Meds for menstrual pain

I suffer from painful cramps and bloating during my period. What can I do to alleviate these symptoms?

You’ll have your period about 400 times in your life—so you’d better make sure it’s as painless as possible! Half of all women experience painful periods (called dysmenorrhea), which usually start a year or two after their first period. The frequency of painful periods usually decreases as you age or after you have had a baby.

Pain and cramping in the abdomen and pain in the lower back can range from mild to severe, lasting two or three days. Severe cramping may be accompanied by nausea, vomiting and diarrhea. Some women may also experience breast tenderness, bloating and weight gain.

There are a number of things you can do to feel better during your period. Regular aerobic exercise helps to relieve stress, reduce bloating and promote good blood flow throughout your body. You may find that heat reduces your discomfort because it relaxes your muscles, so try taking a warm shower or bath, or use a heating pad or hot water bottle on your abdomen. Drinking alcohol during your period, smoking or being overweight may increase the chance that you experience painful cramps, so make healthy choices. Other research has shown that limiting your caffeine consumption may reduce breast tenderness. Research also suggests that calcium may decrease moodiness, pain and bloating, so taking a calcium supplement (500 milligrams, twice a day) or eating calcium-rich foods such as milk, yogurt and other dairy products may help reduce symptoms.

During ovulation, an egg is released, typically occurring around Day 14 of your cycle. If the egg is not fertilized, there is a shedding of the uterine lining (also known as your period or menstruation). Prostaglandins are like chemical messengers. Released just prior to your period, prostaglandins cause the signs and symptoms of painful periods. Your doctor may prescribe birth control pills, which are about 90 per cent effective in treating painful periods.

Birth control pills reduce the amount of prostaglandins that your body produces. The pill can be dangerous if you have a blood-clotting disorder or heart condition, or if you are over 35 and smoke. Talk to your doctor for more information. Anti-inflammatories can also be helpful. These kinds of drugs reduce pain and swelling and are about 80 per cent effective in treating period pain. Examples include over-the-counter ibuprofen (e.g. Advil and Motrin) or prescription indomethacin (e.g. Indocid), mefenamic acid (e.g. Ponstan) and naproxen (e.g. Naprosyn). Take these medications with food to lessen the chance of stomach upset. Begin taking them at the start of your period and continue for one or two days.

You should not use anti-inflammatories if you have ulcers or are taking blood thinner medication. You may want to consider taking acetaminophen (e.g. Tylenol) if anti-inflammatories upset your stomach. What about over-the-counter combination products that are specifically aimed at menstrual discomfort? These medications can contain a mild diuretic (pamabrom) to treat bloating, an antihistamine (pyrilamine) to reduce tension and irritability and a painkiller (ASA or acetaminophen). Research suggests that these drugs are not very effective. A prescription diuretic such as spironolactone (e.g. Aldactone) may be helpful for relieving water retention and bloating.

Discuss with your physician whether you would really benefit from a diuretic. Finally, consult your doctor if your cramps get more painful or last longer than a few days as this may indicate that you have a medical condition such as endometriosis or pelvic inflammatory disease.

Colleen Brady is a practising pharmacist in Vancouver and lecturer in the faculty of pharmaceutical sciences at the University of British Columbia.

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