Use essential oils several days before dysmenorrhea. Also, consider these other herbal treatments – Melissa officinalis (Lemon Balm), Zingiber officinale (Ginger), Rosmarinus officinalis (Rosemary), Matricria recutita (Chamomile).

An Australian and Chinese study entitles, “Dysmenorrhea: A Comparative Study of Australian & Chinese Women,”by Xiaoshu Zhu et. Al, from Complementary Therapies in Medicine explored the extent to which traditional Chinese Medicine diagnostic categories for primary dysmenorrhea would be useful for describing clinical presentation of women in Australia. The study included 120 Australian women and 122 Chinese women aged 18 to 45. Diagnostic categories were effective for the difference in presentation. Here are some therapies and their results:

Qi and blood stagnation with cold retention and underlying kidney deficiencies showed distention, stabbing pain before/during menstruation, breast tenderness, increased warmth and blood clots released.
Excess Fire with blood stagnation resulted in distention and burning pain before/during cycle, heavy flow, small clots, dry stool, thirst and breast tenderness.
Blood and Qi Stagnation demonstrated distention, stabbing pain, decreased pressure, mood swings, scanty flow, and increased clots discharged.
Liver and kidney impairment resulted in dull pain before/after cycle with lower blood pressure, scanty flow, vertigo or weakness of knees
Blood and Qi deficiency shown distention, burning pain before/during menstruation, heavy flow with small clots, vertigo/dizziness, and shortness of breath.

A Middle Eastern study from Iran, titled “The Effect of an Iranian Herbal Drug on Primary Dysmenorrhea: A Clinical Controlled Trial by Khodakrami Nahid, et. Al in the Journal of Midwifery & Women’s Health was a randomized, double-blind, placebo controlled pilot trial among 180 females aged 18 -27 demonstrating the effectiveness of the following herbal treatments:

Crocus sativus (saffron) traditionally used to treat symptoms of amenorrhea, dysmenorrhea, PMS and infertility.
Apium graveolens (celery seed extract) used in Ayurvedic medicine and containing phthalates that can help balance pregnancy levels, decrease inflammation, pain and swelling.
Foeniculum vulgare mill (anise or fennel) promotes menstruation, alleviates symptoms, relaxes.
Results: A significant decrease in pain scores or use of additional medication for treatment. 35% report no pain with all three herbals, compared to 18% experience pain with Mefenamic and 3.9% on placebo. The saffron group pain scales decreased from 5.3 to 0.5 in 3 months

In the United States, a study called “An Innovative Acupuncture Treatment for Primary Dysmenorrhea: A Randomized, Crossover Pilot Study,” by Chao MT et. al, from The Alternative Therapy Health Medicine, shows this pilot study examined the feasibility, acceptability, and preliminary effects of a spleen -6 acupuncture point injection (spleen-6) of vitamin K1 as an alternative treatment for primary dysmenorrhea among 14 diagnosed American women between 18 and 25 years of age. The potential biological mechanism of an acupuncture point injection of vitamin K1 on dysmenorrhea is unknown, but research studies indicate that vitamin K may play a role in reproductive health. Below are the details of this study:

Procedure: Vitamin K1 injection in the spleen-6 acupuncture point at the start of menses, followed by saline in a non-acupuncture point after two months. Or the treatments were administered in reverse.
Results: Women had an average 2.5 point decrease in pain after vitamin K1 injection in Spleen-6 (p < 0.001) compared with a 1.8 point decrease after saline (p < 0.001) administered.

In Mali, Africa a study of Medicinal Plants Traditionally Used in Mali for Dysmenorrhea by Rokia Sanogo featured in the African Journal of Traditional, Complementary and Alternative Medicine, highlighted the prevalent use of medicinal medicine. More than 80% of the population in Mali, use traditional medicine and medicinal plants for primary health care. Many medicinal plants are used in the treatment of dysmenorrhea. The main goal of the project was to propose enhanced traditional prescription developed from efficient plant extracts against dysmenorrhea in Mali. The medicinal plants emphasized included, Maytenus senegalensis (Bamanan (Mali), Gnikélé), synonyms: Gymnosporia senegalensis Loes and family: Celastraceae, Stereospermum kunthianum (local name in Bamanan: Mogoyiri), family: Bignoniaceae and Trichilia emetica (local name in Bamanan (Mali): Sulafinzan), synonyms: Trichilia umbrifera Swyn. T. Somalensis Chiov. T. grotei Harms; T. roka Chiov; T. jubensis Chiov, family: Meliaceae.

Procedure: The study reviewed the medicinal use, chemical constituents, Biological and pharmacological activities of these plants, believed to have analgesic, anti-inflammatory and antispasmodic properties.
Results: Some of medicinal plants proved effective for treatments of dysmenorrhea with minimal side effects. Important anti-inflammatory and analgesic properties were described for senegalensis, S. kunthianum and T. emetica, three plants widely used to treat dysmenorrhea in the Malian traditional medicine. The peripheral analgesic and the anti-inflammatory effects of the decoctions of the three plants may be mediated via inhibition of cyclooxygenases and/or lipoxygenases and all three of the aqueous extracts contribute to the inhibiting the synthesis of prostaglandins that cause menstrual pains and uterine hypercontractility.

With 30–60% of reproductive age women reporting pain during menstruation, primary and secondary dysmenorrhea are both common gynecological complaints. And with current options for the relieve of pain and discomfort, constituting mainly with the use of NSAIDs that have adverse long-term effects that may result in liver, kidney and digestive systems dysfunction. Traditional medicine can therefore offer an alternative treatment options for the treatment of dysmenorrhea and can enhance quality of life with minimal side effects. Often as practitioners we have standard recommendations for conditions, exploring how other cultures treat conditions such as dysmenorrhea may help expand our toolkit of options for our patients while optimizing the body’s natural ability to heal.

Dr. Nyarai Paweni Is a passionate about naturopathic medicine with a keen focus on women’s health, skin and digestive health. A 2015 National University of Health Sciences graduate,she has a private practice working downtown Chicago and Lisle (Western Suburb), Chicago where she provides naturopathic/integrative care to all ages. Dr. Nyarai is active in multiple community organizations and is a member of ILANP- Illinois Association of Naturopathic Physicians, AANP- American Association of Naturopathic Physicians, Endocrine Association of Naturopathic Physicians and the Cook County Physicians Association.

References:

Zhu, X., Bensoussan, A., Zhu, L., Qian, J., Xu, M., Zhou, C., Chao, P. and Lo, S. (2009). Primary dysmenorrhea: A comparative study on Australian and Chinese women. Complementary Therapies in Medicine, 17(3), pp.155-160.
Nahid, K., Fariborz, M., Ataolah, G. and Solokian, S. (2009). “The Effect of an Iranian Herbal Drug on Primary Dysmenorrhea: A Clinical Controlled Trial,” Journal of Midwifery & Women’s Health, 54(5), pp.401-404.
Han, S., Hur, M., Buckle, J., Choi, J. and Lee, M. (2006). “Effect of Aromatherapy on Symptoms of Dysmenorrhea in College Students: A Randomized Placebo-Controlled Clinical Trial, ” The Journal of Alternative and Complementary Medicine, 12(6), pp.535-541.
Eryilmaz, G. and Ozdemir, F. (2009). “Evaluation of Menstrual Pain Management Approaches by Northeastern Anatolian Adolescents.” Pain Management Nursing, 10(1), pp.40-47.
Hillen, T., Grbavac, S., Johnston, P., Straton, J. and Keogh, J. (1999). “Primary Dysmenorrhea in Young Western Australian Women: Prevalence, Impact, and Knowledge of Treatment,” Journal of Adolescent Health, 25(1), pp.40-45.
Lasco, A. (2012). “Improvement of Primary Dysmenorrhea Caused by a Single Oral Dose of Vitamin D: Results of a Randomized, Double-blind, Placebo-Controlled Study,” Archives of Internal Medicine, 172(4), p.366.
Pasquale, R., ND, RH (AHG), r. (2014). DYSMENORRHEA – IT ISN’T NORMAL. NDNR, (July 2014).
Rokia Sanogo, African Journal of Traditional, Complementary and Alternative Medicine (AJTCAM), 2011; 8(5 Suppl): 90–96. Published online 2011 Jul 3. doi: 4314/ajtcam.v8i5S.4