Period problems

For safe use of over-the-counter medicines, herbal remedies and supplements, consult a qualified person (such as a doctor or pharmacist) before buying or taking any medicine, remedy or supplement:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you are already taking other medicines
– if you suffer from allergies

Always read the package insert before taking any product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Many modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. Some of these remedies have been tested against the toughest health conditions, and plants with the strongest reputations across many cultures deserve a close look. In particular much information was gained by women, who were often the community health providers, nurses and midwives. There are often particularly strong traditions for using herbs for women’s problems (see below).

From the way they have been described in old texts, and from what we now know of the action of many plant constituents, it is possible favourite plant remedies work particularly by nudging better function in digestion, circulation, and eliminatory processes: helping the body help itself rather than directly attack a disease.

Researchers are now discovering that many herbal medicines have useful benefits for the body, including in healing and repair, in stabilising hormonal responses (including stress hormones, insulin and sex hormones), and in reducing long-term inflammation.

Summary
This shrub (chasteberry or Vitex agnus castus) from southern Europe produces small, fragrant white flowers and strongly aromatic dark fruits about the size of peppercorns. This herb has long been used by women in Mediterranean countries for a range of health problems.

Evidence
A number of clinical studies suggest that agnus castus extracts help in PMS.

Safety
Side-effects are not common, and they are mild and reversible. The most frequent problems are digestive upsets and headaches. Allergic skin reactions are rare. There are no known problems caused by taking agnus castus along with ordinary medicines.

Cost
Agnus castus can cost from £10-20 per month depending on the brand. As with other herbal products it is often unwise to find stockists with prices that look too low – assuring even basic quality costs money!

Further information
Check on the website of the British Herbal Medicine Association for agnus castus and other women’s health products that are registered as medicines in the UK. These products, marked with a THR logo on the pack are independently assured for their quality.

Summary
Some women find using a combination of magnesium and calcium supplements effective for relieving symptoms of PMS. Others find that using magnesium supplements help with painful periods and also PMS.

Evidence
Research suggests that taking 1000-1200 mg of calcium a day, and that taking 200-400 mg a day of magnesium for the two weeks before a period may both ease PMS symptoms. There is evidence to show that some types of magnesium supplements may help ease painful periods.

Safety
If these supplements have not helped after three cycles they should be stopped. Magnesium supplements give some people diarrhoea: using a lower dose should stop this happening.

Cost
These supplements are generally inexpensive and can be bought from most high street pharmacies.

Summary
Evening primrose is a yellow, flowering plant that blooms in the evening. The oil from its seed contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can’t make GLA so we need to get it from our food.

Evidence
Although EPO has a reputation for easing PMS symptoms, the research results have been inconclusive.

Safety
Evening Primrose oil is generally safe in recommended doses. Reported side-effects are rare and mild. If you experience stomach pain and loose stools, this may mean you are taking too much. If you get seizures (such as epileptic fits), be careful with omega-6 supplements like EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.

Cost
These supplements are generally inexpensive and can be bought from most high street pharmacies.

Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen stop prostaglandins from cramping the womb and may also reduce bleeding. NSAIDs are safe for most people in short courses. Read the package information for cautions.

Start the tablets as soon as your period begins or even the day before. Try taking them every 6 hours for two or three days and check with a pharmacist that you are taking a large enough dose. If you still have problems with period pain, despite a full course at the full dosage, get your GP’s advice.

Paracetamol is good to try if NSAIDs don’t suit you. Tablets containing a mixture of paracetamol and codeine may be even better. Ibuprofen can also ease period pain. You can also combine these sorts of painkiller with an NSAID. Do not take more than the maximum recommended daily dose of any painkiller.

Evidence
There is good evidence that ibuprofen helps with painful periods. Paracetamol may be helpful if the pain is mild.

Safety
Evening Primrose oil is generally safe in recommended doses. Reported side-effects are rare and mild. If you experience stomach pain and loose stools, this may mean you are taking too much. If you get seizures (such as epileptic fits), be careful with omega-6 supplements like EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.

Cost
These supplements are generally inexpensive and can be bought from most high street pharmacies.

Summary
St John’s wort was often used in European folk medicine for women’s problems, and rebuilding energies, these traditions quite separate from its modern reputation for helping low mood and depression. There may be enough overlap between PMS and depression for this remedy to be doubly useful.

Evidence
Research has shown this herb can treat depression and there is some research suggesting that it helps PMS.

Safety
If you are taking other medicines you should always get medical advice before taking St John’s Wort. This is especially important if you are taking warfarin (an anti-coagulant or blood-thinning medication), digoxin (for heart failure), oral contraceptives, protease inhibitors for HIV infection, chemotherapy or transplant drugs, or anti-schizophrenia drugs.

Cost
St John’s wort tablets can cost from £10-20 per month depending on the brand. As with other herbal products it is often unwise to find stockists with prices that look too low – assuring even basic quality costs money!

Further information
Check on the website of the British Herbal Medicine Association for St John’s wort products that are registered as medicines in the UK. These products, marked with a THR logo on the pack are independently assured for their quality.

Summary
Transcutaneous electrical nerve stimulation (TENS) is a way of delivering a small, pulsating current to your muscles and nerve endings. Small electrical currents are sent through pads on the skin near the site of pain.

Evidence
Some small studies of TENS have shown that it may help in painful periods. Some people did have mild side-effects.

Safety
See the information sheet on TENS machines from Arthritis Care for information on how to use TENS machines safely.

Cost
TENS machines are available from many pharmacies and some Internet retailers. They usually cost between £20 and £40 but this is a one-off cost.

Summary
Vitamin B1 is used by some women to help relieve painful periods.

Evidence
In one large research study, vitamin B1 supplements were found to help with painful periods.

Safety
Vitamin B1 was effective when taken at 100 mg daily. There should not be any safety issues with this dose.

Cost
These supplements are generally inexpensive and can be bought from most high street pharmacies.

Summary
Vitamin B6 is used by some women to help relieve symptoms of PMS.

Evidence
Vitamin B6 seems to help with PMS symptoms, according to the available research.

Safety
The safe maximum dose of vitamin B6 is 100 mg a day. So start off with 50mg a day and take no more than 100. Larger doses may cause pain and numbness.

Cost
These supplements are generally inexpensive and can be bought from most high street pharmacies.

Summary
Throughout history and around the world women have been their own physicians, looking after their own fertility, menstrual problems, managing their own pregnancies, sharing midwife/doula duties, baby nursing and child minding. As often also the experts in gathering and other plant foraging skills they were well placed to find medicines around them. They were often under huge pressure to find remedies that worked , especially for infertility, and so women’s favourite medicines in any culture are worth looking at.

For example it is interesting that many women’s medicines are now found to contain the plant equivalents of steroids (saponins and triglycerides) and others we now learn can affect other hormonal activity or womb functions. As well as chaste berry and St Johns wort (in Europe often a favoured women’s medicine) covered separately here, the following are prominent in various cultures and may be worth exploring.

Black cohosh (Actaea racemosa) – from North America though widely available as traditional herbal medicines or as supplements in UK and Europe. It is most important here to get assured quality products, such those with the  THR logo, to avoid the widespread adulteration of this herb in commerce.

Dong quai (Angelica sinensis) – from China available through suppliers of Chinese medicines.

Red clover (Trifoilium pratense) – widespread in Europe.

Sage (Salvia officialis) – across the northern hemisphere and readily available as a culinary spice as well as medicines and supplements.

Shatavari (Asparagus racemosus) – a very widely used women’s medicine from India.

Wild yam (Dioscorea spp) – from North America. Not because of supposed hormone content (it does not contain any – it was only the precursor for industrial manufacture of the contraceptive pill) but for its traditional North American repuation in relieving cramping of bowel and womb.

Safety
There are few known risks in taking the herbs above. However self-medicating around pregnancy requires particular caution. In general stop taking any herbs or other non-essential remedies as soon as pregnancy is confirmed. It is prudent unless needed to stay off anything unknown for the first three months of pregnancy while the baby’s organ development is underway.

It is also advisable not to buy herbs online or from unregulated premises unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products.

Perhaps the best approach in choosing traditional herbal approaches to women’s health is to see a qualified herbal practitioner. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will of course entail extra costs but will allow you to have herbs you might not find elsewhere and tailored to your needs.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. Seeing a practitioner may cost around £50 for a first visit.