Dysmenorrhea is a condition in which women experience pain during menstruation. The pain occurs during the ovulatory cycle and is caused by excess production of prostaglandins. Prostaglandins are hormone-like complex fatty acids that belong to the family of eicosanoids. Eicosanoids are present in tissues throughout the body and are involved in inflammation. They also have other functions, including smooth muscle contractility, blood clotting, vascular dilation, and immunity.
The primary types of prostaglandins are anti-inflammatory prostaglandins (PGE1 and PGE3), which decrease inflammation, and pro-inflammatory prostaglandins (PGE2 and PGF2 alpha), which cause uterine contraction. When there is an imbalance and an increased production of PGE2 in the uterus, dysmenorrhea is the result.
The pro-inflammatory prostaglandins have a stimulating effect on the uterus. The endometrium (uterine lining normally shed during the bleeding phase) secretes excess prostaglandin, which causes the smooth muscle of the uterus to contract, leading to cramping and pain. In some cases the constriction and tightening of the uterine muscle are so severe that blood circulation and oxygen to the uterine muscle is severely diminished. Metabolic waste products like carbon dioxide and lactic acid accumulate and tend to make the pain worse.
An excessive release of pro-inflammatory prostaglandins during the sloughing of the endometrium is a popular and valid explanation for this painful condition. But there is another theory that states that dysmenorrhea is an inflammatory disorder due to an imbalance of fats (phospholipids) in the cell membranes throughout the body. Dietary fats are broken down into prostaglandins through a series of metabolic steps. This involves optimal enzyme conversion to better shunt certain fats toward PGE1 and PGE3 (anti-inflammatory) and away from PGE2 (pro-inflammatory). In some cases these enzymes do not work optimally due to aging, family history (genetics), environmental toxins, cigarette smoking, disease, or vitamin and mineral deficiencies.
It is estimated that as many as 30 to 50 percent of women suffer from pain during menstruation. However, this is a conservative figure, since most women don’t seek medical treatment for dysmenorrhea.
There are two classifications of dysmenorrhea—primary (by far, the most common) and secondary. Primary dysmenorrhea occurs when the pain itself is the main problem. At least 10 percent of younger women (teens and early twenties) have symptoms so severe that they cannot go to school, work, or participate in normal activities. Some women also experience low back pain, pinching and pain sensations in the inner thighs, as well as many premenstrual symptoms (breast tenderness, weight gain, headaches, bloating, and irritability). Women in their thirties and forties tend to have more severe cases of dysmenorrhea, especially if they have an excess estrogen imbalance.
Secondary dysmenorrhea is menstrual pain caused by an underlying pathological factor, such as endometriosis, pelvic inflammatory disease, or a congenital deformity.
I have seen a number of women who have had excellent results treating their menstrual pain with MMJ. Their dysmenorrhea is well controlled using indica or high-CBD products, especially CBD Cheeba Chews. These are edibles lasting for six to eight hours that allow you to function well throughout most of the day without pain, drowsiness, or getting high at work or school. CBD, as an analgesic, anti-inflammatory, and muscle relaxant without the psychoactive effect, is an ideal choice for women suffering with severe menstrual pain.
In addition to edibles, high-CBD tinctures and hash oils (ingested), both with low amounts of THC, are also effective, with minimal if any psychoactivity.
For topicals, I highly recommend Mary Jane’s Medicinals Cannabis Infused Massage Oil, which is high in both THC and CBD. It deeply penetrates the uterine muscle, and patients report that it creates a sensation of “dissolving the cramps away.”
I’ve also heard from several patients that the topical cream Apothecanna Extra Strength works well for less severe cramps. It’s a good choice for more mild pain while at work or school.
Another recent addition to the MMJ options for treating menstrual pain are the Foria Relief vaginal suppositories (high CBD/low THC). Their availability in dispensaries is still limited, but the few patients I’ve seen who have used them were extremely pleased with the results.
THCa tincture as a strong anti-inflammatory can provide considerable relief and prevention when taken consistently throughout menstruation.
I would also highly recommend medicated bath products during menstruation. Dixie THC Infused Bath Soak (bath salts) and Mary Jane’s Medicinals Heavenly Hash Bath (bath tea bag) are both excellent options for providing relief of severe menstrual pain.
Transdermal patches are also effective for daytime use in relieving menstrual pain. Nearly all the available patches can be beneficial, depending on the most prominent symptoms: CBD, 1:1/CBD:THC, THCa, THC-indica, THC-sativa, and CBN.
• Poor diet—one of the primary risk factors for dysmenorrhea. Nutrient deficiency is a common contributing factor. The most common depleted nutrients are antioxidants and magnesium. An excess amount of unhealthy fats (hydrogenated and trans-fatty acids) also contribute to menstrual pain.
• Food allergies—can lead to inflammation in the gut, known as “leaky gut,” which increases permeability of the intestinal wall. Food allergies make the intestine a conducive environment for pathogens (parasites, bacteria, yeast overgrowth) to grow, which are also strong contributors to dysmenorrhea, especially if constipation is involved.
• Hormone imbalance—Hormones are metabolized through the liver. If the liver is congested due to gastrointestinal problems, then hormones can become imbalanced and cause estrogen dominance and adrenal insufficiency. If the thyroid gland is not functioning optimally, then this too can exacerbate painful menstruation.
• Stress—contributes to dysmenorrhea by raising cortisol and causing excess estrogen and low levels of progesterone.
NOTE: The conventional medical treatment of choice for most women with dysmenorrhea is nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen. The overuse of these drugs can cause liver toxicity, in addition to decreasing blood flow to the kidneys.
Prostaglandins are made from fatty acids. By modifying the types of fats you consume in your diet, you can manipulate your prostaglandin levels in favor of more anti-inflammatory prostaglandins (PGE1 and PGE3), which decrease inflammation and produce less pro-inflammatory prostaglandins (PGE2). The foods primarily responsible for increasing PGE2 contain omega-6 fatty acids. The precursor to PGE2 is an omega-6 fat known as arachidonic acid (AA). The body produces this AA naturally, but it also comes from foods.
Your goal is to eliminate or significantly reduce rich dietary sources of AA, such as: egg yolks, beef, lamb, and high-fat dairy products. The production of AA in the body also increases whenever you consume sugar or other high-glycemic foods, such as white bread, white potatoes, and bananas. Eating more fresh fruits and vegetables and whole grains, and moderate amounts of proteins such as seafood and soy (non-GMO), will reduce AA production.
The anti-inflammatory prostaglandins (PGE1 and PGE3) come from the fatty acid eicosapentaenoic (EPA). Cold-water fish (cod, tuna, herring, salmon, sardines, and mackerel) and fish oils will raise EPA levels. The two main fatty acids found in fish oil are EPA and DHA. Vegetarians can indirectly produce EPA from omega-3 fats found in walnuts and flax.
Another dietary recommendation is to reduce hydrogenated and trans-fatty acids.
Lowering alcohol and sugars helps to lower insulin as well as balance blood sugars and lower cholesterol levels.
• Fatty acids: With dysmenorrhea, women typically need 3,000–5,000 mg of combined EPA/DHA daily. Healthy women, without menstrual pain, should take 1,100 mg daily.
• Vitamin E: 200–400 IU as d-alpha tocopherol with mixed tocopherols is recommended. Vitamin E releases endorphins, which block pain, within fifteen minutes after taking it.
• Niacin: 100 mg twice daily starting seven days before menstruation, then every two to three hours during cramping. It may cause flushing as the dose increases. It is also more effective when combined with vitamin C.
• B6 and magnesium: the cofactors that help enzymes work effectively in the production of anti-inflammatory prostaglandins. Magnesium is a smooth muscle relaxant, dilates pelvic blood vessels, and inhibits the production of the pro-inflammatory prostaglandins PGE2 and PGF2 alpha. Taking magnesium with B6 boosts its effectiveness. It’s recommended to start with 300 mg of magnesium and increase until you have a soft stool. The dose for B6 is 100 mg taken in a B-complex supplement. Magnesium and B vitamins can also be infused intravenously prior to or during menstrual pain. This can both prevent and effectively relieve pain very quickly.
• Curcumin: very effective in reducing inflammation. The recommended dosage is 400 mg three times per day.
• Ginger powder capsules: Take 750–2,000 mg per day for the first three to four days of the menstrual cycle. Ginger root reduces prostaglandin production and reduces pain and inflammation.
1. Avoid food allergens and constipation.
2. Stress reduction and exercise help reduce hormone imbalance.
I recommend colon cleansing (colonics/colon hydrotherapy) and liver detoxing under professional supervision, acupuncture, and psychotherapy/counseling (especially if you relate to the description in “The Issues in Your Tissues” below).
Painful menstruation is often associated with a dislike of one’s body. Lack of self-acceptance and self-love are typically accompanied by anger with oneself. This emotional profile may have begun in a family in which a woman felt devalued, denigrated, and powerless. This was then transformed into a strong dislike of herself and of being a woman.
Louise Hay, in You Can Heal Your Life, describes the probable emotional cause of menstrual problems as “rejection of one’s femininity; guilt; fear; belief that the genitals are sinful or dirty.” The affirmation she recommends: I accept my full power as a woman and accept all of my bodily processes as normal and natural. I love and approve of myself.
Rachel F. is a thirty-four-year-old graduate student who has been suffering with what she describes as “extreme and nearly incapacitating menstrual cramps” since high school. She reports having had to frequently stay home from school or work when the pain was most acute. She also has had a problem with severe anxiety.
Since she began using medical marijuana about four years ago, her symptoms, both the cramps and the anxiety, have significantly improved. She has had the greatest benefit from vaporizing Harlequin and other high-CBD and indica strains, in addition to CBD Cheeba Chews (an edible). She’s also noticed some moderate improvement from applying the topical cream Apothecanna Extra Strength to her lower abdomen above her uterus, even without doing any of the other MMJ products.
When I mentioned the “issues in your tissues” that are typically present in women with dysmenorrhea, she became somewhat animated and replied, “Wow, that describes me perfectly!”