Wednesday, August 11, 2010

Menstrual Cramps (Dysmenorrhea) AND THE DRUG TO USE

What are menstrual cramps?

Menstrual cramps are pains in the abdominal (belly) and pelvic areas that are experienced by a woman as a result of her menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual syndrome (PMS), although the symptoms of both disorders can sometimes be experienced as a continual process. Many women suffer from both PMS and menstrual cramps.
Menstrual cramps can range from mild to quite severe. Mild menstrual cramps may be barely noticeable and of short duration - sometimes felt just as a sense of light heaviness in the belly. Severe menstrual cramps can be so painful that they interfere with a woman's regular activities for several days.

How common are menstrual cramps?

Menstrual cramps of some degree affect more than an estimated 50% of women, and among these, up to 15% would describe their menstrual cramps as severe. Surveys of adolescent girls show that over 90% of girls report having menstrual cramps.

What is dysmenorrhea?

The medical term for menstrual cramps is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.
In primary dysmenorrhea, there is no underlying gynecologic problem causing the pain. This type of cramping may begin within six months to a year following menarche (the beginning of menstruation), the time when a girl starts having menstrual periods. Menstrual cramps typically do not begin until ovulatory menstrual cycles (when an egg is released from the ovaries) occur, and actual menstrual bleeding usually begins before the onset of ovulation. Therefore, an adolescent girl may not experience dysmenorrhea until months to years following the onset of menstruation.
In secondary dysmenorrhea, some underlying abnormal condition (usually involving a woman's reproductive system) contributes to the menstrual pain. Secondary dysmenorrhea may be evident at menarche but, more often, the condition develops later.

What causes menstrual cramps?

Each month, the inner lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. After ovulation, if the egg is not fertilized by a sperm, no pregnancy will result and the current lining of the uterus is no longer needed. The woman's estrogen and progesterone hormone levels decline, and the lining of the uterus becomes swollen and is eventually shed as the menstrual flow and is replaced by a new lining in the next monthly cycle.
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.

Why are some cramps so painful?

Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman's cervical canal is narrow.
The difference between menstrual cramps that are more painful and those that are less painful may be related to a woman's prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in the endometrium (uterine lining) when compared with women who do not experience cramps. Menstrual cramps are very similar to those a pregnant woman experiences when she is given prostaglandin as a medication to induce labor.

Can menstrual cramps be measured?

Yes. Menstrual cramps can be scientifically demonstrated by measuring the pressure within the uterus and the number and frequency of uterine contractions. During a normal menstrual period, the average woman has contractions of a low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions every 10 minutes. When a woman has menstrual cramps, her contractions are of a higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.

What other factors influence menstrual cramps?

As mentioned above, an unusually narrow cervical canal tends to increase menstrual cramps. Another anatomical factor thought to contribute to menstrual cramps is a backwards tilting of the uterus (a retroverted uterus).
Lack of exercise is now recognized to contribute to painful menstrual cramps.
It has long been thought that psychological factors also play a role. For example, it is widely accepted that emotional stress can increase the discomfort of menstrual cramps.

What are the symptoms of menstrual cramps?

Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual.
Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after the onset of the pains, and subside again after a day or two.
Menstrual cramps may be accompanied by a headache and/or nausea, which can lead, although infrequently, to the point of vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea because the prostaglandins which cause smooth muscles to contract are found in both the uterus and intestinal tract. Some women experience an urge to urinate more frequently.

How are menstrual cramps diagnosed?

The diagnosis of menstrual cramps is usually made by the woman herself and reflects her individual perception of pain. Once a woman has experienced menstrual cramps, usually with the adolescent onset of her menses (monthly menstrual flow), she becomes well aware of the typical symptoms.

What is the treatment for common menstrual cramps (primary dysmenorrhea)?

Every woman needs to find a treatment that works for her.
Current recommendations include not only adequate rest and sleep, but also regular exercise (especially walking). Some women find that abdominal massage, yoga, or orgasmic sexual activity help. A heating pad applied to the abdominal area may relieve the pain and congestion and lesson symptoms.
A number of nonprescription (over-the-counter) agents can help control the pain as well as actually prevent the menstrual cramps themselves. For mild cramps,aspirin or acetaminophen (Tylenol), or acetaminophen plus a diuretic (Diurex MPR, FEM-1, Midol, Pamprin, Premsyn, and others) may be sufficient. However, aspirin has limited effect in curbing the production of prostaglandin and is only useful for less painful cramps.
The main agents for treating moderate menstrual cramps are the nonsteroidal antiinflammatory drugs (NSAIDs), which lower the production of prostaglandin and lessen its effect. The NSAIDs that do not require a prescription are:
A woman should start taking one of these medications before her pain becomes difficult to control. This might mean starting medication 1 to 2 days before her period is due to begin and continuing taking medication 1-2 days into her period. The best results are obtained by taking one of the NSAIDs on a scheduled basis and not waiting for the pain to begin.
Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic acid (Ponstel) and meclofenamate (Meclomen).

What if the cramps are very severe?

If a woman's menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low dose oral contraceptives containing estrogen and progestin in a regular or extended cycle. This type of approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins which, in turn, reduces the severity of cramping and causes a light menstrual flow.
Use of an IUD that releases small amounts of the progestin levonorgestrel directly into the uterine cavity, has been associated with a 50 percent reduction in the prevalence of menstrual cramps In contrast, IUDs that do not contain hormones, such as those containing copper, may worsen menstrual cramps.

Are there surgical solutions?

In the past, many women with menstrual cramps had an operation known as a D & C (dilation and curettage) to remove some of the lining of the uterus. This procedure is also sometimes used as a diagnostic measure to detect cancer or precancerous conditions of the uterine lining. Some women even resorted to the ultimate solution to menstrual problems by having ahysterectomy, surgery that removes the entire uterus.
Today, when a woman has abnormally heavy and painful uterine bleeding, her doctor may recommend endometrial ablation, a procedure in which the lining of the uterus is burned away or vaporized using a heat-generating device.

What is the treatment of secondary dysmenorrhea?

The treatment of secondary dysmenorrhea depends on its cause. There are a number of underlying conditions which can contribute to the pain including:
  • endometriosis (cells from the uterine lining tare located in other areas of the body);
  • uterine fibroids (non-cancerous uterine growths that respond to estrogen levels);
  • adenomyosis (a benign condition in which the cells of the inner uterine lining invade its muscular wall, the myometrium);
  • pelvic inflammatory disease (PID);
  • Adhesions (abnormal fibrous attachments between organs); or
  • use of an intrauterine device (IUD) for contraception.
All of these conditions should be first diagnosed by a physician who will then recommend the optimal treatment.
If a woman begins to experience changes in her menstrual cramps, such as in their severity, timing, or location, she should consult her physician, especially if the changes are of sudden onset.

What is the long-term outlook (prognosis) for menstrual cramps?

In general, a woman's menstrual cramps do not worsen during her lifetime. In fact, the menstrual cramps of primary dysmenorrhea usually diminish with age and after pregnancy. This is thought to be due to the fact that the nerves of the uterus degenerate with age and disappear late in pregnancy, with only a portion of these nerves regenerating after childbirth.
When there is secondary dysmenorrhea with an underlying condition contributing to the pain, the prognosis depends on the successful treatment of that condition.
As women have learned more about their bodies and how to maintain them in optimal health, menstrual cramps have become less of a debilitating illness, and more often, merely a minor monthly inconvenience.
Menstrual Cramps At A Glance
  • Menstrual cramps are periodic abdominal and pelvic pains experienced by women.
  • More than half of all menstruating women have cramps.
  • The cramps are severe in at least one in seven of these women.
  • Medically, menstrual cramps are called dysmenorrhea.
  • Primary dysmenorrhea is common menstrual cramps without an identifiable cause.
  • Secondary dysmenorrhea results from an underlying abnormality that usually involves the woman's reproductive system.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat cramps.
  • Physical exercise can help alleviate menstrual cramps.
  • Menstrual cramps tend to improve with age.

Patient Discussions: Menstrual Cramps - Effective Treatments

 have been getting my period since the age of nine. I have had bad cramps since I started. I vomit up to 5 times a day. I can't eat so I just vomit stomach acids. Even when my period is over my stomach is still sore from all the pain. Motrin used to be my best friend and would take away my pain, but my body started rejecting it and now I have nothing. I go through the pain each month trying to find something to help but I have yet to find my magic remedy or pill. Using a heating pad sometimes helps but I have to be sweating from it in order for my body to completely relax to feel better. I miss days from work and no one seems to understand the pain is unbearable!Published: September 11 ::
Comment from: kokomo19, 25-34 Female (Caregiver)
I have gotten horrible cramps for the last 6-7 years or so. I get really sweaty, diarrhea nausea, they go down my legs, and I pretty much just lay or crouch in pain. I call in sick all the time because I can't get up. I've tried hot baths, showers, heating pads, every pain killer that is out there, and several prescription pain killers. Motrin 800 doesn't prevent the cramps, but it's the only one that has made them less severe for me. I’ve tried several birth control pills, which always help, but then the side effects I get from them are sometimes not any better than the cramps!Published: September 11 ::
Comment from: stressisa4letterword, 25-34 Female (Patient)
I will take two ibuprofen (not Midol or Tylenol) when I first get the familiar symptoms just before my period (gassy, bloated, kind of a diarrhea-type feeling). If it’s bad enough, I'll supplement it with one of those other over-the-counter PMS medications containing ibuprofen and an antihistamine instead of acetaminophen and caffeine, which is less effective and can make you agitated and restless. The medication needs to have some form of diuretic in it to reduce the bloated, gassiness feelings. I recommend that you wear comfortable pajamas, lie on your back with a pillow under your knees and one between your knees. Drink an herbal tea designed for PMS (you can find them at your local health food store). Place a heat pack on your uterus. Read a book, draw, watch TV, surf the Internet or sleep. Calming music, fresh clean sheets and the ambiance of a fan also help. Tell everyone not to disturb you for the next few hours.Published: August 05 ::
I have had success taking magnesium (you also need calcium to release the magnesium from your cells - but be careful not to take too much calcium or you'll use up all the magnesium). The pain gradually got less and after about three months I had almost no pain. Some people also recommend omega 3 (not 6).Published: July 25 ::
Comment from: Painful, 25-34 Female (Patient)
I have had my period since the age of 13. The day I started, I had cramps. I have tried using Advil, Motrin, Vicodin, heating pads, walking, and lying down. I still continue to have bad cramps, headaches, mood swings and heavy bleeding. My doctor has even tried many forms of birth control pills, but nothing seems to help the pain. I feel like the older that I get, the worse the pain gets.Published: September 25 ::
Comment from: Porchia, 19-24 Female (Patient)
I am a 21-year-old young lady and have been getting cramps since my first period. I get migraines, which make me aware that I'm about to start, and the cramping lasts for three days. The only thing I find helpful is staying on top of it. It’s not fun, but I take pills at least a day before my scheduled cycle and drink warm or hot drinks to soothe my muscles. I also use a heating pad and try to relax as much as possible.Published: September 25 ::
I'm currently in South Korea where drug usage is nonexistent. For my cramps, I usually use herbal meditation to calm me down, and relax my muscles. A heating pad, hot tea and a good book seems to do the trick.Published: September 25 ::
Comment from: ginger, 35-44 Female (Patient)
I found that if I take Advil three to four days prior to my period that my periods are less painful. I also suffered from bad PMS, tender breast, sadness, anger, you name it. My vision was even off if you know what I mean. I started taking a multi vitamin with calcium and magnesium and within a couple of months I was no longer suffering from the PMS. I haven’t had any symptoms for over a year now, so please start taking your vitamins. I take Advil before period and take 2 every 4 to 5 hours the first 2 days of my period to keep the pain tolerable. Not fun, but some relief.Published: September 11 ::
Comment from: Shelbie, 13-18 Female
I am 15 years old, and I started my period when I was 9. I have severe cramps. I vomit, wake up in cold sweats in the middle of the night and can’t fall back asleep. I am extremely irate with anyone who touches me, my upper legs hurt, my lower back and stomach cramp up. I have yet to find a sure way to help ease my pain. I’ve tried herbal teas, pain relievers, strong pain relievers, light exercise, heat packs, warm baths, hot showers, and even sleeping for long hours. Nothing seems to help.

During my period, I experience mild discomfort lasting for a few days before escalating to a high level. This intense pain lasts up to 12 hours. It tends to accompany nausea, elevated temperature and headaches, and can wake me from deep sleep and inhibit normal, everyday activity. A little careful massage can help. Constant heat (careful not to burn yourself – I did this once!) on the lower abdomen while lying down helps even more. If the pain is sufficiently intense, I take an over-the-counter ibuprofen combined with codeine – although I am always cautious with medication of this strength.Published: August 22 ::
The only way to ease my pain is to take extra-strength Midol and Advil and apply two heat bags, one to my lower abdomen and one to my lower back. I have severe cramps, and I also get nausea, but nothing seems to help that.Published: July 15 ::
Heating pads seem to be the only things that help me. Applying heat to my lower back helps my muscles relax. Once the pain subsides a bit, doing some light exercise also seems to help. My cramps also induce nausea though, and nothing seems to help that except curling up into a ball and waiting it out.Published: July 08 ::
I have severe cramps and Midol maximum strength is the only medicine strong enough to take away the pain. I also use a heating pad and lay either on my stomach or sit on my knees and curl into a ball. Concentrating on taking deep breaths during the worst pain sometimes helps too.Published: June 30 ::
I take mefanamic acid after many years of trying to find a remedy! My cramps are in the severe range of being sick, pains in legs and not knowing whether to stand up and walk or curl up and sleep! Mefenamic acid, a short nap when I get in from work (or mid afternoon if I am not in work) and a hot pack on my abdomen usually helps to ease the pain!Published: June 30 ::
I take ibuprofen and then put a warm rice bag on my stomach.Published: June 25 ::
Comment from: wings, 25-34 Female (Patient)
I agree with the person who suggested Magnesium, except that I suggest Magnesium Citrate, which is absorbed better by the body. It is best if it is taken with calcium (or better yet -- calcium citrate.) I have had severe cramps for over 10 years, although they have gotten a little better with time. I also have found that eating Salmon and other forms of Omega 3 a few days before the period starts is helpful.Published: September 11 ::
Comment from: Hanna, 25-34 Female (Patient)
About every six months or so, I have very severe cramps that cause me to pass out, vomit, cry, and moan. I don't have any more energy for anything else. Every time, I almost go to the emergency room. The only thing that helps me is to take some very, very strong pain relievers that put me to sleep. My gyno hasn't given me any other recommendations, but she believes I have ovarian cysts.Published: August 29 ::
Comment from: Dani34, 13-18 Female (Patient)
I’m 18 years old, and I got my period when I was 10 years old. I experience bad cramps every month (gassiness, diarrhea, lower back pain, abdomen and upper leg pains). The pains are so severe that they wake me up in the middle of the night. I am unable to get comfortable. I have tried the heating pad, and it works the times when I am able to relax my muscles. Sometimes, I am in so much pain that I am constantly tightening my muscles and the heating pad does not have a chance to work. Taking three Advils instead of two has seemed to help a little bit, although I still get cramps, they are not as severe.Published: August 29 ::
Comment from: Aurora, 25-34 Female
My period is of the nature that I have to sleep with a towel on my bed to prevent complete ruination of my sheets. However I find for the cramps that if I do (and this may sound silly) Greer Childers Body Flex which stretches the body and increases the oxygen to the blood that the cramps subside until I am done. A long, hot shower, Ibuprofen, heating pad, pillows and (most importantly) Chocolate are just what I need to help calm the cramps and nausea. Good luck ladies, it's nice to know that I am not alone in the painful period corner.Published: August 14 ::
I have used an electric heating pad which has soothed the pain.
Every time I exercise about 2 weeks prior to actually getting my period, I get very bad cramps and if I exercise for more than 10 minutes, they get severe and don't stop till maybe 20-30 minutes after, sometimes more. Does that happen to any of you? I think I'm the only one this happens to.Published: July 22 ::
You are probably just ovulating- this happens midway through your cycle. When I ovulate, I tend to get pretty severe cramping on the side that the egg is coming from (so it alternates from month to month. I don't think it has anything to do with you exercizing. You should take some Aleve or something to minimize the pain.Published: July 28 ::

DRUG TO USE 






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