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Menstruation: Severe Cramps (Dysmenorrhea)

Description

An in-depth report on the causes, treatment, and prevention of menstrual cramps.

Alternative Names

Cramps (Menstrual); Endometrial Ablation; Menstrual Disorders

Treatment

Making dietary adjustments starting about 14 days before a period may help some women with certain mild menstrual disorders, such as cramping. The general guidelines for a healthy diet apply to everyone; they include eating plenty of whole grains, fresh fruits and vegetables, and avoiding saturated fats and commercial junk foods.

Effects of Dietary Fats. A 2000 study reported that women who followed a low-fat vegetarian diet for two menstrual cycles experienced less pain and bloating and a shorter duration of premenstrual symptoms than those who ate meat. Women who are losing too much blood, however, may need meat to help maintain iron levels. Choosing more fish and eggs may be a helpful alternative.

More than one study has reported less menstrual pain with a higher intake of omega 3 fatty acids (fat compounds found in oily fish, such as salmon and tuna). In one study, supplements of fish oil also appeared to reduce heavy bleeding in adolescent girls.

Salt Restriction. Limiting salt may help bloating. One study found that restricting salt does not alleviate bloating or other symptoms, but salt reduction in the study was modest and may have been too small to effect improvement.

Reducing Caffeine, Sugar, and Alcohol. Reducing caffeine, sugar, and alcohol intake may be beneficial. The effects of alcohol are mixed. One study found that women who drank less wine had less menstrual pain than those who drank more wine. Another reported that regular consumption of alcohol lowered the risk for developing cramps, but it actually increased the length of cramping time in certain women. Alcohol is certainly not recommended in any case for relieving menstrual disorders.

Vitamins and Minerals. There have been some reports that menstrual disorders may be caused or exacerbated by certain vitamin or other nutrient deficiencies. No studies, however, have confirmed this. Some benefits have been reported with the following supplements:

  • One large study reported that vitamin B1 (thiamin) was more effective than placebo (dummy pill) in relieving cramps. In the study, women took 100 mg daily. Thiamin is found in almost all foods, but the best source is pork. Other good sources of thiamin are dried fortified cereals, oatmeal, and sunflower seeds.
  • A 2001 analysis of three small studies suggested that magnesium may help women with dysmenorrhea. But researchers who performed the analysis could not recommend a specific regimen or dose.
  • One study comparing vitamin E with a placebo (a dummy pill) reported less pain with both, although vitamin E was more beneficial. In the study, women took 500 units of vitamin E five times a day, beginning two days before menstruation and continuing through the first three days of bleeding. Currently the upper level recommended is 1,100 IU per day. Doses in the study were much higher. Large doses may cause bleeding problems, particularly in people taking anti-clotting medications. Some research now indicates that vitamin E, like other antioxidants, may have damaging effects in high doses.

It should also be noted that there is no strong proof that any of these supplements can reduce menstrual cramps and high doses of certain supplements may not be harmless. No one should take large doses of any supplements without talking to a physician.

Exercise

A review of individual studies revealed a reduction in menstrual pain with exercise. It is not clear, however, how intense the exercise should be to reduce dysmenorrhea. For example young female athletes in a 2001 Croatian study were only half as likely to suffer from dysmenorrhea as their non-active peers. However, they were also three times more likely to experience an absence of periods. Exercise may be very helpful for women with menstrual pain due to endometriosis. It relieves stress and tension and may reduce hormonal levels that could contribute to endometrial growth.

Other Lifestyle Measures

Sexual Activity. There have been reports that orgasm reduces the severity of menstrual cramps.

Applying Heat. A 2001 study found that continuously applying a heated abdominal pad for 12 hours two days in a row was as effective in reducing menstrual cramps as ibuprofen (Advil). A warm bath may also be helpful.

Menstrual Hygiene. Tampons should be changed every four to six hours. Scented pads and tampons should be avoided; feminine deodorants can irritate the genital area. Women should not douche during or between periods. Women who douche on a weekly basis are more likely to contract cervical cancer than those who do not. Douching may destroy the natural anti-viral and anti-bacterial agents normally present in the vagina. Bathing regularly is sufficient.

Alternative Remedies for Cramp Relief

Certain techniques that ease muscle and joint pain and inflammation throughout the body may be applied to menstrual cramps.

Acupuncture and Acupressure. Some studies, including a small well-conducted trial, have reported relief from pelvic pain after acupuncture or acupressure, a technique that applies small pins or pressure to specific points on the body. It is believed to work by exciting nerve receptors in those locations that interact with pain blockers in the brain.

Some women report relief with reflexology, an acupuncture technique that uses manual pressure on acupuncture points on the ears, hands, and feet.

The Relief Brief is an investigative acupressure product. This is employs cotton Lycra panties that have been designed to apply specific acupressure points in the abdominal and pelvic area. In one interesting study, 90% of women who wore the Relief Brief reported at least 25% less pain and two thirds reported at least half as much pain. This warrants more research.

Transcutaneous Electrical Nerve Stimulation. Transcutaneous electric nerve stimulation (TENS) applies electrodes to certain parts of the body and administers low-level electrical pulses to those locations. Researchers suggest that it works by altering the body's ability to receive pain signals. The standard approach is to give 80 to 100 pulses per second, for 45 minutes, three times a day; patients are barely aware of the sensation. A major 2002 analysis of a number of small studies suggested that this approach can help some women with dysmenorrhea. There may be some minor side effects.

Yoga and Meditative Techniques. Yoga and meditative techniques that promote relaxation may also be helpful for menstrual cramps.

Chiropractic. Some women with primary dysmenorrhea have sought help from chiropractors trained in spinal manipulation. One study compared a high-force spinal manipulation technique with a low-force maneuver used as a placebo technique. Both showed lower scores on tests that measure pain, perhaps indicating that a simple back rub by a sympathetic partner or friend may be helpful.

Herbal and Other So-Called Natural Remedies for Cramp Relief. Studies have not found herbal or other so-called natural remedies to be any more effective than placebos for reducing menstrual disorders. In addition to possibly being ineffective, these remedies can be expensive.

  • An analysis of the few studies done on evening primrose oil found that it contains a polyunsaturated fatty acid known as gamma linolenic acid. This compound seems to block the release of cytokines and prostaglandins. These are factors in the immune system that are manufactured by the endometrium. They are involved in uterine muscle contraction and cramping. Foods that contain gamma linolenic acid are black currant oil and cold-water fish.
  • Ginger tea is safe and may help in relieving nausea.
  • Valerian has been used by some women for menstrual cramps. This herb is listed on the FDA's list of generally safe products. However, its effects could be dangerously increased if it is used with standard sedatives. Other interactions and long-term side effects are unknown. As with all herbal remedies, the quality and effectiveness of specific products is not regulated.
  • Black cohosh (also known as Cimicifuga racemosa or squawroot) contains a plant estrogen and has been the herbal remedy most studied for menopausal symptoms. It may be helpful for some women with dysmenorrhea. Black cohosh has been used for decades in Germany and appears to be safe, but because its actions resemble estrogen, well-conducted clinical studies are needed to confirm both long-term safety and effectiveness. One study, for example, reported an association between black cohosh and cell proliferation in the uterus, which theoretically could increase cancer risk. Headaches and gastrointestinal problems are common side effects. At this time experts do not recommend taking it for more than six months.
  • Krill Oil. In one study, a natural product derived from the krill fish (Neptune Krill Oil), which is rich in omega-3 fatty acids and other chemicals, improved PMS symptoms and reduced menstrual cramps compared to omega-3 fatty acids alone.
  • In one study, oil of fennel, a common root vegetable, had some benefit in women with dysmenorrhea.

Until scientific studies determine actual benefits, proper doses, and side effects of unregulated remedies, the patient is at risk for ineffective and even harmful treatments.

Warnings on Alternative and So-Called Natural Remedies

Alternative or natural remedies are not regulated and their quality is not publicly controlled. In addition, any substance that can affect the body's chemistry can, like any drug, produce side effects that may be harmful. Even if studies report positive benefits from herbal remedies, the compounds used in such studies are, in most cases, not what are being marketed to the public.

There have been a number of reported cases of serious and even lethal side effects from herbal products. In addition, some so-called natural remedies were found to contain standard prescription medication. Most reported problems occur in herbal remedies imported from Asia, with one study reporting a significant percentage of such remedies containing toxic metals.

The following website is building a database of natural remedy brands that it tests and rates for quality. Not all are yet available (www.consumerlab.com).

The Food and Drug Administration has a program called MEDWATCH for people to report adverse reactions to untested substances, such as herbal remedies and vitamins (800-332-1088).

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