by Ellen Hale
For many women "that time of the month" is
one they'd rather forgo. More than half routinely experience
some form of pain associated with menstruation, say doctors
at the Mayo Clinic in Minnesota, and 1 in 10 suffers such
severe dysmenorrhea--menstrual pain--she cannot function
normally without taking medication.
Throughout history, women have tried to alleviate these menstrual discomforts
themselves. But home remedies--teas, hot baths, heating pads, and such--offered
only limited help. As recently as a decade ago, when there were far fewer products
readily available for menstrual cramps than now, some doctors prescribed powerful
prescription painkillers. Others, many women recall, told patients their problems
would disappear as they grew older or after they had children.
But today, the pain associated with menstruation is taken more seriously, and
there are new, highly effective treatments for it.
"Nearly all women--I would say 99.9 percent--should be able to function
quite well during their periods with the menstrual treatments available
now," says Charles H. Debrovner, M.D., a gynecologist in private practice
and on the faculty of the New York University School of Medicine in New York
What's Causing the Pain?
There are two kinds of painful menses--primary and secondary dysmenorrhea--and
it is very important to distinguish between them so both are treated properly,
Primary dysmenorrhea usually starts within three years of the onset of menstruation
and lasts one or two days each month. While this type of menstrual pain may lessen
for some women as they grow older or after the birth of children, it also can
continue until menopause.
Secondary dysmenorrhea is menstrual pain caused by disease such as pelvic
inflammatory disease, endometriosis (abnormalities in the lining of the uterus),
or uterine fibroids (nonmalignant growths). Endometriosis is a major cause of
secondary dysmenorrhea. Pain from it usually starts later in life and worsens
with time, according to Debrovner. Another hint that disease might be the cause
of menstrual pain is if pain also occurs during intercourse or during other parts
of the cycle.
Primary dysmenorrhea is a result of the normal production of prostaglandins--chemical
substances that are made by cells in the lining of the uterus. (Prostaglandins
are also produced elsewhere throughout the body.) The lining of the uterus--which
has built up and thickened during the early stages of the menstrual cycle--breaks
up and is sloughed off at the end of the cycle and releases prostaglandins, explains
Lisa Rarick, M.D., medical officer in FDA's division of metabolism and endocrine
The prostaglandins, in turn, make the uterus contract more strongly than at any
other time of the cycle. They can even cause it to contract so much that the
blood supply is cut off temporarily, depriving the uterine muscle of oxygen and
thus causing pain. Women who suffer painful contractions may be producing excessive
amounts of prostaglandins. Or, it may be that some women are just more sensitive
to them, says Rarick.
The cramps themselves help push out the menstrual discharge. Because the cervical
opening is often widened after childbirth or years of menstruation, cramps may
lessen in severity later in life.
Most women describe their menstrual cramps as a dull aching or a pressure low
in the abdomen. The pains may wax and wane, remain constant, or be so severe
that they cause nausea, vomiting, diarrhea, backache, sweating, and an achiness
to the hips, lower back, and thighs.
For many years, women had little help for these symptoms. Doctors recommended
aspirin, heating pads, and hot baths. When those failed, they often prescribed
painkillers such as Demerol or Tylenol with Codeine. These treatments were all
aimed at the perception of pain rather than the cause of it. Even tranquilizers
were sometimes used,
according to Debrovner.
But the advent of pain relievers that impede the production of prostaglandins
has made it possible to directly treat the cause of the cramps. Called NSAIDs,
for nonsteroidal anti-inflammatory drugs, these medications have proven remarkably
effective for many women.
Because NSAIDS inhibit synthesis of prostaglandins, and thereby the contractions
of the uterus, they may actually reduce menstrual flow. Many of Debrovner's patients
report shorter periods when they take the drugs at the first sign of pain. He
recommends taking them as early as possible after the menstrual flow starts.
Waiting too long may mean they won't
be as effective.
The prostaglandin inhibitors can cause gastrointestinal distress, so most doctors
also recommend they be taken with milk and food. Labeling on the OTC products
contains this information.
While there are about a dozen prescription NSAIDs, three--ibuprofen (Motrin,
Rufen, etc.), naproxen (Naprosyn), and mefenamic acid (Ponstel)--are now approved
to treat menstrual cramps.
FDA approved ibuprofen for over-the-counter use in 1984. It now can be found
as the active ingredient in several OTC medications, such as Advil, Nuprin, and
Motrin IB. The OTC dose per pill is 200 milligrams. The recommended dose is one
tablet every four to six hours (or two, if one does not work), not to exceed
six in a 24-hour period. Prescription formulations come in dosages of 400 to
Aspirin--long a standard over-the-counter treatment for cramps--works as a prostaglandin
inhibitor, although probably not so powerfully as the specific inhibitors such
as ibuprofen. While aspirin is known to thin the blood and increase bleeding,
it does not appear to have this effect on menstrual flow, according to Rarick.
Researchers are not sure if acetaminophen, an analgesic found in drugs such as
Tylenol and Datril, works to prevent prostaglandin production. If it does, its
effect appears to be milder than that of aspirin or other NSAIDs. Doctors say,
however, that it can successfully treat the headache and backache that often
accompany menstrual cramps.
Some over-the-counter menstrual pain medications, such as Midol and Pamprin,
contain a mix of ingredients that include an analgesic such as acetaminophen,
a diuretic such as pamabrom, and an antihistamine such as pyrilamine maleate.
Some newer formulations now use ibuprofen in place of more classic analgesics
such as aspirin or acetaminophen. Midol 200 Advanced Cramp Formula, for example,
contains ibuprofen as its active ingredient. Maximum Strength Midol Multi-Symptom
Formula, however, contains acetaminophen as an analgesic. With the variety of
ingredients now available, it's wise to read the label to make sure the product
is the best one to treat your symptoms. If in doubt, consult
Women who use oral contraceptives rarely suffer menstrual cramps, so some doctors
prescribe them for women whose cramps are unrelieved by other treatments. Contraceptive
pills disrupt the normal hormonal changes of the menstrual cycle, resulting in
a thinner uterine lining and a decrease in prostaglandins production. However,
menstrual cramp relief is not considered by FDA to be a primary reason to use
oral contraceptives; rather, it is included
in the labeling as a secondary benefit.
Exercise, too, may be of some benefit, possibly because it raises levels of beta
endorphins, chemicals in the brain associated with pain relief. With new knowledge,
such as the possible roles of exercise and of prostaglandins in preventing cramps,
most women can avoid suffering
the monthly anguish of severe menstrual pain.
is a freelance writer
in Washington, D.C.
syndicated from U.S.
Food and Drug Administration:
FDA Consumer Magazine Article