Nutritional Management of Primary Dysmenorrhea

Essential Fatty Acids
Essential fatty acids (EFAs), such as linoleic acid (LA) and gamma-linolenic acid (GLA), are vital precursors of prostaglandins. The anti-inflammatory series 1 PGs are derived from LA, which is converted to GLA by the enzyme delta-6-desaturase (D6D), and then to dihomo-gamma-linolenic acid (DGLA). Nutrients known to increase the conversion of EFAs to the anti-inflammatory series 1 PGs include magnesium, vitamin B6, zinc, niacin, and vitamin C. Factors that interfere with the production of anti-inflammatory PGs include diets rich in saturated fats, alcohol consumption, and catecholamines released from the adrenal medulla during stress.
Arachidonic acid (AA), found in animal fats, is the precursor of the pro-inflammatory series 2 PGs. Much of the AA used for 2 series PG formation comes from dietary sources, notably meat and dairy products.7 A deficiency of EFAs, either due to inadequate intake or failure of normal conversion of linoleic acid to GLA, and a high consumption of saturated animal fats can result in overproduction of AA to the pro-inflammatory PGs.
Because there is little GLA or DGLA in the usual human diet, supplementation with GLA-rich evening primrose oil or borage seed oil may effectively reduce the production of pro-inflammatory PGs in favor of anti-inflammatory PGs.
Magnesium
Magnesium’s role in dysmenorrhea may be due to several factors:
1) magnesium has a direct effect on vascular tone and can act physiologically to control and regulate the entry of calcium into smooth muscle cells, acting as a naturally occurring calcium channel blocker. Through controlling calcium, magnesium influences the contractility, tone, and relaxation of the uterine smooth muscle;
2) magnesium is required for the synthesis of second messenger cAMP (cyclic AMP) from adenosine triphosphate (ATP).cAMP, a ubiquitous nucleotide derived from ATP through the action of the enzyme adenylate cyclase, plays a crucial role in the communication process between the gonadotropins (LH, FSH) and the ovaries
3) magnesium plays an important role in the conversion of LA to GLA, a rate limiting step in anti-inflammatory series 1 PG synthesis, and may inhibit the synthesis of PGF2α;
4) magnesium is involved in estrogen conjugation and the activation of the B vitamins, especially vitamin B6.
Large numbers of women may be at risk for magnesium deficiency. Dietary intake studies consistently show intakes of magnesium to be below the RDA in many age groups, with teenage girls and adult women among those most at risk of low intakes. Magnesium depletion can be compounded by the use of diuretics, increased alcohol and dietary fat intakes, a high intake of dairy products, stress, and malabsorption syndromes.
Vitamin B6
Vitamin B6 (pyridoxine hydrochloride) is an important cofactor for the conversion of LA to DGLA in the production of antiinflammatory PGs; for enzymes involved in estrogen conjugation in the liver; and for the synthesis of several eurotransmitters. With decreased levels of B6 in the body, the liver cannot conjugate estrogens, thus causing an increased blood level of estrogens. Vitamin B6 also stimulates cell membrane transfer of magnesium and increases intracellular magnesium, which plays a role in muscle relaxation.