Q. Is there anything I can do for painful menstruation?
This is a quite common condition with no easy solution. Up to 15 percent of women have severe cramps. Sometimes nothing short of a hysterectomy will help. The things you have tried in terms of the natural remedies usually give some relief if there is no underlying conditions. You need to have a thorough examination by a very competent gynecologist, to make sure you do not have cysts, cancer, endometriosis, pelvic inflammatory disease or other contributing abnormal factors. If you have already had children, and this condition persists, you may very well have one of these conditions to the degree of creating a significant problem.
Sometimes understanding the physiology of menstruation helps:
When the old uterine lining begins to break down, molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina. Other substances known as leukotrienes, which are chemicals that play a role in the inflammatory response, are also elevated at this time and may be related to the development of menstrual cramps. Natural remedies that help alter the prostaglandin levels do exist: You have mentioned several in your question: black cohosh, flax meal, turmeric, and you might add primrose oil to this.
Probably the two most helpful natural remedies is to get plenty of exercise, and use a heating pad. There is actually a heating pad that can be worn during the day. Talk to your pharmacist about these and other means to relieve the pain, which either eases the muscle contractions or prevents the inflammatory prostaglandin release. To alter prostaglandin release, try doubling the amount of ground flax seed you are using, even up to a quarter a cup per day would be OK. The flax seed helps divert the prostaglandin release away from the pro-inflammatory cascade to the anti-inflammatory cascade of chemicals. Non steroidal anti-inflammatory drugs such as Motrin or Midol are now the most widely prescribed medications for this condition. These block the inflammatory prostaglandin release. You may have to resort to this if nothing else helps.