What is the recommended treatment for a female patient of reproductive age with dysmenorrhea using magnesium glycinate?

Magnesium Glycinate for Dysmenorrhea

Magnesium supplementation shows promise for treating dysmenorrhea, but the evidence is limited and of low quality, with no specific data on magnesium glycinate formulation—NSAIDs remain the first-line treatment with stronger evidence. 1

First-Line Treatment Approach

NSAIDs are the established first-line pharmacologic treatment for dysmenorrhea, with considerably higher quality evidence than any dietary supplement. 1 While NSAIDs have a failure rate of 20-25%, they remain the most evidence-based initial approach. 2

Hormonal contraceptives (combined oral contraceptives, patches, or vaginal rings) represent an equally valid first-line option, particularly when contraception is also desired. 1 These can be used independently or in combination with NSAIDs. 1

Magnesium Supplementation Evidence

Efficacy Data

The evidence for magnesium in dysmenorrhea comes from small, low-quality trials:

• Three small trials showed magnesium was more effective than placebo for pain relief, with reduced need for additional medication and no significant difference in adverse effects. 2

• One randomized double-blind study (n=21 analyzed) using magnesium 3 × 5 mmol orally (starting the day before menstruation through day 2-3 of cycle) showed only slight effect on day 1, but therapeutic benefit for back pain and lower abdominal pain on days 2-3, with marked reduction in work absences. 3

• A 2016 Cochrane review concluded there is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhea, though magnesium showed "promising" results warranting further research. 4

Critical Limitations

The existing evidence has major weaknesses: 4

• Very small sample sizes causing imprecision
• Poor reporting of study methods
• Inconsistent results across trials
• Unclear optimal dosing or treatment regimen
• Most studies conducted in middle-income countries among student populations
• No studies specifically evaluated magnesium glycinate—the form matters for bioavailability and tolerability

Clinical Recommendation Algorithm

For a reproductive-age woman with dysmenorrhea:

1. Initial treatment: Start with NSAIDs (taken during menses for 5-7 days) as first-line therapy 5, 1

2. If contraception desired: Consider combined hormonal contraceptives as first-line, either alone or with NSAIDs 1

3. If NSAIDs fail or are contraindicated: Trial hormonal contraceptives if not already using 1

4. If both fail or patient prefers non-pharmacologic options: Consider evidence-based alternatives including exercise, transcutaneous electrical nerve stimulation, heat therapy, or self-acupressure 1

5. Magnesium supplementation: May be considered as adjunctive therapy, but counsel patient that evidence is limited and quality is low 4

   • No established optimal dose or formulation
   • The studied regimen used 15 mmol daily for 3 days per cycle 3
   • Magnesium glycinate specifically has not been studied for this indication

Red Flags Requiring Further Evaluation

Refer for pelvic examination and ultrasonography if: 1

• Progressive worsening of pain (suggests secondary dysmenorrhea)
• Abnormal uterine bleeding
• Vaginal discharge
• Dyspareunia (painful intercourse)
• Failure to respond to first-line treatments

Secondary dysmenorrhea from endometriosis, pelvic anatomic abnormalities, or infection requires different management. 1

Common Pitfalls

• Assuming all magnesium formulations are equivalent—bioavailability and gastrointestinal tolerability vary significantly between magnesium oxide, citrate, glycinate, and other forms, yet no comparative data exists for dysmenorrhea
• Delaying effective treatment by trying unproven supplements first when NSAIDs or hormonal contraceptives have much stronger evidence 1, 4
• Missing secondary causes by not pursuing further evaluation when first-line treatments fail 1
• Not addressing contraceptive needs when hormonal options could serve dual purposes 1

Safety Considerations

Only 4 of 27 studies in the Cochrane review reported adverse effects in both treatment groups, with data too scanty to reach conclusions about supplement safety. 4 Magnesium supplementation generally has good tolerability, but gastrointestinal side effects (particularly diarrhea) can occur with certain formulations.