Magnesium plays a role in controlling muscle tone and could be important in preventing menstrual cramps.^{14 , 15} Magnesium supplements have been reported in preliminary and double-blind European research to reduce symptoms of dysmenorrhea.^{16 , 17 , 18} In one of these double-blind trials, women took 360 mg per day of magnesium for three days beginning on the day before menses began.¹⁹

In a double-blind trial, women with PMS took 2 grams of either krill oil from Antarctic krill (a zooplankton crustacean) or fish oil for one month, followed by two months in which the women took their supplement beginning eight days prior to menstruation and continuing for two days after the start of menstruation. While abdominal pain symptoms were similarly reduced by either oil, those taking krill oil reported using fewer pain relievers for menstrual pain.²⁰

Preliminary research reported that 60 mg Pycnogenol twice daily for two months reduced abdominal and back pain during menses.²¹ A double blind trial by the same researchers using 60 mg Pycnogenol per day confirmed these findings for women with more severe pain, but not for those whose menstrual pain was mild.²²

The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle. They then took 100 mg every two or three hours while experiencing menstrual cramps.²³ In a follow-up study, this protocol was combined with 300 mg of vitamin C and 60 mg of the flavonoid rutin per day, which resulted in a 90% effectiveness for relieving menstrual cramps.²⁴ Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.

The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle. They then took 100 mg every two or three hours while experiencing menstrual cramps. In a follow-up study, this protocol was combined with 300 mg of vitamin C and 60 mg of the flavonoid rutin per day, which resulted in a 90% effectiveness for relieving menstrual cramps. Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.

In a double-blind trial, supplementation with 500 IU of vitamin E per day for two months, beginning two days before menstruation and continuing for three days after the onset of menstruation, was significantly more effective than a placebo at relieving menstrual pain.²⁵ Similar benefits were seen in four-month double-blind trial using 400 IU per day, beginning two days before the expected start of menstruation and continuing through the first three days of bleeding.²⁶

Açaí is reported to be a traditional remedy for dysmenorrhea. There is preliminary evidence that anthocyanins from bilberry, some of which are also found in açaí, may help with dysmenorrhea symptoms.²⁷ However, there have been no clinical trials investigating açaí’s effect on dysmenorrhea.

Black cohosh has a history as a folk medicine for relieving menstrual cramps. Black cohosh can be taken in several forms, including crude plant, dried root, or rhizome (300–2,000 mg per day), or as a solid, dry powdered extract (250 mg three times per day). Standardized extracts of the herb are available, though they have primarily been researched for use with menopausal women suffering from hot flashes. The recommended amount is 20–40 mg twice per day.²⁸ The best researched form provides 1 mg of deoxyactein per 20 mg of extract. Tinctures can are also used (2–4 ml three times per day).²⁹ The Commission E Monograph recommends black cohosh be taken for up to six months, and then discontinued.³⁰

Blue cohosh , although unrelated to black cohosh, has also been used traditionally for easing painful menstrual periods. Blue cohosh, which is generally taken as a tincture, should be limited to no more than 1–2 ml taken three times per day. The average single application of the whole herb is 300–1,000 mg. Blue cohosh is generally used in combination with other herbs. Women of childbearing age using this herb should cease using it as soon as they become pregnant—the herb was shown to cause heart problems in an infant born following maternal use of blue cohosh.³¹

In theory, calcium may help prevent menstrual cramps by maintaining normal muscle tone. Muscles that are calcium-deficient tend to be hyperactive and therefore might be more likely to cramp. Calcium supplementation was reported to reduce pain during menses in one double-blind trial,³² though another such study found that it relieved only premenstrual cramping, not pain during menses.³³ Some doctors recommend calcium supplementation for dysmenorrhea, suggesting 1,000 mg per day throughout the month and 250–500 mg every four hours for pain relief, during acute cramping (up to a maximum of 2,000 mg per day).

Corydalis contains several alkaloids, and one called tetrahydropalmatine (THP) is considered to be the most potent. In laboratory research, THP has been shown to exhibit a wide number of pharmacological actions on the central nervous system, including pain-relieving and sedative effects.³⁴ According to a secondary reference, painful menstruation responded favorably to the administration of THP.³⁵ For a pain-relieving effect, the recommended amount for the crude dried rhizome is 5–10 grams per day. Alternatively, one can take 10–20 ml per day of a 1:2 extract.

Cramp bark (Viburnum opulus) has been a favorite traditional herb for menstrual cramps, thus its signature name. Cramp bark may help ease severe cramps that are associated with nausea, vomiting, and sweaty chills. Research from animal studies shows that cramp bark blocks spasms of smooth muscle.³⁶ Cramp bark is traditionally prepared by placing two teaspoons of the dried bark into a cup of water and bringing it to a boil; it is then simmered gently for 10 to 15 minutes. The tea may be drunk three times per day.³⁷ Alternatively, 4–8 ml of tincture may be used three times per day.

Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.³⁸

False unicorn was used in the Native American tradition for a large number of women’s health conditions, including painful menstruation. Generally, false unicorn root is taken as a tincture (2–5 ml three times per day). The dried root may also be used (1–2 grams three times daily). It is typically taken in combination with other herbs supportive of the female reproductive organs.

Diets low in omega-3 fatty acids (EPA and DHA) have been associated with menstrual pain.³⁹ In one double-blind trial, supplementation with fish oil, a good source of omega-3 fatty acids, led to a statistically significant 37% drop in menstrual symptoms. In that report, adolescent girls with dysmenorrhea took an unspecified amount of fish oil that provided 1,080 mg of EPA and 720 mg of DHA per day for two months to achieve this result.⁴⁰ A double-blind trial found that the same amount of EPA and DHA plus 7.5 mcg per day of vitamin B12 led to a greater than 50% decrease in menstrual symptoms, but a group taking only fish oil did not obtain as much relief.⁴¹ Six grams of fish oil per day provides the approximate levels of EPA and DHA used in these trials.

Ginger has been used in some systems of traditional medicine to treat dysmenorrhea. In a double-blind trial, ginger powder was as effective as anti-inflammatory medication (mefenamic acid and ibuprofen) in relieving symptoms of dysmenorrhea. Ginger was used in the amount of 250 mg four times per day, beginning at the start of menstruation and continuing for three days.⁴²

Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.⁴³

Some practitioners report success using topical progesterone cream for dysmenorrhea.⁴⁴ To date, this approach lacks sufficient research.

Vervain is a traditional herb for dysmenorrhea, however there is no research to validate this use. Tincture has been recommended at an amount of 5–10 ml three times per day.

In a double-blind trial, adolescents living in India who were suffering from dysmenorrhea took 100 mg of vitamin B1 (thiamine) per day for three months. Eighty-seven percent of those treated experienced marked relief of dysmenorrhea symptoms.⁴⁵ However, vitamin B1 deficiency is relatively common in India, whereas it is rare in the Western world, except among alcoholics. It is not known whether vitamin B1 supplementation would relieve dysmenorrhea in women who are not B1 deficient.

In a double-blind trial, women with dysmenorrhea received a placebo or a single administration of a large amount of vitamin D (300,000), five days before the expected onset of the next menstrual period. During the next two menstrual periods, menstrual pain was significantly lower in the vitamin D group than in the placebo group.⁴⁶ Such a large amount of vitamin D should be given only under the supervision of a doctor. Further research is needed to determine whether daily supplementation of a smaller amount (such as 800 to 2,000 IU per day) would have a similar beneficial effect.

Clinical reports from Germany have suggested that vitex may help relieve different menstrual abnormalities associated with premenstrual syndrome, including dysmenorrhea.⁴⁷ These studies used 40 drops of a liquid preparation that delivers the equivalent of 40 mg of the dried berries of the plant.