a purple garden variety of black cohosh
Dysmenorrhea is basically period pain. Doctors will often diagnose period pain as “primary dysmenorrhea”, which means the pain cannot be contributed to any other cause or disease. The typical method for dealing with period pain within the medical model is prescribing hormonal birth control. Much less infrequently pain medications are prescribed; over-the-counter pain-relievers are typically suggested.
Dysmenorrhea is not just a case of “grin and bear it”. It can seriously effect a woman’s ability to function in her daily life. While I am a big fan of resting, nourishing, and turning inwards during the moon time, I acknowledge that there are many woman who’s life is not set up to take such personal time (or rather our society is not set up to take such personal time). And besides, pain is pain, and for most everything besides menstruating and childbirth, we see pain as a sign that something is wrong with the body. Most women I know with dysmenorrhea can’t help but wonder if something is wrong with their body when their uterus is cramped.
Pain and symptoms vary from woman to woman, so it is important to treat the individual, not the condition.
Furthermore, pain and symptoms vary from month to month, as harmony within the menstrual cycle is reached through a process of changes and adjustments. Therefore, herbal formulas should be updated accordingly. At the same time, keep in mind that when working with the endocrine system treatment should be for at least 3 months but often as long as a year or more. Each month the ovaries alternate hormone production, so to ensure an herbal treatment (or conventional, for that matter) is effective let the left, then right, then back to left ovaries do their thing (thus the 3 month recommendation). I also think a quarter of a year is a fair time frame to let your body, mind and spirit go through their natural cycles a number of time, establish rhythms, process emotions, and adjust to physical surroundings and seasons.
It may be tempting to stop taking herbs after a month or so when you a) notice an improvement and b) don’t see any improvement. At this time, especially if you are in the “b” category, keep on! Figure out your dosages and preparations and stick with them. Tinctures? Teas? How often? When I was fist getting into herbs I would stop treatments when I felt they were not working, “so why bother?”, I thought. While it was true they weren’t making horrible cramps disappear, there were many other benefits to be had. Some signs of improvement may be a more regular cycle, less PMS, pre-bleeding spotting, blood clots, nausea, teeth-shattering (yes, some women find they shiver and their teeth-shatter..sounds like a cold condition to me!), more energy and vitality, and simply better able to cope with their cycle no matter how tumultuous it may be.
When creating a formula for dysmenorrhea, you may wish to include: (from Ruth Tricky in Woman, Hormones and the Menstrual Cycle)
- A uterine tonic, as they normalize the uterine tissue
- Antispasmodics, relaxing, pain-relieving, prostaglandin-inhibiting herbs based on symptoms
- Emmenagogues may be used with late or slow starting periods
- Most always use warming herbs
- Don’t forget to balance emotional and mental tension with nervines, and treat any other body system that may be out of balance and aggravates dysmenorrhea
Regulates and normalizes the uterine tissue. Add when there is a heavy, dragging type of pain, pain towards the end of the cycle, some types of pain during sex (of a congested, heavy nature). They often provides nutrition, minerals and can be astringents so the do actually tone (by precipitating excess proteins in cell walls).
Examples: Raspberry leaf, nettle, shepherd’s purse, lady’s mantle, ect…
Improves the action of antispasmodic herbs when the period if aggravated by cold, relived by heat, lower abdomen feels relatively cool to the touch, relived by movement of the hips.
Examples: Ginger, cinnamon can be added to other herbal formulas, or taken alone, but drink them warm. Many Chinese patent formulas include cinnamon to warm the interior and promote a healthy circulation of blood.
Ginger tea – grate or chop 1 inch of ginger into a saucepan. Add about 2 1/3 cups of water. Bring to a boil, reduce to low simmer, cover. Simmer for 20 minuets. Turn off heat and let cool slightly before straining and drinking. You may add honey to taste and sip while emerged in a hot bath; doesn’t that sound divine?
Hormone regulating herbs
The goal here is to regulate the hormones, which reduceds pain by indirect action on prostaglandins.
Examples: Vitex angus-castus (chastetree berries) is very useful for congestive dysmenorrhea, and pain with PMS. A picky herb about dosing…when I get the correct does I will let you know. Everyone seems to have different suggestions.
Paeonia lactiflora (peony), Cimicifugia racemosa (black cohosh) are both antispasmodics and have the potential to competitively inhibit the activity of estrogen.Verbena officinalis (blue vervain) is a sedative, traditionally used for menstrual disorders with a hormonal origin. Schisandra berries.
Blue vervain flowers close up
These are relaxing herbs, used for both physical and mental/emotional tension or anxiety accompanying pain.They potentate antispasmodic and pain-killing herbs, as some are antispasmodics themselves.
Examples: Valerian, peony, corydalis, vervain, chamomile, agrimony, hops, lemon balm, lavender…
These have analgesic effects. Much weaker than conventional analgesics, so they must be prescribed with other herbs that actually attempt to correct the imbalance. I don’t think anodynes work on all systems and complaints, except for corydalis.
Examples: Wild lettuce, pulsatilla, corydalis, valerian, feverfew (463)…
Don’t over look the liver
Congestive period pain with heavy, dull, dragging pain has historically been treated with liver herbs and bitters, as well as those who are “irritable, hot-headed, constipated, headaches, heavy fiery-red flow”. Liver herbs most likely work through an indirect effect on hormone imbalance by improving the liver’s ability to excrete estrogen from the bowel and through the liver and bile.
Examples: Barberry and other bererine-containing herbs are useful, as are many other ‘liver’ herbs like dandelion root, burdock, Oregon grape, yellow dock. Yellow dock and dandelion in particular (especially when combined with blackstrap molasses) can encourage the body to use iron stores more efficiently, thus relieving fatigue following blood loss.
Tricky, Ruth. Woman, Hormones, and the Menstrual Cycle.
Meadowsweet, willow, cottonwood, black haw, cramp bark, birch, wintergreen, black coshosh and Indian pipe all have some derivatives of salicylic acid, though slightly different depending on the plant family. According to Chanchal Cabrera, salicylate-rich herbs are “…antiseptic, analgesic, anti-inflammatory, diaphoretic, anti-pyretic, anti-thrombotic, [and they] stimulate peripheral circulation and promote epithelial regeneration”(27). To reduce fever these herbs act on the hypothalamus (in charge of thermoregulation) which starts the diaphoretic action.
I often hear herb commerce and the media call meadowsweet and other salicylate-rich plants the “herbal aspirins”. Aspirin got its name, of course, from spirea (salicylic acid, the active ingredient in aspirin, is named after another rich source, Salix, or willow). While it is certainly true that plants share an ingredient of aspirin, it is not a one-for-one trade. Jill Stansbury states “[Botanical medicines] are more comprehensive tools than aspirin or acetaminophen. Furthermore, they are better tolerated, have fewer side effects, and are more readily excreted via the kidneys, liver, and intestines then are pharmaceutical[s]“(123).
For instance, aspirin and its chemical relatives are harmful to the stomach. Meadowsweet is healing to the stomach. The salicin found in these herbs is not nearly as strong as acetylsalicylic acid (aspirin) and does not act the same way. In the 1960′s, researchers found that aspirin is a COX (cyclooxygenase, an enzyme) inhibitor, which means that it prevents COX from converting to pain- and inflammation- causing prostaglandins. Herbs can also act as COX inhibitors, but often they achieve this by correcting the imbalance that lead to an elevated incidence of prostaglandins. Essential fatty acids are often suggested for painful periods because of this mechanism. And lastly, meadowsweet and its salicin-containing cohorts are living, breathing entities while aspirin is man-made; an herbalist doesn’t recommend someone to simply “take two willow bark tablets and call me in the morning”. Care is taken to find which pain-relieving, fever-reducing, anti-inflammatory, blood-thinning herbs, lifestyle and dietary changes are suited to an individual constitution and condition.
Inflammation and is viewed by herbalists as a normal bodily response to injury and irritation. It is, essentially, the body’s way to heal itself. An increase of blood and lymph circulating to the injured tissue helps to remove the waste products and promotes healing. Simple as that. I do not support the use of cold packs on injured areas because it stops the inflammatory response, causing a longer healing time. One of the treatments for a badly sprained ankle last fall was a hot pack; in addition to blood-moving herbs (lots of yarrow and elder) I felt it actually soothed the pain and lessened the swelling. I have also found that carpal tunnel and plantar fasciitis respond extremely well to heat, cured even, as I experienced first hand. Chinese moxa sticks work exceedingly well in these cases.
Obviously, then, fever is also viewed as a normal bodily response. “Fevers accomplish much for the organism. It stimulates circulation of both blood and lymph that bring lymphocytes, immune globulins, and other infection-fighting agents to the site of need. Fever also enhances the removal of lysed, spent, and infected cells for processing by the liver, spleen and lymph nodes” (Stansbury, 118). If a fever is stopped prematurely the individual does not receive the benefits from this complex process, and in fact, may increase the duration of the illness. A fever should be around 102 degrees to be optimal, and definitely no higher than 106 degrees, which could cause seizures (118).
Many herbalists still call Meadowsweet (Filipendula ulmaria) by its former botanical name, spirea. According to Matthew Wood, it is a “true normalizer of a badly functioning stomach”, as it both “regulates acidity and rectifies alkalinity”. Meadowsweet can be used as an antacid replacer. It treats peptic ulcers as well as all stomach irritations, especially with fullness without appetite, and treat diarrhea in young children and the elderly. Drink cupfuls of the tea every hour for “fevers, flus, aches in joints, arthritic pain, headache with indigestion” (255). Even though it is high in methyl salicylate, meadowsweet has a great deal of mucilage and tannins that makes it useful as a “tonic to a battered stomach wall” (Mills, 281). Meadowsweet is a beautiful site to find in a field or by a lakeshore. Even the dried, dead, wintered leaves are soft and soothing.
Willow, (Salix spp.) has been used since antiquity for fever, joint pain, osteoarthritis, headaches and injuries as one would expect from a salicylate-rich plant, but because of the high amount of tannins, it is also used for “passive hemorrhages, atonic menstrual bleeding, loose stool” (Wood, 448). Some herbs are seductive to medical researchers; willow is definitely one. Here is a link to some interesting research on willow. After all, it was the plant that led to the synthesis of aspirin in the first place. Cottonwoods and poplars (Populus spp.) are resinous as well as containing salicin. Cottonwood, or balm of Gilead, is known as a stimulating expectorant for bronchitis, soothing to sore throats and laryngitis, as well as an anti-inflammatory for arthritis and sore joints and muscles. Cottonwood oil made from the aromatic gooey buds is one of my favorite chest rubs during a bronchial infection when your chest aches to the touch. One of my favorite The Medicine Woman’s Roots posts on cottonwood.
Black haw (Viburnum prunifolium) and cramp bark (V. opulus) are botanical cousins that are used in similar ways for muscular tension, notably cramps. Both viburnums contain salicosides along with tannins and valerianic acids, making their individual blends of inflammation and pain relieving properties. For women’s health it is used for menstrual cramps, premature labor, and threatened miscarriages, but can be used any time a powerful relaxant is needed for muscular cramps. David Hoffmann uses black haw to treat high blood pressure since it relaxes the peripheral blood vessels as well as for asthma (181). Both viburnums, as typical of barks, contain tannins that make them useful in tonification; cramp bark has been used as an astringent for treating heavy periods or bleeding during menopause (Gladstar, 239; Hoffmann, 194). I seem to recall hearing that menstrual cramps that wrap around the pelvis to the sacrum and lower back call for cramp bark, while cramps that shoot down into the legs indicate black haw.
Gladstar, Rosemary. Herbal Healing for Women.
Hoffmann, David. The New Holistic Herbal.
Mills, Simon. The Essential Book of Herbal Medicine.
Wood, Matthew. The Earthwise Herbal Vol. I.
Cabrera, Chanchal. “Pain Management in Phytotherapy”. Medicines from the Earth Official Proceedings, 2005.
Stansbury, Jill. “Botanical Therapies for Fever”. Medicines from the Earth Official Proceedings, 2005.