HOW TO DEAL WITH MENSTRUAL CRAMPS

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For this issue, Dr. Torn Ferguson's column was written by the Women's Health Editor of Medical Self-Care.

by By Sandra Ritz

Menstrual pain and discomfort—or dysmenorrhea—is America's (and likely the world's) number one gynecological problem. More than half of all women who have periods also experience monthly cramps. And, of those, approximately 10% suffer pain severe enough to send them to bed for a day or more each month. In fact, a 1978 study published in the American Journal of Obstetrics and Gynecology named dysmenorrhea as the greatest single cause of school and work absences among American women (it accounts for the loss of an estimated 140 million productive hours annually).

The pain of menstrual cramps is all too real, but traditionally physicians label the symptoms "psychogenic" (originating in the mind) and prescribe either narcotics or tranquilizers. And why do health care professionals tend to take the condition lightly? Well, their seeming lack of concern is likely due to the fact that dysmenorrhea hasn't fit into the medical profession's accepted definition of disease . . . that is, it couldn't (until recently) be traced to an identifiable cause (such as a microorganism or a toxin), and it doesn't result in any significant visible injury (except the pain, which varies widely from woman to woman). Now that attitude may be insensitive, but it's not too surprising that women with a problem which defies the very standards doctors are trained to view as near sacred are often dismissed as "neurotic"!

THE CULPRIT: PROSTAGLANDINS

However, there's no longer any reason to consider monthly cramps as psychosomatic, because their cause—at least— has finally been identified. The culprits, prostaglandins, are chemicals—produced by tissues in the bodies of both males and females—which stimulate the contractions in smooth muscles (one of which is the uterus). The first link between prostaglandins and dysmenorrhea was uncovered in 1957, when a British doctor isolated some fatlike substances in menstrual blood that appeared to stimulate uterine contractions . . . and the same chemicals were later identified as two types of prostaglandins. Subsequent research showed that women who suffer from severe dysmenorrhea have considerably higher amounts of prostaglandins in their menstrual discharge than do women who don't have painful cramps. It has also been proved that birth control pills relieve cramps by preventing ovulation and thus limiting the buildup of prostaglandins that normally occurs during that part of the menstrual cycle. Finally, it was found that chemical prostaglandin inhibitors, such as aspirin, can help ease the discomfort of dysmenorrhea. (In fact, Midol—a popular over the—counter cramp remedy—is mostly aspirin.)

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