Menstruation: Severe Cramps (Dysmenorrhea)
DescriptionAn in-depth report on the causes, treatment, and prevention of menstrual cramps.
Alternative NamesCramps (Menstrual); Endometrial Ablation; Menstrual Disorders
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:
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.
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.
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.