Believe it or not, there was a time not that long ago when menstrual cramps were thought to be entirely psychosomatic, caused by some inner conflict in a woman’s femininity. People believed that cramps ran in families because girls were taught by their mothers to expect pain, and that periods were a bad thing.
Fortunately, things have changed since those Freudian days, and scientific advances–as well as social progress–have led to a better understanding of menstrual pain.
Scientific experiments using pressure monitors (like the ones put inside the uterus during labor) found that women who experienced bad cramps actually had measurably stronger uterine long contractions than women who did not feel much menstrual discomfort. (In some cases, these spasms of the uterus created as much pressure as labor contractions!)
These contractions are caused by hormones called prostaglandins, which appear at higher levels in women who suffer menstrual cramps. Treatment with medications such as ibuprofen can decrease the production of prostaglandins and result in measurably weaker and less frequent cramping (or contractions) of the uterus. However, it’s still not known why some people suffer from this common condition so much more than others.
What do normal menstrual cramps feel like?
Cramps usually start after menstrual cycles become regular and involve ovulation, usually a year or two after the first period. The pain most commonly begins the first day of the period, although it may start the day before, and usually lasts a few days. Most people experience the cramps as low abdominal or low back pain, sometimes radiating down the thighs. The pain can range from mild to severe and can disrupt normal activities. Many girls and women experience nausea, vomiting, diarrhea, or headache associated with the pain.
Who should seek treatment for menstrual pain?
Menstrual cramps are extremely common and when left untreated, can cause much suffering. School and work attendance may suffer as a result. But this pain is treatable, so no one should have to miss her normal activities because of painful menstrual cramps and the other associated symptoms. Most girls and women can benefit from medications designed to alleviate these symptoms. Even the nausea and diarrhea that some people experience goes away simply by treating the cramps.
How can you tell if the pain signals something serious?
Most of the time, menstrual cramps that start before the age of 19 are the garden-variety kind, medically known as primary dysmenorrhea. Even if the cramps are severe, they’re not associated with any abnormalities in hormones or anatomy.
Secondary dysmenorrhea is the term used for pain caused by an underlying problem, such as endometriosis or fibroids. While secondary dysmenorrhea is more common in middle-aged women than in teens, endometriosis is one cause of secondary dysmenorrhea that can be found in teenagers. The signs of secondary dysmenorrhea in teenagers include pain that starts many days before the period, pain that also occurs at other times of the month, and cramps that are not helped by the usual treatments.
Keeping a Menstrual Calendar
Keeping track of when you get your period each month and knowing how long it is likely to last is certainly practical, as it allows you to avoid potentially embarrassing or uncomfortable situations by being prepared accordingly–for example, having pads and ibuprofen on hand.
But knowing when to expect your menstrual cycle also can provide important information when it comes to figuring out if you are pregnant, are planning to conceive, or if you or your practitioner suspect a menstrual problem. That’s why it’s good to get into the habit of using a menstrual calendar.
In adults, normal menstrual cycles occur every 24 to 35 days and last a week or less. Teenagers and women near menopause are more likely to experience irregular cycles, but a good rule of thumb is that periods should not come closer than three weeks apart and the bleeding should not last more than eight days.
Your doctor may want to see a record of your menstrual cycles if there are any concerns about menstrual irregularities or if you are trying to get pregnant.
Treatments for Menstrual Cramps
It is unfortunate but true that many women and girls experience menstrual cramps during their monthly period. For some, the discomfort is just an annoyance; but for others, the cramps actually can be quite debilitating. No matter what the situation, though, most women are likely to jump at the chance to make the belly pain, headache, and lower-back pain go away.
Treatment for menstrual cramps can be tried in stages, starting with comfort measures, then moving to over-the-counter (OTC) medications, prescription cramp medicine, and finally, hormonal treatments. While you may be tempted to jump right to one of the later measures, a majority of girls and women can save themselves the time and added expense and get effective relief from simple comfort measures or OTC pain relievers.
Many people get some relief from cramps with the use of a heating pad or hot water bottle or by taking a warm bath. And while it may not seem intuitive, regular exercise also seems to help stave off bad cramps. Even involving yourself in distracting activities–something as simple as listening to music or calling a friend–can make you feel better. We all know that any pain hurts worse when we focus on the problem and don’t give ourselves a reason to feel better.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Comfort measures can help but are not always adequate. Since uterine hormones called prostaglandins are responsible for causing menstrual cramps, medications in the nonsteroidal family of drugs, which prevent production of these hormones, work well to alleviate symptoms.
This class of drugs includes ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve), available in nonprescription strengths. Most of the combination medications marketed for menstrual cramps, such as Midol, also contain NSAIDs.
If the over-the-counter strengths are not enough, prescription NSAIDs can be used. Acetaminophen (Tylenol) and aspirin usually are not effective.
Key points about NSAIDs
- Doctors used to think that you had to start taking medication the day before your period began. Now it turns out relief starts within an hour of the first dose, which can be taken as needed. As with all pain treatment, though, it’s easier to resolve menstrual pain early on, before it becomes excruciating.
- Most cramps are worse the first day or two of the cycle, so a lot of girls and women find that they can get good control of their pain with just a few days of medication.</l
- Studies have shown that these drugs also help to alleviate the nausea, diarrhea, and headache that may accompany a woman’s period.
- One well-known side effect of NSAIDs is that blood may not clot as well. However, if you usually have heavy periods and are avoiding NSAIDs because you don’t want your flow to get any heavier, you might want to rethink your decision. The fact is, most people on NSAIDs do not see an increase in blood loss during their period, and NSAIDs have actually been shown to decrease the menstrual flow for some conditions.
- People who are allergic to aspirin or NSAIDs, who take prednisone or other steroids, or who have had stomach ulcers or other gastrointestinal problems should consult a physician before taking NSAIDs.
Birth control pills, the birth control patches and vaginal rings not only are an effective method of birth control, but they also work extremely well at diminishing menstrual pain. By the third or fourth month of using them, many women who suffered horribly in the past are pain-free.
This may not be a viable option for younger patients, though, for several reasons. First, many parents are concerned about the health effects of the Pill and these other similar methods. They also may worry that having their daughters take birth control pills to treat cramps will only encourage them to start sexual activity at an earlier age. (While it really would be better for everyone if birth control pills could be called “cycle control pills” and not packaged as contraception, this is not likely to happen.) It may be reassuring for parents to know, however, that studies have shown that using the Pill for medical reasons does not increase the likelihood of sexual activity in teenagers.
As for the girls themselves, some young teens might find it embarrassing to be on the Pill, and most teenagers worry about side effects, such as weight gain.
If you decide to take the Pill, the Patch or the Ring to treat your cramps, keep in mind that it doesn’t reach its maximal benefit until a few cycles have passed. Try to be patient, and don’t pass final judgment until about four months into the course of treatment. Cramps that don’t respond to hormonal contraceptives and NSAIDs may be a sign of a medical condition. Be sure to see your doctor again if you have cramps between periods or if you do not see improvement after four cycles.