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From the Townsend Letter for Doctors & Patients
November 2004


Nutritional Influences on Illness
Nutrients in the Treatment of Dysmenorrhea
by Melvyn R. Werbach, M.D.

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In the 1950s, Hudgins reported the results of open trials which suggested that niacin supplementation provided relief of menstrual cramps for about 90% of women whose cramps had been severe enough to require bed rest, heavy sedation or loss of time from work.1

Hudgins prescribed 100 mg of the nutrient twice daily and at least 100 mg every 2 to 3 hours during cramps. He believed that the dosage should produce flushing—although he found in a preliminary trial that niacinamide (which does not produce flushing) seemed to work as well. He also believed that the efficacy of niacin was enhanced by the addition of ascorbic acid 300 mg daily and rutin 60 mg daily, and suggested that, by improving capillary permeability, they enhanced the vasodilating effect of the niacin.

Unfortunately, his work was never confirmed by randomized trials, although his extremely high success rate makes it likely that the response was more than a placebo effect.

A group of 556 young women in India with moderate to very severe primary spasmodic dysmenorrhea received thiamine hydrochloride 100 mg daily and placebo in random order for 90 days each. When the results of the 2 active treatment groups were combined, it was found that 87% of the women were completely cured, while for 8% the pain was reduced to almost gone. Moreover, 2 months later, the improvements remained, causing the investigator to suggest that the treatment was curative.2
These findings are consistent with those of open trials which found thiamine to have an analgesic effect, although those studies employed much higher dosages. However, thiamine deficiency is fairly common in India, so it is possible that the nutrient is only effective when repleting a deficiency.

Vitamin E
In 1955, Lancet published a placebo-controlled study in which 100 young women with spasmodic dysmenorrhea received either alpha-tocopherol 50 mg 3 times daily or placebo for 10 days premenstrually and for the next 4 days. After 2 cycles, 68% of women in the supplemented group improved compared to only 18% of the controls.3 These results were confirmed recently in a similar study.4

Treatment with the opioid antagonist naloxone blocks the effect in some patients, suggesting that the analgesic effect efficacy is related to endorphin release.5 Since the vitamin inhibits thromboxane A2 release and stimulates prostacyclin synthesis,6 supplementation is likely to be more effective if started at least several days prior to menses.


Iron deficiency, as marked by low ferritin levels or low transferrin saturation, may be associated with an increased risk of dysmenorrhea.7

In 1965, Nathaniel Shafer of the department of medicine, New York Medical College, learned from 2 patients receiving iron supplementation for iron deficiency anemia that their severe symptoms of dysmenorrhea had disappeared. He proceeded to question another 4 patients whom he had treated for iron-deficiency anemia, and to treat another 6 patients complaining of dysmenorrhea (several of whom also had iron deficiency anemia) with iron, without informing them that the treatment may relieve their pain. (None of these patients had endometriosis or other organic pelvic disease to account for the dysmenorrhea.)

All reported diminution or complete disappearance of menstrual pain following iron supplementation.8 Unfortunately, these preliminary findings have yet to be confirmed by randomized trials.

There is some evidence that patients may have reduced magnesium nutriture.9 Double-blind studies have found magnesium supplementation to be effective for treating primary dysmenorrhea.10,11 In addition to its vasodilatory and muscle relaxant effects, magnesium inhibits the synthesis of prostaglandin F2 alpha.11

Since vitamin B6 increases the influx of ionic magnesium into the myometrial cell, it may increase magnesium's efficacy.12 Indeed, when the combination was given every 2 hours as needed during menses and 4 times daily during the rest of the cycle, during the next 4 to 6 months there was a progressive decrease in the intensity and duration of menstrual cramps.12

Essential Fatty Acids
A study of the dietary habits of women who were not pregnant and did not use oral contraceptives found that a low intake of omega-3 fatty acids and a low dietary omega-3 to omega-6 ratio was inversely associated with dysmenorrhea.13

In a double-blind crossover study, half of a group of 42 adolescents with dysmenorrhea and a low dietary intake of fish received fish oil daily for 2 months followed by a placebo for an additional 2 months, while the other half of the group took placebo followed by fish oil. While there were no baseline differences in menstrual symptoms between the 2 sub-groups, following the 2 months of treatment with fish oil, each of the sub-groups had a marked reduction in menstrual symptoms.14

Doctor Werbach cautions that the nutritional treatment of illness should be supervised by physicians or practitioners whose training prepares them to recognize serious illness and to integrate nutritional interventions safely into the treatment plan.

1. Hudgins AP. Vitamins P, C and niacin for dysmenorrhea therapy. West J Surg Gynecol 62:610–11, 1954
2. Gokhale LB. Curative treatment of primary (spasmodic) dysmenorrhoea.
Indian J Med Res 103:227–31, 1996
3. Butler EB, McKnight E. Vitamin E in the treatment of primary dysmenorrhoea.
Lancet i:844–7, 1955
4. Ziaei S et al. A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea.
BJOG 108(11):1181–3, 2001
5. Kryzhanovskii GN et al. [Endogenous opioid system in the realization of the analgesic effect of alpha-tocopherol.]
Biull Eksp Biol Med 105(2):148–50, 1988 (in Russian)
6. Gisinger C et al. Vitamin E and platelet eicosanoids in diabetes mellitus.
Prostaglandins Leukot Essent Fatty Acids 40:169–76, 1990
7. Penland J, Hunt J. Nutritional status and menstrual-related symptomology. Abstract.
FASEB J 7:A379, 1993
8. Shafer N. Iron in the treatment of dysmenorrhea: A preliminary report.
Curr Ther Res 7(6):365–6, 1965
9. Henrotte JG et al. [Sexually-related variations in magnesium in regard to excitability and fatigue.]
CR Soc Biol 167:843–7, 1973 (in French)
10. Fontana-Klaiber H, Hogg B. [Therapeutic effects of magnesium in dysmenorrhea.]
Schweiz Rundsch Med Prax 79(16):491–4, 1990 (in German)
11. Seifert B et al. [Magnesium—a new therapeutic alternative in primary dysmenorrhea.]
Zentralbl Gynakol 111(11):755–60, 1989 (in German)
12. Abraham GE. Primary dysmenorrhea.
Clin Obstet Gynecol 21(1):139–45, 1978
13. Deutch B. Menstrual pain in Danish women correlated with low n-3 polyunsaturated fatty-acid intake.
Eur J Clin Nutr 49(7):508–16, 1995
14. Harel Z et al. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents.
Am J Obstet Gynecol 174(4):1335–8, 1996

Updated from Werbach MR with Moss J. Textbook of Nutritional Medicine. Tarzana, California, Third Line Press, Inc., 1999.

Doctor Werbach's voluminous Nutritional Influences on Illness CD-ROM, with 4,200 pages of text and covering over 100 different illnesses, makes it easy to search the nutritional literature. For information, contact Third Line Press Inc., 4751 Viviana Drive, Tarzana, California 91356. [Tel: 800–916–0076; 818–996–0076; FAX: 818–774–1575; E-mail:; Internet:].


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