What is the treatment for common menstrual cramps (primary dysmenorrhea)?

Every woman needs to find a treatment that works for her. Perhaps the most common
treatment, especially in the past, has been to lie down at the first sign of pain. It used to be
that many women's restrooms contained a cot or a couch so that a woman who felt
"indisposed" could lie down. A bed in the school nurse's office served the same purpose
and girls were routinely excused from physical education or other classes because of
menstrual cramps.
Current recommendations include not only adequate rest and sleep, but also regular
exercise (especially walking). Some women find that abdominal massage, yoga, or
orgasmic sexual activity help. A heating pad applied to the abdominal area may relieve the
pain and congestion.
A number of nonprescription (over-the-counter) agents can help control the pain as well as
actually prevent the menstrual cramps themselves. For mild cramps, aspirin or
acetaminophen (Tylenol), or acetaminophen plus a diuretic (Diurex MPR, FEM-1, Midol,
Pamprin, Premsyn, and others) may be sufficient. However, aspirin has limited effect in
curbing the production of prostaglandin and is only useful for less painful cramps.

The main agents for treating moderate menstrual cramps are the nonsteroidal
inti-inflammatory drugs (NSAIDs), which lower the production of prostaglandin and lessen
its effect. The NSAIDs that do not require a prescription are:ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others);naproxen sodium (Aleve, Anaprox); and ketoprofen (Actron, Orudis KT).

A woman should start taking one of these medications before her pain becomes difficult to
control. This might mean starting medication 1-2 days before her period is due to begin and
continuing taking medication 1-2 days into her period. The best results are obtained by
taking one of the NSAIDs on a scheduled basis and not waiting for the pain to begin.
Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic
acid (Ponstel).

What if the cramps are very severe?

If a woman's menstrual cramps are too severe to be managed by these strategies, her
doctor might prescribe low dose oral contraceptives containing estrogen and progestin in a
regular or extended cycle. This type of approach can prevent ovulation (the monthly release
of an egg) and reduce the production of prostaglandins which, in turn, reduces the severity of
cramping and causes a light menstrual flow.
Use of an IUD that releases small amounts of the progestin levonorgestrel directly into the
uterine cavity, has been associated with a 50 percent reduction in the prevalence of
menstrual cramps. In contrast, IUDs that do not contain hormones, such as those
containing copper, may worsen menstrual cramps.

Are there surgical solutions?

In the past, many women with menstrual cramps had an operation known as a D&C
(dilatation and curettage) to remove some of the lining of the uterus. This procedure is also
sometimes used as a diagnostic measure to detect cancer or precancerous conditions of
the uterine lining. Some women even resorted to the ultimate solution to menstrual
problems by having a hysterectomy, surgery that removes the entire uterus.
Today, when a woman has abnormally heavy and painful uterine bleeding, her doctor may
recommend endometrial ablation, a procedure in which the lining of the uterus is burned
away or vaporized using a heat-generating device.

What is the treatment of secondary menstrual cramps (dysmenorrhea)?

The treatment of secondary dysmenorrhea depends on its cause. There are a number of
underlying conditions which can contribute to the pain including:

	Endometriosis (cells from the uterine lining tare located in other areas of the body);
	Uterine Fibroids (non-cancerous uterine growths that respond to estrogen levels);
	Adenomyosis (a benign condition in which the cells of the inner uterine lining invade its muscular wall, the myometrium);
	Pelvic Inflammatory Disease (PID);
	Adhesions (abnormal fibrous attachments between organs); or
	Use of an intrauterine device (IUD) for contraception.

What is the long term outlook (prognosis) for menstrual cramps?

In general, a woman's menstrual cramps do not worsen during her lifetime. In fact, the
menstrual cramps of primary dysmenorrhea usually diminish with age and after pregnancy.
This is thought to be due to the fact that the nerves of the uterus degenerate with age and
disappear late in pregnancy, with only a portion of these nerves regenerating after childbirth.
When there is secondary dysmenorrhea with an underlying condition contributing to the
pain, the prognosis depends on the successful treatment of that condition.
As women have learned more about their bodies and how to maintain them in maximum
health, menstrual cramps have become less of a debilitating illness, and more often,
merely a minor monthly inconvenience. Read more about natural remedies for cramps.

Menstrual Cramps At A Glance

	Menstrual cramps are periodic abdominal and pelvic pains experienced by women.
	More than half of all menstruating women have cramps.
	The cramps are severe in at least one in seven of these women.
	Medically, menstrual cramps are called dysmenorrhea.
	Primary dysmenorrhea is common menstrual cramps without an identifiable cause
	Secondary dysmenorrhea results from an underlying abnormality that usually involves the woman's reproductive system.
	Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat cramps
	Physical exercise can help alleviate menstrual cramps.
	Menstrual cramps tend to improve with age   (by Melissa Conrad Stöppler and William C. Shiel Jr)