Vitamin B6 One small trial showed vitamin B6 to be more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6.
Vitamin B1 One large trial showed that vitamin B1 was more effective than placebo in reducing pain.
Vitamin E One small trial comparing daily vitamin E with ibuprofen taken during menses showed no difference in pain relief.
Omega-3 fatty acids One small trial showed fish oil to be more effective than placebo in pain relief. A number of studies have found that the intake of marine origin omega-3 fatty acids (such as salmon and sardines) decrease symptoms of dysmenorrhea. Given the established benefits of omega-3 fatty acids in other conditions such as heart disease, high intake of these compounds can be recommended throughout the cycle.
Adapted from Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhea. Cochrane Database Syst Rev 2001;3:CD002124.
alternatives. Table 13.9 lists findings by a Cochrane review study on alternative treatments. The review concluded that vitamin B1 is effective in the treatment of dysmenorrhea when taken at 100 mg daily, although this finding is based on only one large randomized controlled trial (23). The results further suggested that magnesium is a promising treatment, but it is unclear what dose or treatment regimen should be used (23). The addition of fish oils showed promising results. The concentration of omega-6 fatty acid derived eicosanoids such as PgE2 are elevated during menstruation in women who experience dysmenorrhea. Dysmenorrhea was associated with low dietary intake of omega-3 fatty acids. Several studies showed supplementation to be effective in the management of dysmenorrheal (42). Krill omega-3 phospholipids, which contain phosphatidylcholine with DHA/EDA, outperformed conventional fish oil DHA/EDP in double blind studies on PMS and dysmenorrhea (43). Given the established benefits of omega-3 fatty acids in other conditions, such as heart disease, high intake of these compounds can be recommended throughout the menstrual cycle.
Massage relieves anxiety, sadness, and pain immediately after the therapy, but it does not reduce symptoms of PMS/PMDD overall.
There is no evidence to support the effectiveness of chiropractic manipulation in these conditions. One small (N = 25) placebo-controlled crossover study showed the group receiving chiropractic treatment had a significant improvement in symptoms, but the group that received placebo first improved over baseline with the placebo and experienced no further improvement when they received the active treatment (44).
A Cochrane review of the use of spinal manipulation for primary and secondary dysmenorrhea concluded that overall there is no evidence to suggest that spinal manipulation is effective in the treatment of primary or secondary dysmenorrhea. In four trials, high-velocity, low-amplitude manipulation was no more effective than sham manipulation, although it was possibly better than no treatment (45). Three of the smaller trials indicated a difference in favor of the manipulation; the one trial with sufficient sample size found no difference. There was no difference in adverse effects between the two groups (45).