New Drugs Expand the Options for Relieving Monthly Cramps
They’re a monthly pain for half the women of childbearing age and an occasional bugaboo for the other half. Although there’s no magic wand to make menstrual cramps disappear, their causes are now better understood. As a result, there are more treatment options than ever. And if one doesn’t work, chances are another will.
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The Research: Menstrual cramps, described as a feeling of dull achiness or pressure in the lower abdomen, are associated with prostaglandins, natural substances made in many parts of the body. Although researchers began discussing prostaglandins decades ago, there is still much to learn.
When it comes to menstrual cramps, however, prostaglandins in the endometrium--the membrane lining the uterus--are believed to be the culprit. As menstruation approaches, production and release of these prostaglandins increase. This leads to uterine contractions and the resulting pain.
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The Sorority: “Half of women who menstruate have some menstrual pain one or two days a month,” says Alice Kirkman, spokeswoman for the American College of Obstetricians and Gynecologists. For one in 10 women, the pain is so severe that daily activities would have to be curtailed if not for medication.
Cramps are likely to be most severe in teen-agers and to lessen with age. But not always. Women who have given birth tend to have fewer problems with cramps, at least temporarily. It might be due to uterine changes associated with childbirth, says Dr. Penny Wise Budoff, an assistant professor of obstetrics-gynecology (family practice) at Cornell University who has researched cramps.
If you’ve had few problems with cramps but suddenly develop them in your 20s, 30s or 40s, consult a doctor, says Budoff, who also directs a Long Island women’s health center affiliated with Northshore University Hospital. Later onset of cramps could be a tip-off to such abnormalities as fibroid tumors or endometriosis (in which uterine-like tissue is found outside the uterus, often in the ovaries and other pelvic areas).
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The “Two Birds” Approach: Women who need contraception and have cramps often get a twofer by using oral contraceptives, which have been shown to reduce cramps in 90% of women.
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Other Routes to Relief: Many women reach first for aspirin, acetaminophen or special “menstrual relief” medicines, many of which contain acetaminophen.
For more painful cramps, most doctors and pharmacists now recommend a nonsteroidal anti-inflammatory drug (NSAID) such as Advil or Motrin. “Any nonsteroidal that will work for arthritis will work for cramps,” says Sylvia Curry, director of pharmacy at Century City Hospital. Like aspirin, NSAIDs work by inhibiting prostaglandin production.
“If one (over-the-counter medicine) doesn’t work, try another,” Budoff suggests.
“If a nonsteroidal upsets the stomach, take it with food,” Curry adds.
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Stronger Stuff: When over-the-counter drugs aren’t enough, some doctors recommend prescription drugs. Among those frequently prescribed are Ponstel (mefenamic acid) and Anaprox (naproxen sodium), both NSAIDs.
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On the Horizon: This spring, an over-the-counter version of Anaprox, called Aleve, will be on the market, says Linda Thomas of Syntex Corp. in Palo Alto. Each Aleve tablet contains 220 milligrams of naproxen sodium, the same active ingredients as in Anaprox. By prescription, the tablets come in 275 or 550 milligrams.
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Natural Routes: Herbal remedies for cramp relief are available at health food stores. Although some women swear by the formulas, Budoff recommends caution, noting that growing and harvesting methods may vary. “You really don’t know what you’re getting,” she says.
Regular exercise and a nutritious diet seem to minimize problems with cramps, she adds.
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Timetable: Whatever pain medication you choose, take it when the pain starts or a bit before you expect it, experts suggest, so you can nip it in early stages.
Cramps usually begin several hours before or just after the onset of the period, with the first one to two days normally the most uncomfortable.
