Dysmenorrhea is defined as painful pelvic cramping associated with menses, which may be associated with low back and thigh pain, headache, nausea, diarrhea, and fatigue.  Symptoms often start a few days before menses and last through the first few days of bleeding.  Many women are affected by this condition, with estimates ranging from 16%-97%.^1,2

Primary dysmenorrhea, not explained by an alternative diagnosis, is thought to be secondary to elevated prostaglandin levels that cause uterine hypercontractility and subsequent ischemia.³  Associated symptoms, including pain and nausea, can also be explained by high prostaglandin levels.  Secondary causes of dysmenorrhea must be ruled out, including infection, cervical stenosis, adenomyosis, fibroids, or endometriosis.  Diagnosis may require a pelvic exam, transvaginal ultrasound, or even laparoscopy.

The standard approach to treatment of dysmenorrhea includes NSAIDs and hormonal contraception, both of which help to suppress prostaglandin production.  Research supports the use of many self-care and complementary approaches that should also be considered.

1.  Physical Activity

Exercising 45-60 minutes at least three times a week may result in improved menstrual pain.⁴ This improvement was seen in both low-intensity activities (such as yoga) and high-intensity exercise.⁵

2.  Substance Use

Tobacco use is a risk factor for dysmenorrhea and alcohol can increase the duration and intensity of cramping.⁶ Work on a plan to support limiting tobacco and alcohol use. 

3.  Nutrition

Eat an anti-inflammatory diet that is high in omega-3 fatty acids to modulate prostaglandin production and decrease painful cramping.  Small studies support the use of fish oil supplementation to decrease painful contractions.³  Review methods for increased dietary consumption of omega-3 fatty acids, and consider supplementing with 1,000-2000 mg of combined DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) if dietary intake is insufficient.  Refer to the “Nutrition” overview.