Got cramps? If so, you’re not alone.
Pelvic pain during menstruation affects more than half of menstruating women, according to the American College of Obstetricians and Gynecologists, or ACOG. Some studies show that menstrual pain is a leading cause of missed work and school for females.
However, period pain that limits daily activities–called dysmenorrhea–is not normal, women’s health experts say. If you suffer killer cramps that do not respond to home remedies and over-the-counter pain relievers, it’s time to ask about prescription relief.
“Cramps shouldn’t keep you in bed,” said Dr. Sean George, a urogynecologist with Advocate Illinois Masonic Medical Center. “Any woman should see a doctor if cramps interfere with her ability to function.”
Katie Robinson knew it was time to see a doctor when menstrual pain caused her to faint in the lobby of a New York City hotel eight years ago. Now 25, the Cincinnati resident said she dreaded her period because of severe cramps and nausea.
“I had killer cramps that would last a day,” Robinson said. “I was non-functional.” The good news for Robinson and others like her is that medical treatments can help. Several new drugs treat menstrual pain, including a contraceptive pill to limit the number of periods and anti-inflammatory pain relievers that are easier on the stomach.
The pill and non-steroidal anti-inflammatory drugs are longtime treatments for menstrual pain. Approximately 75 percent of women get relief of menstrual cramps from oral contraceptives and NSAIDs, according to a 2000 Cochrane Review study.
Both the pill and NSAIDs like ibuprofen and naproxen reduce menstrual cramps by hindering production of the chemical that causes them, prostaglandin. At the start of a menstrual period, prostaglandin levels rise and cause uterine contractions that usually are mild or moderate. In about 15 percent of women with dysmenorrhea, however, the pain is severe, according to ACOG, and may be accompanied by nausea and other disabling symptoms. Women who suffer painful cramps have higher amounts of prostaglandin than do those without menstrual pain.
“Menstrual cramps are not in a woman’s mind,” said Dr. Jo Van Winter, assistant professor of obstetrics and gynecology, Mayo Medical School in Rochester, Minn. “Women with dysmenorrhea do have more pain.”
When menstrual cramps are severe, NSAIDs alone probably will not be sufficient treatment, Van Winter said. The next step she recommends is to suppress ovulation with contraceptives: the pill or the newer contraceptive patch or vaginal ring.
Studies show that women taking oral contraceptives have less dysmenorrhea.
“Birth control pills alone or in combination with NSAIDs work best,” George said.
Birth control pills brought Robinson relief from her cramps. Before going on the pill in 1996 to treat menstrual symptoms, she took seven naproxen tablets a day during her period, she said.
“Since then, I’ve barely had cramps. I haven’t taken any [naproxen] at all.”
Side effects of oral contraceptives may include spotting or breakthrough bleeding between periods, headache, nausea, breast tenderness, weight gain, depression and acne.
Another way to avoid menstrual cramps is to not have a period. To do that, women can take contraceptives continuously, by skipping the placebo pills or patch-free week.
However, many doctors recommend that women have a period at least every few months to minimize possible long-term health risks such as endometrial cancer, George said.
A new birth control pill, Seasonale, allows a woman to have a period four times a year. It is the only extended-cycle oral contraceptive approved by the Food and Drug Administration that gives the choice of one period every season, according to the manufacturer, Duramed Pharmaceuticals. Duramed reports that side effects are similar to those of other birth control pills.
Women also can turn off their menstrual flow with the contraceptive Depo-Provera, a progesterone derivative given in a shot every three months. Side effects, include weight gain, depression, acne and spotting. If contraceptives do not improve menstrual cramps, Van Winter advised further medical evaluation. ACOG reports that 25 percent of women with menstrual pain have secondary dysmenorrhea, meaning there is another cause besides rising prostaglandin levels.
Common causes of secondary dysmenorrhea include uterine fibroids–benign tumors–and endometriosis, in which tissue from the uterine lining attaches to pelvic organs. Women with these types of abnormalities may need other treatment, such as surgery.
Robinson, who has endometriosis, recently chose to stop taking the pill, but the cramps have not returned. That’s fine with her, because when a period is that painful, she said, “it makes you want to be a man.”
Do you get the most from anti-inflammatory drugs?
Women taking non-steroidal anti-inflammatory drugs, or NSAIDs, to relieve menstrual cramps generally don’t take them properly, according to one gynecologist. Dr. Sean George of Advocate Illinois Masonic Medical Center said women should begin taking NSAIDs one or two days before their period, not after the pain starts. Here are more tips from George for getting the most out of these pain relievers:
Keep taking the medication for two or three days after the start of your period, when cramps are most painful.
If an anti-inflammatory drug does not relieve your cramps, increase the dose or try another.
To avoid stomach upset, take NSAIDs with food. Or try a COX-2 inhibitor, such as Vioxx, Celebrex or Bextra, that is approved for treatment of menstrual cramps. COX-2 inhibitors are newer prescription NSAIDs that may cause less stomach upset.
— Kathleen Louden
