Primary dysmenorrhoea is caused by uterine contractions which are too strong and occur too frequently. Between the contractions, the uterine muscle does not relax properly, and there is an abnormally high ‘resting tone’. The overall effect is a reduction in the amount of blood flowing through the uterine muscle (ischaemia) which causes the pain known as primary dysmenorrhoea.
The most usual cause of primary dysmenorrhoea is an imbalance in the prostaglandins levels. Prostaglandins are complex hormone-like substances found in most body tissues. There are many different types of prostaglandins which control bodily functions by working together as an integrated team. When the different types of prostaglandins are present in normal ratios, menstruation proceeds normally. An imbalance in the ratios in favour of the type of prostaglandins which increase muscle spasm will cause period pain. Their role in menstruation is complex and is discussed in ‘Prostaglandins’.
The uterine tonics
The uterine tonics, Aletris farinosa, Caulophyllum thalictroides, Angelica sinensis and Rubus idaeus, are used to treat pain because they are believed to regulate the muscular activity of the uterus and help initiate contractions which are regular, rhythmic and more orderly. They are combined with other herbs which are indicated by the symptoms.
Antispasmodic herbs are indicated for period pain which is crampy, colicky and comes in intermittent waves of pain. They are also useful for the vomiting and diarrhoea that sometimes accompanies dysmenorrhoea. Antispasmodics are more effective if given to stop the onset of spasm, rather than to treat pain that has already started. They should be started several days before the expected onset of the period. There is no reason to take antispasmodics throughout the whole cycle.
Viburnum opulus and V. prunifolium, Caulophyllum thalictroides, Dioscorea villosa, Ligusticum wallichii and Paeonia lactiflora are useful antispasmodics. Paeonia lactiflora is usually combined with Glycyrriza glabra to obtain the best effect. Caulophyllum thalictroides is used when the spasm seems to be localised in the cervix, resulting in acute crampy pain with very little flow. Women with this pain pattern usually experience relief once the flow becomes established.
Emmenogogues are herbs which can increase the strength of uterine contractions. They are used to increase the expulsive activity of the uterus and start the menstrual flow. Artemesia vulgaris, in combination with any of the uterine tonics, is particularly indicated for period pain which is dull and congestive and which occurs in conjunction with periods which are slow to start.
Herbs which are Warming improve the action of the antispasmodic herbs, especially when the period pain is aggravated by cold, relieved by heat, or the woman has a tendency to ‘feel the cold’ easily. Two herbs are specific for the pelvic region: Zingiber officinale and Cinnamomum zeylanicum. Both can be added to a herbal mix in the form of a tincture, or taken as a tea, either alone, with other therapeutic herbs or in an ordinary cup of tea.
Warming herbs are best if taken hot. To make ginger tea, grate 2-4 cm green root ginger, place in a stainless steel saucepan with 1-2 cups of water, cover and bring slowly to the boil. Keep covered and simmer for about ten minutes. Strain, add honey to taste and sip while still hot. If possible, also have a bath. Other herbs can be taken at the same time. Ginger also eases nausea and is useful for period pain accompanied by vomiting.
Herbs which regulate the hormone levels can improve period pain. Regulating hormone levels is believed to have an indirect effect on the prostaglandins levels and is one of the reasons that the Pill is effective for pain. The most valuable of the herbal hormone regulators is Vitex agnus-castus, which is very useful for congestive dysmenorrhoea, particularly when the pain is accompanied by premenstrual tension. Vitex agnus-castus is a very difficult herb to prescribe successfully and should only be taken while under the supervision of an experienced herbalist. A number of other herbs have subtle effects on hormonal balance and are also effective for the treatment of pain. The exact reasons for their actions is often unknown, but it is likely that they work at a variety of levels. Included in this group are Paeonia lactiflora, P. suffruticosa and Cimicifuga racemosa, which are antispasmodics and may also competitively inhibit the activity of oestrogen; and Verbena officinalis, which is sedative and has been traditionally used for menstrual disorders which have a hormonal origin.
Nervine (relaxing) herbs are useful, especially where anxiety or tension accompany the pain. Some nervine herbs are also antispasmodics, the best being Valeriana officinalis, Paeonia lactiflora, Piscidia erythrina, Corydalis ambigua, Verbena officinalis and Matricaria recutita. Even when anxiety is not a problem, nervine herbs in the formula potentiate the actions of the antispasmodic and pain-killing herbs.
Herbs to reduce pain: the anodynes
Anodyne is the term used in herbal medicine to describe herbs that have analgesic (pain-reducing) effects. Corydalis ambigua from the Chinese Materia Medica is the most potent of these, and can be used for pain anywhere in the body. It also reduces heavy menstrual flow. Other important anodynes for menstrual pain are Piscidia erytbrina, Lactuca virosa and Anemone pulsatilla.
It may seem strange that the anodyne herbs are included so far down the list of herbs used to treat period pain. There are very good reasons for this. Anodynes are much weaker than conventional analgesics and must be prescribed with other herbs for the best effect. Also, a herbalist never tries to treat painful conditions by just stopping the pain. The aim is to rectify the underlying causes so that the problem is cured, rather than the symptom abolished.
There is no herbal tradition for the use of prostaglandins-inhibiting herbs in dysmenorrhoea. (Prostaglandins were only discovered in the 1930s, and by this time herbal medicine had been used for thousands of years.) However, a number of commonly used herbs for period pain have been discovered to have prostaglandins-inhibiting effects similar to those of drugs. Zingiber officinale, Tanacetum partbenium and Curcuma longa are commonly prescribed, and there are probably others, but there is little research in this area. In fact, Tanacetum partbenium was suspected of having prostaglandins-inhibiting effects when women taking it for migraines noticed an improvement in their period pain. Curcuma longa is used in Chinese and Indian herbal medicine and has a long tradition of use for period pain. It has proven prostaglandin-inhibiting effects.
Treating the liver
Congestive period pain, the heavy, dull, dragging type of pain experienced by many women before their period, is often improved when Liver herbs or bitters are given. Historically, the Choleric (liverish) woman was described as being inclined to be irritable, hot-headed, constipated, as suffering from headaches and ‘congestive complaints’ like congestive dysmenorrhoea, with heavy, fiery-red menstrual flow. She was given bitter and Cooling herbs to expel Heat and remove the Yellow Bile humour.
These herbs are still used today for the same kinds of symptoms, even though we don’t know exactly why they work. They may have an indirect effect on hormone balance and improve the excretion of oestrogens from the bowel and through the liver and bile. Berberis vulgaris seems to be particularly useful, but as it is also an emmenogogue, the positive results may come from multiple effects.
Spasmodic or congestive dysmenorrhoea accompanied by constipation is difficult to treat successfully unless the constipation is improved as well. The aperient herbs such as Cassia senna, Rhamnus purshiana and Aloe barbadensis can be used but will often aggravate spasm if taken during the period. Bitters are safer and equally reliable, especially Taraxacum officinalis, Silybum marianum and Berberis vulgaris.
By far the best method to treat constipation is to increase the level of fibre and fluids in the diet. About two litres of water should be taken every day when fibre intake is increased.
Irritable bowel syndrome frequently becomes worse around the period and can aggravate period pain — sometimes it is even mistaken for period pain. A diet and regime for treating irritable bowel syndrome follows.