A detailed look at the causes, varieties, and methods of relieving menstrual pain.
For this issue, Dr. Torn Ferguson's column was written by the Women's Health Editor of Medical Self-Care.
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"!
However, there's no longer any reason to consider monthly cramps as psychosomatic, because their cause 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 fat-like substances in menstrual blood that appeared to stimulate uterine contractions. 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.)
In addition to prostaglandins, there are several other factors that—it's speculated—contribute to dysmenorrhea.
Family history. It hasn't yet been established whether prostaglandin overproduction is hereditary, but studies do show that daughters of women with severe dysmenorrhea are likely to experience such cramps themselves.
IUD's. Painful cramping is a common effect of IUD usage ... and it now appears that intrauterine devices actually stimulate prostaglandin production. Many women have had them removed for that reason.
Other common troublemakers include bladder infections, bowel problems, and yeast infections. It's also long been noted that women who suffer acute dysmenorrhea often become depressed and irritable as their periods approach (who wouldn't, when anticipating several days of severe pain?), and there was a time when doctors believed that depression in women caused menstrual discomfort. I'd say it's more likely the other way around!
Whatever their origins, there are three separate kinds of severe monthly cramping. Primary spasmodic dysmenorrhea is characterized by sharp, wavelike cramps—in the lower abdomen and inner thighs—which last for a day or two after the onset of menstruation. The condition usually subsides when a woman reaches her late twenties. Primary congestive dysmenorrhea, on the other hand, involves a dull, aching pain and the uncomfortable, bloated feeling of edema. This type of menstrual distress often persists until menopause, getting worse with age.
Secondary dysmenorrhea tends to occur suddenly, often after years of less painful periods. It may be associated with one of several health problems, some of them as serious as pelvic inflammatory disease or reproductive cancers. This ailment, therefore, should be treated by a physician. The more common primary forms of menstrual discomfort, though, can usually be alleviated—or even eliminated—by following a carefully chosen program of self-care.
The following list begins with "nonaggressive" approaches menstrual pain relief, then moves on to more drastic measures. You should feel free to use whatever techniques suit your needs.
Exercise. Medical studies agree that as a woman's physical condition improves, her cramps tend to lessen in severity ... so going to bed when discomfort hits is actually one of the worst things you can do! Any form of mild exercise will help: Take a walk, ride your bike, or try a few minutes of yoga. Certain postures—such as kneeling on all fours with your head down and your hips elevated—will sometimes help relieve cramping, too.
Diet. Individual women's reactions to foods vary tremendously, but it's often said that dairy foods aggravate menstrual-related bowel problems. Of course, if you become constipated, you can alleviate the problem by drinking more fluids (probably not milk) and increasing your fiber intake. Word-of-mouth endorsement also speaks well of dolomite (or any mixture of calcium and magnesium in a 2:1 ratio). Begin taking the mineral supplements one week before your period is due. (Eating more leafy vegetables will also provide a calcium boost.)
Other women say that B vitamins—especially B6—act as diuretics and help alleviate edema. And if yeast infections are a problem, reduce your consumption of sugar and take more buttermilk and yogurt for their beneficial lactobacillus bacteria.
Contraception. It's widely agreed that dysmenorrhea is—to a certain extent—stress-related, and the fear of an unwanted pregnancy can cause enormous anxiety to accompany the onset of a woman's period (or the lack of it). If you don't want to conceive, avoid the worry by using contraception consistently.
Herb teas. Traditional remedies for cramps include catnip, saffron, chamomile, mint, raspberry, and blackberry leaf infusions. Dandelion and sassafras are mild diuretics, so teas brewed from such herbs may help relieve a bloated feeling.
Heat. Grandmother was right! Warm baths or a hot water bottle held on the lower back or the abdomen will work wonders.
Massage. Menstrual pain is often transferred to the lower spinal area, so a soothing back massage with warm coconut oil or another lubricant can really help. Some women obtain relief from abdominal massage, as well.
Acupressure. This form of natural healing is simply acupuncture without the needles: To use it, you press a fingertip firmly on the appropriate points to release blocked currents of energy. There are several acupressure points that help relax the uterus. First, stimulate the small hollow of bone that's one hand's width above the ankle on the inside of the leg. Also try the point two thumb widths up the inner arm, above the junction of the wrist and arm and in line with the middle finger ... or the one between the nail and first joint of the middle finger on the side toward the thumb.
Aspirin. This old standby is a mild prostaglandin inhibitor, but it's only 1/30 as potent as the powerful drugs listed below. Both plain and buffered aspirin can cause stomach upset or gastrointestinal bleeding, though, so be sure to take either of those medications on a full stomach or with milk.
If the nonaggressive approaches listed above don't provide enough relief, you probably ought to have a physical (including a pelvic exam) to rule out any organic problems, particularly gonorrhea. At any rate, you will need to see a doctor to obtain a prescription for any of the following medications.
Prostaglandin inhibitors. These are the "latest thing," which means they have both advantages and disadvantages. They do work very well to reduce cramping, but have also been known to cause such side effects as rashes, headaches, gastrointestinal upset, and/or severe bleeding. (Because the drugs are so new, other long-term effects have not yet been determined.) If you're not using any form of contraception in conjunction with the prostaglandin inhibitors, don't take then until your period actually starts. If you ingest the drug for a few days before you expect your menstrual flow, and it turns out that you've actually been pregnant for a month, you'll have bathed the first-trimester fetus in a possibly dangerous chemical.
Narcotics. Narcotics—especially codeine—have long been administered to women suffering severe cramps. Although they're undoubtedly effective, the drugs can cause unpleasant side effects (such as drowsiness, nausea, and constipation). Personally, I'd suggest that you try to get by without narcotics and instead use some form of stress reduction. However, anyone with really debilitating pain needs the strength of narcotics. For such cases, I'm glad they're available. Addiction, by the way, won't be a problem for anyone who takes narcotics for only one or two days each month. It would require one or two weeks of steady high doses to create a physical dependence.
Birth control pills. As I mentioned earlier, the Pill prevents ovulation, which is the signal for a buildup of cramp-producing prostaglandin. Oral contraceptives can be quite effective in relieving menstrual pain. Each woman, I think, should weigh for herself the costs and benefits of the Pill. There are well-known health risks involved, but in some cases the disadvantages may be preferable to severe monthly pain.
EDITOR'S NOTE: Those of you who are interested in learning more about acupressure will enjoy Michael Blate's text, The Natural Healer's Acupressure Handbook: G-Jo Fingertip Technique.
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