Painful cramping during the menstrual cycle (dysmenorrhea) is a common and often troubling complaint for women of reproductive age. Described as pain or discomfort in the lower abdomen which often radiates to the lower back and thighs, dysmenorrhea usually occurs just before or with the onset of menstrual flow. Painful cramps typically last for several hours or longer, but rarely longer than two days. Complaints of discomfort range from mild to severe, and may involve associated symptoms of nausea, vomiting, or diarrhea. In fact, dysmenorrhea affects 50% of all women and is the leading cause of school absenteeism in adolescent females.
What causes the pain associated with menses? Under the influence of the natural hormonal changes which occur late in the cycle after ovulation, the uterine lining (the endometrium) begins to break down, preparing to shed (menses). This process leads to the release of hormones called prostaglandins. It is this release of prostaglandins which leads to uterine contractions which then causes uncomfortable, sometimes painful cramping. When this pain occurs early in a woman’s reproductive life and is purely associated with ovulation and the subsequent prostaglandin surge, it is referred to as ‘primary dysmenorrhea’. Some women, however, will develop painful menses later in life, frequently as a result of a pelvic or gynecologic abnormality. In this circumstance, the menstrual pain would be described as ‘secondary dysmenorrhea’. Uterine fibroids, endometriosis, pelvic infections, and adhesions are all examples of conditions which can lead to secondary dysmenorrhea. With this type of dysmenorrhea, symptoms are often more severe, last longer, and may require approaches to treatment which lie beyond the scope of this discussion.
How, then, to manage the symptoms associated with dysmenorrhea? There are a variety of treatment modalities which have been found to be helpful in alleviating menstrual discomfort ranging from lifestyle changes to pharmacologic options. For instance, there is evidence that simple changes in diet can have a positive impact on symptoms. Increasing complex carbohydrate intake, decreasing salt, and increasing intake of natural diuretics (i.e., peaches, melon, celery) have all been shown to reduce pain. Engaging in exercise and in stress-reducing activities such as breath-focused meditation or yoga have proven beneficial. The use of heat (i.e., hot water bottle, heating pad, shower, thermacare) is often very comforting with pelvic cramping. Dietary supplements can also be helpful – particularly calcium, magnesium, B-6, and the EFAs (essential fatty acids). There is also evidence that certain herbs such as red raspberry leaf and black cohosh root can reduce pain in menses. It is always recommended to discuss the use of supplements or herbs with a practitioner trained in this area of practice.
Finally, there are pharmacologic options available and widely used in treating women with dysmenorrhea. Most commonly, women employ the use of NSAIDS (non-steroidal anti-inflammatory drugs), for their effect on inhibiting the release of prostaglandins. It makes sense that if a surge in prostaglandins is the factor which leads to menstrual cramps, then preventing the release of prostaglandins will significantly affect the amount of discomfort. Of note, it is important to start NSAID therapy as soon as possible with
the onset of symptoms (or even a day before is possible, in order to prevent the release of prostaglandins) in order to achieve the best possible results. In some cases, a prescription strength NSAID is necessary to afford symptom relief. We also know that some NSAIDS have a greater effect than others in reducing symptoms. Your health care provider can help you to ascertain what type and amount of NSAID therapy may be recommended (if at all) for your particular symptoms. For women who do not respond to NSAID therapy or for whom it is not recommended or preferred, there is also the option of using an oral contraceptive pill (OCP) to manage symptoms. Because the use of OCPs suppresses ovulation, the typical hormonal changes which occur in the menstrual cycle (prostaglandin surge) do not occur. Therefore, most women who take OCPs report significant improvement in menstrual pain and discomfort. Of course, oral contraceptives are not an ideal choice for all women and therefore should be discussed with a health care provider.
To learn more about any of these treatment options to alleviate pain associated with menses, contact your health care provider or feel free to contact us at Harbour Women’s Health.