Niacin
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.
Thiamine
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.
Minerals
Iron
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.
Magnesium
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.
References
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: tlp@third-line.com; Internet: http://www.third-line.com].
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