Menstrual Cramps: An Herbal Approach (November, 2003)
by Tori Hudson, N.D. Professor, NCNM & Bastyr University, and Medical Director, A Woman’s Time in Portland, OR

Overview
Menstrual cramps are one of the most common problems that women face, affecting over 50% of menstruating women. Dysmenorrhea is best classified
as primary or secondary. In primary dysmenorrhea, painful menstrual cramps occur that have nothing to do with any physical abnormalities or identifiable pelvic disease. Secondary dysmenorrhea refers to painful menstrual cramps due to some specific pelvic abnormal condition such as endometriosis, pelvic inflammatory disease, adhesions, ovarian cysts, congenital malformations, narrowing of the cervical opening, polyps or uterine fibroids. Treatment for secondary dysmenorrhea is directed to treating the underlying cause of the condition. The treatment of pain is similar with both primary and secondary dysmenorrhea.

More than 50% of women with menstrual cramps also have additional symptoms, including nausea and vomiting, fatigue, diarrhea, lower backache, and headache. Women with severe cases may also become dizzy or even faint. The symptoms may last from a few hours to one day, but seldom last longer than two to three days. Some women have more congestive symptoms that are characterized by a dull aching in the low back and pelvis, bloating and weight gain, along with some systemic symptoms, including breast tenderness, headaches and irritability.

Valerian (Valeriana officinalis)
Valerian has been primarily used traditionally as a sedative and antispasmodic for the treatment of anxiety disorders, sleep disorders, and a diverse array of conditions associated with pain. Valerian contains an important class of compounds called valepotriates and valeric acid which are found exclusively in this perennial plant native to North America and Europe. It is not difficult to see how Valerian would help to relieve pain, anxiety, and insomnia because both valepotriates and valeric acid are capable of binding to the same receptors in the brain as Valium. Although Valerian has not been scientifically studied for menstrual cramps, it has been shown to relax the spasmodic contractions of intestinal muscles. Both the uterus and intestines are smooth muscles. In clinical practice, Valerian is usually a significant feature of an alternative medicine approach to painful menstruation. The administration of Valerian may make you tired and sleepy, so it is advisable to stay home and rest or fall asleep.

Dose: Valerian tincture: 1 tsp. every 3-4 hours as needed for pain.

Cramp Bark (Viburnum opulus) & Black Haw (Viburnum prunifolium)
Both of these species of Viburnum have been mentioned repeatedly, in traditional botanical reference books, as uterine relaxants and general antispasmodics. They have been used mainly for menstrual cramps, bearing-down uterine pains, and chronic uterine and ovarian pains. Animal studies have confirmed that both species have an antispasmodic effect on the uterus. Laboratory studies on human uterine tissue have also confirmed that Viburnum prunifolium exhibits a relaxant effect on the uterine tissue. When menstrual pains are of either a congestive or spasmodic nature, and include low back pains, especially if the pains radiate down the thighs, there is no better herbal choice than Cramp Bark (Viburnum opulus).

The root bark of Black Haw (Viburnum prunifolium) is reported to contain several active constituents that are uterine relaxants, one of which is scopoletin. Black Haw has been historically used as a specific medicine for menstrual cramps with severe low back pain and bearing-down pelvic pains. For menstrual pains associated with a profuse menstrual flow and intermittent severe pains, Black Haw would probably be a more specific choice than Cramp Bark.

Dose: Cramp Bark Tincture: 1/2 tsp every 2-3 hours.
Dose: Black Haw Tincture: 1/4 tsp every 2-4 hours.
Caution: Both species should be avoided during pregnancy except in the hands of an experienced herbal practitioner.

Black Cohosh (Cimicifuga racemosa)
Black Cohosh has gained increased attention in the last few years largely as an herb for the relief of menopause symptoms. However, when I was first studying botanical medicine, this herb was known more for its relaxant affect on the uterus in dysmenorrhea, false labor pains, and in threatened miscarriage. It can be helpful in both congestive and spasmodic menstrual cramps of even a severe nature. If PMS irritability and anxiety, delayed or irregular menstrual cycles, or scanty flow, are associated with the menses, then Black Cohosh would particlularly be indicated for the menstrual cramps.

Dose: Tincture: 1/4 tsp – 1/2 tsp every 2-4 hours.
Caution: Avoid during pregnancy except in the hands of a trained herbal practitioner.

Additional considerations
Although we typically think of menstrual cramps as a spasmodic condition, some women experience pain that is more related to pelvic congestion, which can be exacerbated by constipation, poor pelvic circulation, and uterine fibroids.

Mild diuretics can be helpful in relieving some of the congestion. Consider Dandelion leaf, Red Clover and Parsley. Digestive tonics such as Yellow Dock, Dandelion root, Hops and Gentian can encourage better digestion and intestinal elimination. Circulatory tonics such as Rosemary and Ginger root can improve blood flow to the pelvis.

Other milder antispasmodic or sedative herbs can also be helpful, especially if the menstrual cramps are mild. Chamomile, Hops, Skullcap can be used in combination with any of the other herbs.

References
Mennini T, et al. In vitro study on the interaction of extracts and pure compounds from Valeriana officinalis roots with GABA, benzodiazepine and barbiturate receptors in rat brain. Fitoterapia. 1993; 54: 291-300.

Hazelhoff B, Malingre M, Meijer D. Antispasmodic Effects of Valeriana Compounds: An In-Vivo and in-Vitro Study on the Guinea-Pig Ileum. Arc. Int. Pharmacodyn. 1982; 257:274-287.

Felter H. The Eclectic Meteria Medica, Pharmacology and Therapeutics. Portland: Eclectic Medical Publications. 1985: 694.

Jarboe C, Schmidt C, Nicholson J, Zirvi K. Uterine Relaxant Properties of Vibernum. Nature. 1966; Nov 19: 837.

Evans W, Harne W, Krantz J. A Uterine Principle From Viburnum Prunifolium. (Journal unknown). Dept. of Pharmacology, School of Medicine, U. Maryland. 1942;174-177.