DRHOOK- Monthly misery: Menstrual cramps sometimes debilitating

"Cramp your style? Someone pulling you off stage while you're singing karaoke can cramp your style. Your spouse telling you that your next business venture must have come from a brain-injured baboon can cramp your style. A co-worker who sarcastically asks if you have a mirror at home can cramp your style.

 What happens if your uterus cramps your style?

 Primary dysmenorrhea is medical jargon for lower abdominal pain that repeatedly happens with menstrual periods. For lucky ladies, the pain is minimal and doesn't interfere with daily activities. For the less fortunate, the menstrual cramps are so bad they can lead to fatigue, headache, vomiting, and diarrhea; and over-the-counter pain pills might not help at all. 

 Heating pads applied to the lower abdomen can help alleviate menstrual pains, though one must be careful to avoid burning the skin. I have known some folks to fall asleep with an electric heating pad, only to awake looking like a pot roast.

 Though diet books and vitamin supplement articles tout amazing results, I'm usually skeptical because they aren't FDA studied and approved. Nonetheless, this is what I have read. 

 Vegetarians might have fewer menstrual pains and of shorter duration. (So those who pop a Midol or Motrin really could have had a V8!) Vitamin E in high doses was associated with heart attacks in one large study, but about 400IU a day might decrease menstrual cramps. I know a lot of women who take 200mg of vitamin B6 daily, as well as 100mg of vitamin B1 to reduce their pains. Fish oil with 1080mg EPA and 720mg DHA might reduce menstrual pains, as well as be good for the heart!

 Exercise. (Oooh, did this word make you shudder?) I have to substitute the word "physically active" for "exercise" for about half my patients, because the latter is considered taboo. Exercise does appear to decrease menstrual pains– although, go figure, one study showed competitive sports made it worse. (But what were the sports, rugby and boxing?)

 Biofeedback, coping strategies, and other perceptual modifications might be helpful. For those who still suffer with pains, pills might be beneficial. A friend just told me today that nothing worked for her except magnesium. I had never heard of that, but some small studies show it reduced symptoms. (Just don't overdo it: magnesium can cause low blood pressure and diarrhea.)

 Oral contraceptives are commonly used to decrease the severity of menstrual bleeding and to reduce pain. However, women who smoke (in particular those 35 years old and older) are more at risk for blood clots when they're taking hormones.

 Ibuprofen is often used to cool the cramps. The problem with ibuprofen is that many folks are taking too high a dose, which can wreak havoc on the stomach, kidneys, and liver. I think over-the-counter medicine directions should be followed like a recipe in baking a cake: do it by the book or your cake will flop. Tylenol is also used, although I have never found a patient to tell me it is effective for menstrual pains. Some NSAIDs like Ponstel and Celebrex have been prescribed to alleviate cramps.

 For those who are out of commission once a month, a gynecologist will likely have to explore the pelvis to see if anything else might be causing the pain. 

 Egad! Menstrual cramps sound terrible! Having someone put a cramp in your style is one thing, but having menstrual cramps is a punch below the belt.

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Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.

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