What are menstrual disorders?

Menstrual disorders are problems that affect women’s menstrual cycles or periods. They include premenstrual disorders such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), and menstrual complaints such as painful periods (dysmenorrhoea), heavy periods (menorrhagia) and irregular periods (amenorrhoea and oligomenorrhoea).¹

Who is affected by premenstrual and menstrual disorders?

The vast majority of menstruating women experience menstrual-related disorders. Almost 85% of women surveyed report pain during menstruation, 54% report heavy menstrual bleeding, and 77% report premenstrual psychological symptoms. This has a significant impact on women’s quality of life, with almost 40% of women reporting that they were unable to carry out their normal activities during menstruation.²

What causes menstrual disorders and how are they treated?

The causes of menstrual disorders are not fully understood, but seem to involve hormonal imbalances, genetic factors, inflammation, and other pelvic disorders. Treatments mainly involve symptomatic relief with analgesics and non-steroidal anti-inflammatory drugs (NSAIDS), and hormonal contraception. More severe cases may be treated with hormone suppressor medications or surgical interventions.¹

Which herbs and nutrients are effective in managing premenstrual and menstrual symptoms?

Chaste Tree (Vitex agnus-castus) fruit is one of the most frequently prescribed herbs for menstrual-related symptoms.³ Chaste Tree berries have been used since ancient times for menstrual irregularities, mastalgia, and to promote lactation.⁴ A systematic review of eight randomised controlled trials found that Chaste Tree was significantly more effective than placebo in relieving PMS and PMDD in all eight trials.⁵

Chamomile (Matricaria chamomilla) flowers have been used for centuries to relieve menstrual complaints.⁶ A systematic review of eight randomised controlled trials found that Chamomile was effective for the treatment of PMS, demonstrating significant impacts on painful menstruation, anxiety and psychological symptoms.⁷ Additionally, a randomised controlled trial found Chamomile was equally as effective as the NSAID mefenamic acid in relieving physical premenstrual symptoms, and more effective than mefenamic acid in relieving psychological and emotional symptoms.⁸

Ginger (Zingiber officinale) rhizome is a warming circulatory stimulant, spasmolytic and anti-inflammatory. It is traditionally prescribed for menstrual cycle conditions such as amenorrhoea and dysmenorrhoea.⁹ A systematic review and meta-analysis involving 24 clinical trials found that Ginger is significantly more effective than placebo in reducing the intensity and duration of pain in dysmenorrhoea, with a similar efficacy to NSAID medication.¹⁰

Vitamin B6 is a water-soluble vitamin with important roles in neurotransmitter synthesis, hormonal regulation, and stress and mood support.⁴ A meta-analysis of 12 clinical trials found that vitamin B6 significantly reduced physical (p=0.006) and psychological (p<0.001) symptoms of PMS compared to controls.¹¹

Zinc is an essential micronutrient for female healthy hormonal balance during the reproductive cycle. Zinc is an antioxidant and regulates cell growth, hormone release, immunological response, and reproduction.¹² A meta-analysis of six randomised controlled trials found that zinc supplementation significantly reduced pain severity compared to placebo (p<0.001), representing a clinically meaningful reduction in pain.¹³ Additionally, a meta-analysis of four clinical trials found zinc was superior to placebo in improving physical and psychological symptoms of PMS.¹⁴

Iodine’s primary role is the synthesis of the thyroid hormones, levothyroxine (T4) and triiodothyronine (T3), required for normal growth and metabolism.¹⁵ A small trial found that young women menstrual disorders had lower than normal levels of iodine, as measured by urinary iodine excretion, versus young women with normal menstruation. Following six months of iodine supplementation, over 70% of previously deficient women were now iodine replete. Furthermore, those with menstrual disorders noted significant improvements in their symptoms following iodine supplementation.¹⁶

Chromium is instrumental for maintaining glycaemic control.⁴ PMS is associated with changes in insulin regulation due to fluctuating progesterone levels, resulting in dysglycaemia and subsequent sugar and carbohydrate cravings in the luteal phase. Increased sugar intake is associated with worsening PMS. Thanks to its blood glucose regulating effects, chromium may therefore be useful to reduce cravings and ease PMS symptoms.¹⁷ In a small trial in women with menstrual-related mood disorders, chromium treatment was associated with reduced mood symptoms and improved overall health satisfaction in most participants.¹⁸

How should they be taken?

Some trials have found benefit when these herbs and/or nutrients were taken perimenstrually, from two days before menstruation until day three of menstruation. However, for best results these herbs and nutrients should be taken daily throughout the month.

Are they safe?

These herbs and nutrients are generally safe and well tolerated. They are not recommended in women who are pregnant or breast feeding without professional advice. For safety information for health professionals on prescribing these herbs and nutrients alongside medication, please contact Integria Healthcare Clinical Support at clinicalsupport@integria.com

References

1. Mount Sinai. Menstrual Disorders [Internet]. New York: Icahn School of Medicine, Mount Sinai. 2019 [cited 2025 Sept10]. Available from https://www.mountsinai.org/health-library/report/menstrual-disorders

2. Schoep ME, Nieboer TE, van der Zanden M, Braat DD, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American Journal of Obstetrics and Gynecology. 2019 Jun;220(6):569.e1-569.e7. DOI:10.1016/j.ajog.2019.02.048

3. Fisher C, Adams J, Frawley J, Hickman L, Sibbritt D. Western herbal medicine consultations for common menstrual problems; practitioner experiences and perceptions of treatment. Phytother Res. 2018 Mar;32(3):531-541. DOI: 10.1002/ptr.6001.

4. Braun L, Cohen M. Herbs & natural supplements – an evidenced-based guide. 4th ed. Volume 2. Sydney (AU): Elsevier/Churchill Livingstone; 2015.

5. Cerqueira RO, Frey BN, Leclerc E, Brietzke E. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017;20(6):713-719. DOI: 10.1007/s00737-017-0791-0.

6. Kabiri M, Kamalinejad M, Bioos S, Shariat M, Sohrabvand F. Comparative study of the effects of chamomile (Matricaria chamomilla L.) and cabergoline on idiopathic hyperprolactinemia: a pilot randomized controlled trial. Iran J Pharm Res. 2019;18(3):1612-1621. DOI: 10.22037/ijpr.2019.1100758.

7. Khalesi ZB, Beiranvand SP, Bokaie M. Efficacy of chamomile in the treatment of premenstrual syndrome: a systematic review. J Pharmacopuncture. 2019 Dec;22(4):204-209. DOI: 10.3831/kpi.2019.22.028.

8. Sharifi F, Simbar M, Mojab F, Majd HA. Comparison of the effects of Matricaria chamomila (Chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome. Complement Ther Clin Pract. 2014 Feb;20(1):81-8. DOI: 10.1016/j.ctcp.2013.09.002.

9. Bone K, Mills S. Principles and practice of phytotherapy. 2nd edition. Sydney: Churchill Livingstone; 2013. p. 578-9.

10. Moshfeghinia R, Salmanpour N, Ghoshouni H, Gharedaghi H, Zare R, Cramer H, et al. Ginger for pain management in primary dysmenorrhea: a systematic review and meta-analysis. J Altern Complement Med. 2024 Nov 1;30(11):1016-30. DOI:10.1089/jicm.2023.0799

11. Soheila S, Faezeh K, Kourosh S, Fatemeh, Nasrollah N, Mahin G, et al. Effects of vitamin B6 on premenstrual syndrome: a systematic review and meta-analysis. J Chem Pharm Sci. 2016;9(3):1346-1353.

12. Ahmadi M, Khansary S, Parsapour H, Alizamir A, Pirdehghan A. The effect of zinc supplementation on the improvement of premenstrual symptoms in female university students: a randomized clinical trial study. Biol Trace Elem Res. 2023 Feb;201(2):559-566. DOI: 10.1007/s12011-022-03175-w.

13. Hsu T, Hsieh R, Huang C, Chen C, Lin W, Huang Y, et al. Efficacy of zinc supplementation in the management of primary dysmenorrhea: a systematic review and meta-analysis. Nutrients. 2024 Nov 28;16(23):4116. DOI:10.3390/nu16234116

14. Haider S, Sajjad M, Zahid M. A systematic review and meta-analysis examining the role of zinc supplementation in ameliorating physical and psychological manifestations of premenstrual syndrome in young females. Eur J Obstet Gynecol Reprod Biol. 2025 May 22;312:114082. DOI: 10.1016/j.ejogrb.2025.114082.

15. Gropper SS & Smith JL. Advanced nutrition and human metabolism. 6th edition. Wadsworth Cengage Learning, Australia, 2013, pp.530-536.

16. Gerasimova L, Denisov M, Samoilova A, Gunin A, Denisova T. Role of iodine deficiency in the development of menstrual disorders in young females. Sovrem Tehnol Med. 2016 Dec;8(4):104-7. DOI:10.17691/stm2016.8.4.14

17. Hechtman L. Clinical naturopathic medicine. 2nd ed. Chatswood NSW: Elsevier Australia; 2019.

18. Brownley KA, Girdler SS, Stout AL, McLeod MN. Chromium supplementation for menstrual cycle-related mood symptoms. J Diet Suppl. 2013 Dec;10(4):345-56. DOI: 10.3109/19390211.2013.830678.