PMS Resource
Center
Taming
Menstrual Cramps
by Ellen Hale
For many women "that time of the month" is
one they'd rather forgo. More than half routinely experience
some form of pain associated with menstruation, say
doctors at the Mayo Clinic in Minnesota, and 1 in 10
suffers such severe dysmenorrhea--menstrual pain--she
cannot function normally without taking medication.
Throughout history, women have tried to alleviate these
menstrual discomforts themselves. But home remedies--teas,
hot baths, heating pads, and such--offered only limited
help. As recently as a decade ago, when there were
far fewer products readily available for menstrual
cramps than now, some doctors prescribed powerful prescription
painkillers. Others, many women recall, told patients
their problems would disappear as they grew older or
after they had children.
But today, the pain associated
with menstruation is taken more seriously, and there
are new, highly effective treatments for it.
"Nearly
all women--I would say 99.9 percent--should be able
to function quite well during their periods with the
menstrual treatments available
now," says Charles H. Debrovner, M.D., a gynecologist in private practice
and on the faculty of the New York University School of Medicine in New York
City.
What's Causing the Pain?
There are two kinds of painful menses--primary
and secondary dysmenorrhea--and it is very important to distinguish between them
so both are treated properly, Debrovner stresses.
Primary dysmenorrhea usually
starts within three years of the onset of menstruation and lasts one or two days
each month. While this type of menstrual pain may lessen for some women as they
grow older or after the birth of children, it also can continue until menopause.
Secondary dysmenorrhea is menstrual pain caused by disease such as pelvic
inflammatory disease, endometriosis (abnormalities in the lining of the uterus),
or uterine
fibroids (nonmalignant growths). Endometriosis is a major cause of secondary
dysmenorrhea. Pain from it usually starts later in life and worsens with time,
according to Debrovner. Another hint that disease might be the cause of menstrual
pain is if pain also occurs during intercourse or during other parts of the cycle.
Primary dysmenorrhea is a result of the normal production of prostaglandins--chemical
substances that are made by cells in the lining of the uterus. (Prostaglandins
are also produced elsewhere throughout the body.) The lining of the uterus--which
has built up and thickened during the early stages of the menstrual cycle--breaks
up and is sloughed off at the end of the cycle and releases prostaglandins, explains
Lisa Rarick, M.D., medical officer in FDA's division of metabolism and endocrine
drug products.
The prostaglandins, in turn, make the uterus contract more strongly
than at any other time of the cycle. They can even cause it to contract so much
that the blood supply is cut off temporarily, depriving the uterine muscle of
oxygen and thus causing pain. Women who suffer painful contractions may be producing
excessive amounts of prostaglandins. Or, it may be that some women are just more
sensitive to them, says Rarick.
The cramps themselves help push out the menstrual
discharge. Because the cervical opening is often widened after childbirth or
years of menstruation, cramps may lessen in severity later in life.
Most women
describe their menstrual cramps as a dull aching or a pressure low in the abdomen.
The pains may wax and wane, remain constant, or be so severe that they cause
nausea, vomiting, diarrhea, backache, sweating, and an achiness that spreads
to the hips, lower back, and thighs.
Inhibiting Prostaglandins
For many years,
women had little help for these symptoms. Doctors recommended aspirin, heating
pads, and hot baths. When those failed, they often prescribed painkillers such
as Demerol or Tylenol with Codeine. These treatments were all aimed at the perception
of pain rather than the cause of it. Even tranquilizers were sometimes used,
according to Debrovner.
But the advent of pain relievers that impede the production
of prostaglandins has made it possible to directly treat the cause of the cramps.
Called NSAIDs, for nonsteroidal anti-inflammatory drugs, these medications have
proven remarkably effective for many women.
Because NSAIDS inhibit synthesis
of prostaglandins, and thereby the contractions of the uterus, they may actually
reduce menstrual flow. Many of Debrovner's patients report shorter periods when
they take the drugs at the first sign of pain. He recommends taking them as early
as possible after the menstrual flow starts. Waiting too long may mean they won't
be as effective.
The prostaglandin inhibitors can cause gastrointestinal distress,
so most doctors also recommend they be taken with milk and food. Labeling on
the OTC products contains this information.
While there are about a dozen prescription
NSAIDs, three--ibuprofen (Motrin, Rufen, etc.), naproxen (Naprosyn), and mefenamic
acid (Ponstel)--are now approved to treat menstrual cramps.
OTC Products
FDA
approved ibuprofen for over-the-counter use in 1984. It now can be found as the
active ingredient in several OTC medications, such as Advil, Nuprin, and Motrin
IB. The OTC dose per pill is 200 milligrams. The recommended dose is one tablet
every four to six hours (or two, if one does not work), not to exceed six in
a 24-hour period. Prescription formulations come in dosages of 400 to 800 milligrams.
Aspirin--long a standard over-the-counter treatment for cramps--works as a prostaglandin
inhibitor, although probably not so powerfully as the specific inhibitors such
as ibuprofen. While aspirin is known to thin the blood and increase bleeding,
it does not appear to have this effect on menstrual flow, according to Rarick.
Researchers are not sure if acetaminophen, an analgesic found in drugs such as
Tylenol and Datril, works to prevent prostaglandin production. If it does, its
effect appears to be milder than that of aspirin or other NSAIDs. Doctors say,
however, that it can successfully treat the headache and backache that often
accompany menstrual cramps.
Some over-the-counter menstrual pain medications,
such as Midol and Pamprin, contain a mix of ingredients that include an analgesic
such as acetaminophen, a diuretic such as pamabrom, and an antihistamine such
as pyrilamine maleate. Some newer formulations now use ibuprofen in place of
more classic analgesics such as aspirin or acetaminophen. Midol 200 Advanced
Cramp Formula, for example, contains ibuprofen as its active ingredient. Maximum
Strength Midol Multi-Symptom Formula, however, contains acetaminophen as an analgesic.
With the variety of ingredients now available, it's wise to read the label to
make sure the product is the best one to treat your symptoms. If in doubt, consult
your doctor.
Other Treatments
Women who use oral contraceptives rarely suffer
menstrual cramps, so some doctors prescribe them for women whose cramps are unrelieved
by other treatments. Contraceptive pills disrupt the normal hormonal changes
of the menstrual cycle, resulting in a thinner uterine lining and a decrease
in prostaglandins production. However, menstrual cramp relief is not considered
by FDA to be a primary reason to use oral contraceptives; rather, it is included
in the labeling as a secondary benefit.
Exercise, too, may be of some benefit,
possibly because it raises levels of beta endorphins, chemicals in the brain
associated with pain relief. With new knowledge, such as the possible roles of
exercise and of prostaglandins in preventing cramps, most women can avoid suffering
the monthly anguish of severe menstrual pain.
Ellen Hale is a freelance writer
in Washington, D.C.
article
syndicated from U.S.
Food and Drug Administration:
http://www.fda.gov/bbs/topics/CONSUMER/CON00004.html
FDA Consumer Magazine Article
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