Download TREATMENT OF MENSTRUAL CRAMPS Menstrual cramps

TREATMENT OF MENSTRUAL CRAMPS
Menstrual cramps (dysmenorrhea) affect about one half of menstruating women. The
cramping pain begins a few hours before or just after the onset of menstrual flow and
usually lasts 48 to 72 hours. It is characteristically strongest over the abdomen and may
radiate to the back or inner thighs. Some women also experience nausea, vomiting,
fatigue, diarrhea, and headache.
At the onset of a menstrual period, the lining of the uterus begins to slough off. The
uterus as a consequence of this process releases chemicals called prostaglandins.
Prostaglandins cause increased uterine contractions and the sensation of cramps, along
with many of the above listed symptoms. Treatment of cramps focuses on decreasing
the production of prostaglandins.
GENERAL RULES
1. Take pain medications at the first sign of cramps to help prevent them from worsening
in intensity.
2. Take pain medications with food to help prevent stomach upset.
3. Take the lowest effective dose of pain medications.
STEP #1: OVER-THE-COUNTER MEDICATIONS
Acetaminophen (Tylenol): A pain reliever which can be offered at 500 mg-1000mg
every 6 hours
Ibuprofen (Midol-IB, Advil, Nuprin, Motrin): A nonsteroidal anti-inflammatory drug
(NSAID) which works by blocking prostaglandin production. Starting dose is one tablet
(200mg) every 4 to 6 hours. Can increase the dose up to 4 tablets (800mg) every 6
hours
Naproxen (Aleve): Also a NSAID. Starting dose is two tablets (220mg x 2 = 440mg)
then one tablet every 8 to 12 hours. Can increase the dose to 2 tablets every 8 to 12
hours.
Designated products (Maximum Strength Midol, Pamprin, etc.): These products
generally contain acetaminophen 500mg but may also contain additives such as caffeine
and antihistamines.
Read the product ingredient label prior to use of these over the counter products and do
not exceed the recommended daily dose
.
STEP #2: PRESCRIPTION PAIN MEDICAITONS
Ibuprofen (Motrin): Same as over the counter ibuprofen, but in prescription strength
tablets. Take one tablet (800mg) every 6 hours.
Naproxen (Anaprox DS): Same as Aleve, but in prescription strength tablets. Take
one tablet (550mg) every 8 to 12 hours.
STEP #3: OVULATION SUPPRESSION WITH ORAL CONTRACEPTIVE PILLS
Birth control pills are an effective way to minimize menstrual cramps. By suppressing
your own hormonal fluctuations, prostaglandin production and cramps are also reduced.
In addition, birth control pills reduce the amount of menstrual flow. The pills are taken for
21 to 24 days out of the 28-day cycle (depending upon which product is prescribed).
Some of the newer low dose pills are given 24 days out of 28). Once all the active
ingredients have been taken, most birthc ontrol pills have a row or 4 to 7 days of a
placebo. Some of the newer pills may include iron pills or low dose estrogen pills at the
end of the pack. It is best to take all of the pills in your pack. If you are
supposed to start a new pack, have it available.
Once a patient is cycling on the oral contraceptive pills, she may choose to take the
active ingredients in a continuous manner. This is not harmful to the body. Many patients
take the 21 (24) active pills for 2 months or 3 months in a row by skipping the placebo
pills. This allows you to have less frequent periods, less cramping and you are in
control of when to have your period!You should try to take your pills at the same time of
day. every 24 hours. Try to remind yourself not to forget by setting the alarm on your cell
phone or wrist watch.
Many patients with severe cramping use both ovulation suppression with birth control
pills and pain medications simultaneously for best symptom relief.
-------------STEPS #1 THROUGH #3 WORK FOR 95% OF PATIENTS!!!!----------------STEP #4: LAPAROSCOPY OR OTHER IMAGING TECHNIQUES
If a combination of the first 3 steps fails, more serious causes of menstrual pain should
be investigated. Laparoscopy is a surgical procedure performed with a fiber optic
laparoscope (camera) through tiny incisions in the abdomen. The scope is used to look
around the abdomen and
pelvis for a cause of menstrual pain, such as endometriosis, infections, and adhesions
from previous surgery, or birth defect (congenital anomalies) of the reproductive system.
Once your doctor is able to diagnoses the cause of your pain it will be easier to help you.
Update 1/05/07