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A Young Woman's Guide to Painful Menstrual Cramps (AKA: Dysmenorrhea)by Pat Sonnenstuhl BSN,
CNM, ARNP,
RH |
 |
Painful menstrual cramps are still with us, despite modern understanding of causation.
I remember when I was in high school, some of my friends would be 'blessed' with painful menstrual cramps and need
to miss days of school because of them. I think this is one of the things that has given menstruation such a bad
reputation.
Because I didn't have menstrual cramps, I considered myself one of the lucky ones, and it always bothered me when
someone would say, 'Oh, it's in your head' to my friends who had severe menstrual cramps. After I had my children,
I began noticing menstrual cramps for the first few days of my periods. By then I knew the cause and immediately
reached for my old favorite Motrin to get me through those difficult days. Through the years I have found things
that have improved my experience with menstrual cramps. This article will discuss pharmacological and non-pharmacological
measures that seem to help menstrual cramps. Please let me know if you've found something that works for you.
What causes painful menstrual cramps?
dys.men.or.rhea: means: painful menstruation.
Christine Northrup, in her book Women's Bodies, Women's Wisdom, presents an overview of the history of menstrual cramps. She states that as many as 60%
of all women have menstrual cramps at some time in their life, and a small percentage of that group are unable
to function one or more days each month because of the severity of their pain. In the 1950s psychological and gynecological
literature was filled with studies suggesting menstrual cramps were mainly psychological, related to a woman being
unhappy being a woman. Some felt it was related to a conflict the women had with her role.
In the late 1970's studies showed that women with menstrual cramps had higher levels of a certain hormone prostaglandin
(F2 alpha), and as the hormone was released into the bloodstream, and into the endometrial lining, the uterus went
into spasm, resulting in cramping pain. So a good approach to lessening or eliminating menstrual cramps is to attack
this aspect of it: the prostiglandins.
There are two types of dysmenorrhea: primary, when the cramps are not related to another organic cause such as
endometriosis or other pelvic disease. Secondary dysmenorrhea is when the cramps are caused by another condition.
Treatments for primary dysmenorrhea might also help secondary dysmenorrhea, although the cause of secondary dysmenorrhea
needs to be evaluated and sometimes the treatment is very different.
When I evaluate an adolescent for the first time, dysmenorrhea is a concern that frequently emerges. In fact, sometimes
this is the only reason an adolescent might come for a pelvic exam: severe menstrual cramps, and the feeling that
something is wrong. Sometimes her mother will bring her in, stating, 'this was a problem for me, when I was in
high school.' I think learning this is a normal physical finding is very reassuring to the adolescent, especially
who is missing school because of cramps. With so many teens starting the birth control pill at an early age, sometimes
dysmenorrhea isn't seen. It is felt that for the first year of menses, many girls do not ovulate, and also don't
have cramps. Then suddenly, the cramps start, and we know from research that this means a teen is ovulating. If
teens start the birth control pill early into their menstrual histories, they might not experience cramps of any
significance. If they go off of the birth control pill, the cramps might start, and again, think something is wrong.
Every month your body alternates ovulation, so one month the cramps might be worse than another month. That is
a good reason why you should give anything you try a few months to see what effect it has. Also, some changes to
take a few months.
Pharmacological measures for dysmenorrhea:
There are three pharmacological approaches to dysmenorrhea.
1. Over the counter medications:
Midol and Pamprin are two over-the-counter medication many girls try first. Motrin lists Acetaminopen, caffeine
and pyrilamine maleate as it's main ingredients. Pamprin lists Acetaminophen, Magnesium Salicylate, and Pamabrom
25mg as its basic ingredients. Some girls find Advil 200mg works just fine for their cramps, taken on a regular
basis on the days the cramps are the worst. The important thing to realize is: everyone is different. What works
for one adolescent, might not be effective for someone else. Each adolescent is an individual. It is also important
to look at the ingredients and be sure it isn't something you are trying to avoid.
2. Prescription Non-steroidal
Anti-Inflammatory medications. These are in some cases stronger medications than what can be obtained over-the-counter,
or sometimes can only be obtained by a prescription. In many cases drugs are prescription, as there is concern
for overuse or misuse. Once a medication has been released to be sold over-the-counter, this does not mean it is
totally safe, but that the dosage available is generally safe. For example, Advil can be purchased in 200mg and
400 mg dosage over the counter. Some adolescents will find taking this adequate. Others might need a stronger dosage,
and can get a prescription for 800 mg, which is now called Motrin. Several other medications are over-the-counter
in smaller doses, and prescription for the larger doses. Examples are: Aleve, Actron, Bufferin, Motrin IB, and
Nuprin. Prescription anti-inflammatories that are most helpful for severe dysmenorrhea are: Anaprox, Cataflam.
Motrin, Naprelan, Naprosyn, and Orudis. We are lucky to have these prescription medications available for individuals
with severe menstrual cramps. NSAIDs , as they are commonly called, appear to relieve primary dysmenorrhea by suppressing
menstrual fluid prostiglandins, and also have a direct analgesic property. The recommendation is to take NSAIDs
only during the first 2-3 days of the menstrual flow, every six hours beginning just before or just after the menstrual
flow begins.
3. Birth Control Pills : one of
the benefits of the birth control pill is the ability to improve severe menstrual cramps. The birth control pill
inhibits ovulation which reduces the menstrual fluid prostaglandin levels by suppressing endometrial (the uterine
lining) tissue growth and therefore menstrual fluid volume. More than 90% of women with primary dysmenorrhea experience
complete relief in response to oral contraceptives. The birth control pill must be taken every day, and has the
added benefit of preventing pregnancy ! If a young adolescent needs birth control and something for menstrual cramps
than the birth control pill might be the best choice. If an adolescent isn't sexually active, the choice of the
NSAI might be more appropriate. This is something you would need to discuss with your personal health care provider.
It is very important to know what the ingredients are in any medication you take, and be aware of possible side
effects or complications. Even over-the-counter medications might have properties you might avoid. An Interesting
place to visit, and where you can look up ingredients (in addition to the label, or course is : Planet RX. Ask
your health care provider about the possible side effects to watch for should you receive a prescription medication.
If the medication causes problems for you, or doesn't work, be sure to discuss this further with your health care
provider.
If the above measures still are not working for you, it is essential you discuss this further with your health
care provider, as there might be something more serious that needs to be evaluated. There are a few other measures
your provider might discuss with you, which are beyond the scope of this article. Occasionally women who have been
sexually abused will experience severe menstrual cramps or pelvic pain, and would needs an extensive evaluation
and appropriate counseling.
Other things that might help:
Non-pharmacological measures for dysmenorrhea
Why would someone choose non-pharmacological measures for dysmenorrhea when there are good pharmacological medications
that provide relief ? One reason would be: an individual might not like the side effects or long term effects of
a particular medication. Another reason would be she would rather feel in control of the medications she puts into
her body. By trying some of these measures, she might find she needs less of the other medications. Some individuals
might use pharmaceuticals sometimes while changing her eating habits or trying specific nutritional supplements.
Tori Hudson in her wonderful book Women's Encyclopedia of Natural Medicine:
alternative therapies and Integrative Medicine has an entire chapter on
Dysmenorrhea. I will be using this information for this section. Tori (1999, p 183) starts by listing things that
might decrease or prevent Dysmenorrhea:
- Stress reduction: relaxation might help relax the pelvis and low back muscles
- Increase Exercise: may improve blood flow to the uterus and create optimal pelvic musculature.
- Try to maintain a healthy weight
- Try to avoid smoking
- Try to maintain optimal digestive functioning: irregular bowel habits may be correlated with primary dysmenorrhea
- Try to avoid foods that might aggravate an excess of prostiglandins
- Good posture and spinal alignment may decrease the tendency toward menstrual cramps
- Avoid tampons, they might make menstrual cramps worse
- Pay attention to food allergies that might contribute to increased water retention, gas and bloating which might increase pelvic congestion
- Avoid an IUD which might make menstrual cramps worse
Dietary Changes: switching
to good nutritional habits might bring relief of menstrual cramps. One recommendation is to decrease the intake
of foods that might be contributing to the condition, and the other is to intake foods that provide the wide range
of nutrients that improve the functioning of the pelvic area.
Foods to avoid would include foods high in arachidonic acid. This is the fat the body uses to produce the series-2
prostiglandins which are the ones that cause muscle and uterine contractions. These foods include: dairy products,
saturated fats and animal foods. Some women find they lack the enzyme to digest dairy products, which contribute
to the menstrual cramps. Chicken and turkey are lower in saturated fat but higher in arachidonic acid than red
meats.
Salt can aggravate menstrual cramps as this will increase fluid retention and worsen bloating. Sugar might interfere
with the absorption and metabolism of some of the B vitamins and minerals. Nutritional imbalances can lead to difficulty
in muscle functioning and lead to muscle spasms.
Foods that seem to improve menstrual cramps are foods that increase the antispasmodic prostiglandins. Certain fish,
including salmon, tuna, and halibut contain linolenic acid, a healthy fatty acid that helps to relax muscles with
the production of a different prostaglandin. Nuts and seeds, especially flax, pumpkin, sesame and sunflower seeds
can improve these prostiglandins.
Of course, whole grains, legumes, vegetables and fruits all can promote regularity and normal body functioning.
Nutritional Supplements:
Several nutritional supplements have been shown to have a positive effect on menstrual cramps (Hudson, 1999, pp185-186).
Vitamin B3 (Niacin) has been shown to be effective in approximately 88% of women with menstrual cramps. Women who
noticed a niacin flush seemed to have better relief than those who didn't. It is thought that the vasodilating
effect of niacin might lessen the spasm of the uterine arteries. Recommended dosages: Niacin: 100mg twice/day throughout
the month, 100mg every 2-3 hours during menstrual cramps.
Vitamin E was studied in the 1950'sd for the treatment of dysmenorrhea and approximately 70% of women tested found
they had relief of their menstrual cramps within two menstrual cycles. Recommended dosage: 150-800 IU/day.
Calcium supplementation seems to decrease menstrual cramps. Muscles need calcium to maintain their normal muscle
tone, and a deficiency might lead to increased cramps. Low calcium intake has been associated with menstrual water
retention and greater pain during menses. Recommended dosages: 800-1000 mg/day.
Essential fatty acids are the source of beneficial prostiglandins: linoleic acid (omega-6)and linolenic acid (omega-3).
These are essential to our body's functioning, and needed every day. The typical American diet seems to be higher
in the omega-6 oils than the omega-3 oils, and the excessive omega-6 fatty acids might contribute to menstrual
cramps. Sources of omega-3 essential fatty acids are: flax oil, borage oil current oil or evening primrose oil.
Increasing these in your diet can improve the balance between these two types of oils. Fish oils can provide this
supplementation, and Evening Primrose Oil 500-1000 mg up to 3 times/day can improve the balance of Omega-3 oils.
Natural Progesterone:
research is supporting the use of Natural Progesterone Creams and menstrual cramps. These over the counter creams
should provide > 400 mg/1 oz of progesterone. Women apply 1/4 tsp 2x/day for the 3-12 days before the expected
onset of menses.
Hudson (1999)continues with several other recommendations that have shown to improve menstrual cramps. Please refer
to her book or other botanical references for more detailed suggestions and recommendations. More research is still
needed to determine effectiveness and risks of various herbs and botanicals.
Hopefully you've learned some things about Dysmenorrhea. Ask questions and search out answers for yourself. You
need not associate pain with your menstrual periods !
Several good references are:
- Hoffmann, D. (1998). The Herbal Handbook. Vermont: Healing Arts Press.
- Hudson, T, (1999) Women's Encyclopedia of Natural Medicine: alternative therapies and Integrative Medicine. Keats Publishing: Los Angeles. ISBN: 0879837888.
- Northrup, C. (1998) Women's Bodies, Women's Wisdom, Bantam Doubleday. ISBN: 0553379534.
- PDR for Herbal Medicines (1st ed.), (1999). Mukesh Mehta .
- Peirce, Andrea (1999). Natural Medicines. New York: Stonesong Press Book.
- Publication of the American Pharmaceutical Association).
Helpful Web Sites:
- Health World On Line: Healthy.Net:
- Dysmenorrhea
- Menstrual Cramps
- Menstrual Cramps
- MotherNature.com
- Dysmenorrhea
- Planet RX
©Pat Sonnenstuhl, ARNP, CNM. May, 1999
Web Midwife: www.cnm.wa.org
http://members.home.net/cnmpat/welcome.htm
LowCarbWebLinks: http://www.members.home.net/cnmpat/favlowcarb.htm
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