Natural Support for Menstrual Discomfort

By Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

October 26, 2020

Natural Support for Menstrual Discomfort
Painful menstruation affects as many as 95 percent of adolescent girls and women. The dreaded monthly battle of menstrual cramps and discomfort affects quality of life and even the ability to work or attend school. Heating pads and over-the-counter pain medications, etc. are used to help with this monthly battle. Several nutrients are needed to help your body manage the stress of the menstrual cycle and can make a substantial impact on this monthly hormone challenge.

Menstrual pain occurs because of uterine muscle cramping. Increased tension or tone of the uterus and higher levels of certain inflammatory compounds (prostaglandins) result in uterine cramping in the few hours before or the first day of the menses. A more comfortable menses results when prostaglandins are in balance.

Prostaglandins 101

The three most common prostaglandins in your body are PGE1, PGE2, and PGE3. The compounds PGE1 and PGE3 are anti-inflammatory, whereas PGE2 mediates inflammation. PGE2 is problematic in excess, but it can be helpful when shunted down an appropriate pathway. Balance and action of these prostaglandins directly depend on diet and nutrient status.

High amounts of PGE2 relative to lower amounts of PGE1 and PGE3 affects inflammatory signals throughout the body. Pain and inflammation mechanisms are impacted by the loss of balance in these compounds. In the hours before and first day or so of the menstrual cycle, PGE2 increases uterine tone, which leads to cramps and pain with your period.

The balance of prostaglandins is directly related to your dietary intake of omega-6 and omega-3 oils. The optimal ratio of omega 6 to omega-3 is 4:1 or even 1:1. Today’s Western dietary intake consists of ratios of 20:1 up to 60:1 – which means tissue stress and inflammation.

PGE2, Dietary Omega-6 Oils, and AA

PGE2 levels are directly influenced by dietary omega-6 oils (linoleic acid/ LA). Vegetable oils such as corn oil, soybean, safflower, sunflower, canola, and walnut oil, etc. contain high amounts of omega-6 linoleic acid. The oils may naturally contain small amounts omega-3, but they are predominantly omega-6 linoleic acid.

The omega-6 oils (LA) are largely converted into arachidonic acid (AA). In addition to the vegetable oils, dietary sources of AA may be found in meats, poultry, and eggs. Trans-fats, margarine, synthetic fats, refined and heated oils, aspirin and drugs, alcohol, and tobacco use also contribute to arachidonic acid levels.

Some arachidonic acid is need by your body for cell membranes and nervous system function. Excess AA and omega-6 promotes PGE2 and inflammation, menstrual pain and discomfort. Too much AA and PGE2 affect the whole body in both sexes and contributes to stiffness, joint pain, and muscle aches, and general discomfort.

Can Omega-6 Oils Be Helpful?

Omega-6 oils can be converted into the helpful PGE1 by a pathway of enzymes. Black currant seed oil, borage oil, or evening primrose oil contain natural GLA or gamma-linolenic acid that supports this mechanism.

The enzyme pathway requires vitamins B3 and B6, vitamin C, zinc and magnesium to work. When these nutrients are present, then your body naturally makes the beneficial anti-inflammatory PGE1 from omega-6. If you lack one or more of these nutrients, then the omega-6 oils get converted into pro-inflammatory compounds, i.e. arachidonic acid (AA) and PGE2.

PGE3 and Omega 3 Oils

PGE3 works to reduce and eliminate inflammatory compounds. PGE3 is made by omega-3 fatty acids which consist of ALA (alpha-linolenic acid), EPA (eicosapentaenoic acid) and DHA (docosahexanoenoic acid). ALA, EPA and DHA are considered essential fatty acids. They must be consumed daily.

Omega-3 ALA fatty acids are found in plant sources such as flax, hemp, and chia seeds, walnuts, canola, with small amounts in green leafy vegetables and other plant-based foods. Omega-3 EPA and DHA are found in fatty fish like salmon, tuna, herring, cod, or mackerel or blue-green algae. Grass-fed meats and eggs also contain higher omega-3 and less AA than conventional grain-fed animals.

The plant source ALA can be converted into EPA and DHA, but the process is inefficient and often ineffective. If you choose to get your omega-3 essential fatty acids from plant sources only, you need 2.2 – 4.4 grams daily to override the poor conversion rate. When you eat fatty fish or take omega-3 EPA and DHA supplements, the active compounds are already present and can be readily made into beneficial PGE3.

The conversion of plant-based omega-3 (ALA) into EPA/DHA to make (PGE3) follows the same enzyme pathway and requires the same nutrients as the omega-6 pathway. Nutrients required include vitamin C, vitamin B3 and B6, iron, magnesium, and zinc. If you lack one or more of these nutrients, anti-inflammatory PGE3 production is diminished.

Uterus and Endometrial Lining

The uterus and endometrial lining are affected by the balance of PGE1, PGE2, and PGE3. High amounts of PGE2 within the uterine tissue leads to increased pain, cramps, and discomfort with your menses.

A healthier balance with omega-6 to omega-3, i.e. more PGE1 and PGE3 than PGE2 helps your uterine muscle action during your period making things less painful. Omega-3 fish oils EPA and DHA directly support the uterus and aid in menstrual comfort.

A tell-tale sign that compounds are out of balance is that you feel better with ibuprofen or NSAIDs. Ibuprofen and other NSAIDs block PGE2, but do not help the production or management of anti-inflammatory PGE1 and PGE3.


It’s easy to get lost with PGE1, PGE2, PGE3, LA, ALA, AA, EPA, and DHA alphabet soup. Think of these things in terms of dietary consumption and nutrient activation. Today’s western diets contain high amounts of vegetable oils found in packaged, processed, and restaurant foods, and even with home cooking. In addition, saturated fats, margarine, and conventional meat, dairy, and eggs promote PGE2 and AA that produce inflammation. Those who consume plant-based diets need to be very mindful about this balance.

Compare it to your consumption of the omega-3 foods from cold water fatty fish, flax, chia, or hemp seeds, walnuts, etc. or grass-fed organic meats, eggs, and poultry. If your diet is all about the first group of foods and almost none of the omega-3 rich foods, this overloads your body.

Then take stock of your nutrients vitamins B3, B6, and C, magnesium, iron, and zinc. These nutrients are commonly inadequate or depleted by birth control pills, other medications, stress, high sugar, and processed foods. They are needed to make the final anti-inflammatory PGE1 and PGE3 compounds. If you have an over-abundance of omega-6 and not enough nutrients, you will have more pro-inflammatory compounds in your body.

Other Helpful Nutrients

The balance of omega-6 and omega-3 is at the forefront of needs for menstrual comfort. There are other nutrients that support comfort levels with your period. Studies show positive results with vitamin B1 (thiamin), vitamin D, vitamin E, vitamin K, magnesium, and lipoic acid.

This article focuses on menstrual discomfort, pain, and cramping. Women of child-bearing age often experience other symptoms related with premenstrual syndrome (PMS), but it is essential to optimize the omega-6 and omega-3 balance to pre-empt pain and inflammation discord. Having a diet with an omega-6 to omega-3 ratio greater than 4:1 is like making a recipe with tablespoons of black pepper. It doesn’t taste good, it’s overwhelming, and may hurt. How is your dietary intake affecting your monthly hormone test?

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