Q. I would like information on herbal remedies for PMS relief and menstrual pain. I am especially interested in dong quai, raspberry leaf and black cohosh.
A. Stansbury responds: Premenstrual symptoms may include physical complaints such as uterine cramps, digestive upset, backache, blood vessel congestion, irritability and weepiness. Therapies to best address any or all of these symptoms may differ. Furthermore, the pattern of the PMS symptoms, as well as any accompanying complaints (digestive problems, varicose veins, irregular blood sugar and breast pain or cysts, etc.) can hint at possible underlying imbalances or causes that would be best treated directly.
For example, PMS accompanied by constipation and acne might be best addressed with liver herbs that assist the body in metabolizing hormones—and not with “female” herbs at all. In such cases, dandelion (Taraxacum officinale) or burdock (Arctium lappa) may help.
Symptoms that are mainly mental and emotional would be best treated with nervine herbs and possible progesterone-enhancing botanicals. Black cohosh (Cimicifuga racemosa), ashwaganda (Withania somnifera) and St. John’s wort (Hypericum perforatum) would be good choices.
If menstrual cramps and backaches are the main complaint, herbs that relax spasms and move congested blood—such as dong quai (Angelica sinensis) and cramp bark (Viburnum opulus)—would be among the best herbal choices.
The herbs you asked about are all good choices for menstrual pain. Raspberry leaf (Rubus idaeus) acts as a uterine tonic and may improve uterine pain and heavy bleeding — it’s a folkloric standard for optimizing uterine tone during pregnancy.
Dong quai is a “blood-mover” herb, effective for promoting circulation in the pelvis. The herb may help alleviate menstrual pain, bloating, backache and other pelvic discomforts.
Black cohosh is a hormonally active, anti-inflammatory and anti-anxiety herb. This herb is popular in the current marketplace for managing menopausal symptoms, but black cohosh benefits also include being beneficial for treating menstrual pain, depression and anxiety disorders, muscle inflammation and headaches.
I would suggest raspberry leaf tea, 2 to 3 cups daily all month long, and combine the dong quai and black cohosh in a tincture. The tincture may also be taken all month—perhaps you could combine it with cramp bark and increase the frequency of the dose as needed for more acute menstrual cramps or discomfort. Often, the need for herbs decreases as the tone of the uterus and vasculature improves over time, allowing the dosage to be reduced or even discontinued altogether.
Willard responds: You have mentioned some of my favorite herbs for PMS and menstrual pain. I would suggest adding two more substances, vitamin B6 and the herb, cramp bark. The formula I recommend most for PMS is 3 parts dong quai root; 1 part black cohosh root; 1 part blue cohosh (Caulophyllum thalictroides) root; 1 part raspberry leaf; and 1 part cramp bark.
Dong quai, sometimes considered “female ginseng,” has many positive effects on the female system. In Asia, it’s commonly used for menstrual irregularities, menopause, recuperating after childbirth and is very helpful for women coming off hormone replacement therapy. Dong quai is more than its reputation as a “female herb,” though. It’s helpful for building up the system after being sick, fortifying the blood and enhancing metabolism and oxygen utilization in the liver.
Black cohosh and blue cohosh help support the nervous and glandular systems. Both of these herbs tone the uterus, reduce cramping and are used to regulate the female reproductive system. Raspberry leaf has been shown to have a definite effect upon the uterus — both stimulating the uterus and relaxing it, offering a regulating effect. Cramp bark is the best herb for cramping, especially in the uterus or intestinal tract.
You can mix this formula as a tincture; take 20 to 30 drops, two to three times a day. I find it’s best to take the formula all month long to deliver the herbal tonic action to the uterus. If this is not strong enough for the cramping, add another 10 drops of cramp bark and 10 drops of ginger to the herbal formula. This should be taken two to three times daily when you’re cramping, or simply drink ginger tea.
I usually suggest that a woman with PMS take 50 to 100 mg of B6 daily and increase the dose to 250 to 400 mg at the first sign of PMS.
There is a special acupressure point for menstrual cramps, commonly called “three yin point.” It’s four finger-widths up from the inside ankle on both legs. It’s quite easy to find, as it’s the most tender spot. Putting firm pressure on this point can greatly reduce menstrual cramps and many other menstrual problems.
Terry Willard is a clinical herbalist, president of the Canadian Association of Herbal Practitioners and founder of the Wild Rose College of Natural Healing in Calgary, Alberta, Canada. He is the author of eight books and a CD-ROM, Interactive Herbal.
Jill Stansbury has been a naturopathic physician for more than 10 years, with a private practice in Battleground, Washington. She is the chair of the Botanical Medicine Department at the National College of Naturopathic Medicine in Portland, Oregon, and the author of many books including Herbs for Health and Healing (Publication International, 1997).
The information offered in “Q & A” is not intended to be a substitute for advice from your health-care provider.