Help, I’ve Got Cramps!
Otherwise known by doctors as “dysmenorrhea”, cramps are the leading cause of school absences in adolescent girls, and a source of significant distress in reproductive aged women. Primary dysmenorrhea is diagnosed when a history and physical examination have ruled out other known anatomic or functional reasons for menstrual pain. The pattern of pain is that it begins just before and may continue for up to three days during the menstrual flow. The pain may be sharp or dull, intermittent or achy, and can be accompanied by upset stomach, diarrhea or constipation, headaches, fatigue, and irritability. The incidence of this problem is greatest in teenage girls, affecting as many as 90% at least occasionally. Factors which increase the likelihood of this problem include never having delivered a child, a heavy menstrual flow, smoking cigarettes, and depression. Dieting can also increase the complaint. The actual causes of the uterine contractions are the prostaglandins contained within the menstrual blood and elevation in the pituitary hormone called vasopressin.

Studies are not clear as to whether cramps can be a sign of hidden endometriosis. Clinically speaking, I know that cramps are much more likely in women with too much estrogen and not enough progesterone. Almost all cramps patients will be found to be “estrogen dominant” on salivary sex hormone testing. Since that type of physiology is also conducive to the later development of endometriosis, the two conditions may share the same pathophysiology. For this reason I feel that cramps serious enough to result in sick days are worthy of a medical workup. Identifying the common hormone imbalance early can reduce the later risk or PMS, endometriosis, fibroids, and probably even breast cancer. Teens are likely to just use over the counter anti-inflammatories rather than seeing a doctor unless encouraged to do so. In older women, tubal ligation has often been thought to bring on cramps when they didn’t exist before. I have noted this correlation in the clinic, but at least one well designed study failed to demonstrate a significant correlation. Be aware of this possibility if you do have your tubes tied.

Most physicians automatically start treatment with non steroidal anti-inflammatory drugs (NSAIDS). These drugs block the action of prostaglandins plus have a direct analgesic effect and reduce the volume of the menstrual flow. They are maximally effective when they are started just before the onset of the period. All the specialized treatments that follow or replace NSAIDS are more costly, more dangerous, and more likely to fail. Such treatments include Danazol, Lupron, depo-Provera, and oral contraceptives. There are not a lot of studies on life style modification and menstrual cramps, but I can tell you from experience that this is important. Trans fatty acids and an excess of omega 6 oils in the junk filled American diet cause problems. Widespread magnesium deficiency makes magnesium replacement therapy worthwhile. Magnesium is used in hospitals to slow down and ease premature uterine contractions in labor. The patient must stop smoking. There are several herbs that can help with cramps. As mentioned above, most patients with cramps have a relative progesterone deficiency. This can easily, effectively, and safely be managed after sex hormone testing with natural progesterone cream, with major short and long term benefits. Acupuncture has helped some patients, but in my opinion it is mostly of temporary palliative benefit. Overall my results with primary dysmenorrheal have been almost overwhelmingly positive. While some drug companies assess the public relations, medical, and ethical damage from the Vioxx anti-inflammatory drug fiasco, and others work feverishly on a new vasopressin receptor antagonist drug, or a hormone laced IUD, see your natural medicine doctor instead and get rid of your cramps naturally!