Menstrual cramps are a very common problem for adolescent girls and women. They may be mild, moderate, or very severe. In fact, they are the single most common cause of days missed from school and work. About 10 percent of girls are incapacitated for up to three days each month. About 80 percent of the time, cramps are part of the primary dysmenorrhea syndrome. Cramps are caused by hormones called prostaglandins, which cause painful cramping of the uterus during menstruation. The production of prostaglandins in the uterus is stimulated by the hormone progesterone, which is made by the ovary after ovulation has occurred. These prostaglandins can affect other organs as well. Frequently, back pain, headaches, nausea and vomiting, dizziness, and/or diarrhea accompany menstrual cramps. These symptoms may begin a day or so before the menstrual flow begins; they usually peak by the second day of flow. Medications are the single best treatment for cramps. Other remedies are helpful also. I'll discuss both in the following sections. Medications That Can Help Many teens and women do not realize that there are very effective medications that can relieve not only menstrual cramps, but also the other symptoms that may accompany them. Generally these medications fall in the category of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Some NSAIDs are available in both non-prescription strength (over-the-counter, or OTC) and in larger doses by prescription only. Other NSAIDs are only available by prescription. For some girls, cramps begin a day or so before their period starts; girls may also notice signs that their period is coming, such as abdominal bloating or constipation. In this case, it can be very helpful to begin taking the medication before the period actually begins. For mild cramps, the recommendation is to start with acetaminophen or ibuprofen at the lower dose, at the lower number of daily doses. Acetaminophen is not an NSAID but is a pain reliever. It works well for some women. Increase as needed to the maximum dosage and frequency indicated on the bottle; if relief is not achieved, switch to a different medication at the higher dosage and frequency. For moderate to severe cramps, the recommendation is to start with ibuprofen 200 milligrams four times daily or naproxen sodium 220 milligrams twice daily. Again, increase as needed to the maximum dosage and frequency. If cramps are moderate or severe, it is also important to continue taking the pain reliever regularly, even if there is no pain when the dosage is due. The regimen should be continued until the day when symptoms would subside, which is usually by the third day of the menstrual period. If ibuprofen or naproxen sodium at the maximum daily dose does not relieve symptoms adequately, it's time to contact your health care provider. Also, there are prescription-only medications that are especially effective against the other problems such as nausea, vomiting, and diarrhea. Don't give up hope. Under medical supervision, higher doses and other medications are safe and effective When Medication Doesn't Work: What To Do Before changing to other medications, schedule a pelvic examination to evaluate for other, far less common causes of menstrual cramps. If one of these causes exists, the dysmenorrhea is referred to as secondary dysmenorrhea. Causes of secondary dysmenorrhea include infection in the genital tract, a narrow passageway connecting the inside of the uterus to the vagina (the cervical canal), and endometriosis. Endometriosis is a condition in which nodules (bumps) of tissue just like the lining of the uterus are found on internal organs in the lower abdomen. It can cause very severe, debilitating pain that is not necessarily limited to the menstrual period. Hormonal Treatment for Period Cramps Assuming the pelvic examination is normal and endometriosis is ot suspected, hormonal treatment can helpl. The hormones prevent ovulation, and thus prevent the ovary from causing the production of the pain-causing prostaglandins. As you probably know, the oral contraceptive pill (OCP) prevents ovulation. And this is the easiest, least expensive way to use hormones to treat severe primary dysmenorrhea. Oral contraceptive pills are 80 percent to 90 percent effective when used for this purpose. Natural Remedies for Cramps Menstrual cramps have been around for thousands of years, and so have many non-medical treatments. I recommend that nonmedical remedies be used in addition to the pain medications described above.Rest and stress reduction. Like many other conditions, cramps may be made worse by fatigue from too many late nights and by anxiety. So, getting enough rest before a period is due can actually help prevent bad cramps. Anxiety and stress are occasionally part of everyone¹s lives, so learning how to manage these is important for every teenager. Meditation, yoga, tai chi, and exercise can all be helpful. Heat, in the form of a warm bath or a heating pad applied to the lower abdomen, can be very helpful (and comforting). Exercise -- A girl who exercises regularly, and who feels up to it despite having cramps, may find that continued participation in her usual activities helps relieve the cramps. FROM: Jennifer Johnson, MD |
Intimate Health Care For Women |
Say Good-bye To Menstrual Cramps! |
Menstrual cramps are a very common problem for adolescent girls and women. They may be mild, moderate, or very severe. In fact, they are the single most common cause of days missed from school and work. About 10 percent of girls are incapacitated for up to three days each month. About 80 percent of the time, cramps are part of the primary dysmenorrhea syndrome. Cramps are caused by hormones called prostaglandins, which cause painful cramping of the uterus during menstruation. The production of prostaglandins in the uterus is stimulated by the hormone progesterone, which is made by the ovary after ovulation has occurred. These prostaglandins can affect other organs as well. Frequently, back pain, headaches, nausea and vomiting, dizziness, and/or diarrhea accompany menstrual cramps. These symptoms may begin a day or so before the menstrual flow begins; they usually peak by the second day of flow. Medications are the single best treatment for cramps. Other remedies are helpful also. I'll discuss both in the following sections. Medications That Can Help Many teens and women do not realize that there are very effective medications that can relieve not only menstrual cramps, but also the other symptoms that may accompany them. Generally these medications fall in the category of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Some NSAIDs are available in both non-prescription strength (over-the-counter, or OTC) and in larger doses by prescription only. Other NSAIDs are only available by prescription. For some girls, cramps begin a day or so before their period starts; girls may also notice signs that their period is coming, such as abdominal bloating or constipation. In this case, it can be very helpful to begin taking the medication before the period actually begins. For mild cramps, the recommendation is to start with acetaminophen or ibuprofen at the lower dose, at the lower number of daily doses. Acetaminophen is not an NSAID but is a pain reliever. It works well for some women. Increase as needed to the maximum dosage and frequency indicated on the bottle; if relief is not achieved, switch to a different medication at the higher dosage and frequency. For moderate to severe cramps, the recommendation is to start with ibuprofen 200 milligrams four times daily or naproxen sodium 220 milligrams twice daily. Again, increase as needed to the maximum dosage and frequency. If cramps are moderate or severe, it is also important to continue taking the pain reliever regularly, even if there is no pain when the dosage is due. The regimen should be continued until the day when symptoms would subside, which is usually by the third day of the menstrual period. If ibuprofen or naproxen sodium at the maximum daily dose does not relieve symptoms adequately, it's time to contact your health care provider. Also, there are prescription-only medications that are especially effective against the other problems such as nausea, vomiting, and diarrhea. Don't give up hope. Under medical supervision, higher doses and other medications are safe and effective When Medication Doesn't Work: What To Do Before changing to other medications, schedule a pelvic examination to evaluate for other, far less common causes of menstrual cramps. If one of these causes exists, the dysmenorrhea is referred to as secondary dysmenorrhea. Causes of secondary dysmenorrhea include infection in the genital tract, a narrow passageway connecting the inside of the uterus to the vagina (the cervical canal), and endometriosis. Endometriosis is a condition in which nodules (bumps) of tissue just like the lining of the uterus are found on internal organs in the lower abdomen. It can cause very severe, debilitating pain that is not necessarily limited to the menstrual period. Hormonal Treatment for Period Cramps Assuming the pelvic examination is normal and endometriosis is ot suspected, hormonal treatment can helpl. The hormones prevent ovulation, and thus prevent the ovary from causing the production of the pain-causing prostaglandins. As you probably know, the oral contraceptive pill (OCP) prevents ovulation. And this is the easiest, least expensive way to use hormones to treat severe primary dysmenorrhea. Oral contraceptive pills are 80 percent to 90 percent effective when used for this purpose. Natural Remedies for Cramps Menstrual cramps have been around for thousands of years, and so have many non-medical treatments. I recommend that nonmedical remedies be used in addition to the pain medications described above.Rest and stress reduction. Like many other conditions, cramps may be made worse by fatigue from too many late nights and by anxiety. So, getting enough rest before a period is due can actually help prevent bad cramps. Anxiety and stress are occasionally part of everyone¹s lives, so learning how to manage these is important for every teenager. Meditation, yoga, tai chi, and exercise can all be helpful. Heat, in the form of a warm bath or a heating pad applied to the lower abdomen, can be very helpful (and comforting). Exercise -- A girl who exercises regularly, and who feels up to it despite having cramps, may find that continued participation in her usual activities helps relieve the cramps. FROM: Jennifer Johnson, MD |
