Menstrual Cramps

WHEN TO SEE YOUR DOCTOR

* Your cramps are so severe that you cannot attend school or work or keep up your usual activities.

* Your cramps are accompanied by nausea, headaches, diarrhea and vomiting.

* You also bleed very heavily or pass clots for more than one day.

* You have severe cramps and you take birth control pills.

* Your painful cramps began suddenly in adulthood.

* Your cramps are not relieved by taking aspirin or ibuprofen.

* You've just begun to menstruate, and your first or second period causes very severe cramps.

What Your Symptom Is Telling You

Menstrual cramping is one of the few symptoms on a schedule. Cramps arrive with the same relentless regularity as the mortgage payment or the utility bills . . . and are about as welcome.

Ever wonder why something as natural as a woman's monthly cycle should be accompanied by varying degrees of discomfort? Well, so have medical researchers. They've found that a woman's body produces hormones known as prostaglandins to help the uterus contract and shed its lining. The uterus has to contract to create the menstrual flow, and many women experience the contractions as cramps.

Fortunately, most of the time menstrual cramps are relatively mild. More than 50 percent of women experience some sort of cramping, usually starting one to three years after they begin their periods, says Susan Coupey, M.D., a researcher studying common menstrual disorders at Montefiore Medical Center in the Bronx.

How painful your cramps are will depend on how much prosta- glandin your body produces, says John Jennings, M.D., a gynecologist at Bowman Gray School of Medicine of Wake Forest University in Winston-Salem, North Carolina. But if you have persistent, really excruciating cramps, there may be other factors at work as well. You may have an overgrown uterine lining--a condition called endometriosis. Endometriosis often makes cramps hurt worse, Dr. Jennings says.

Or if you cramp during a period that's much heavier than usual, your uterus might be squeezing out blood clots caused by fibroids, says Charles Debrovner, M.D., professor of obstetrics and gynecology at New York University School of Medicine in New York City and a gynecologist at New York University Hospital. Fibroids are benign muscle tumors in the uterine wall. And sometimes a woman may experience cramping that signals the loss of an undiagnosed pregnancy.

Symptom Relief

If your monthly period is accompanied by cramps, who cares if they're common--they hurt! Though you can't help having cramps, there are many things you can do to ease the ache.

Swim away from the pain. Not only does exercise release endorphins--your body's own natural painkillers--but it can take your mind off the cramps. "Of all the things you can do if you have bad cramps, swimming is the least traumatic and most helpful," says Marcia Storch, M.D., director of the women's unit of New York University Student Health Services in New York City and coauthor of How to Relieve Cramps and Other Menstrual Problems.

Relax your muscles for relief. If you feel too cramped up and uncomfortable to even consider swimming, try this gentle exercise from Dr. Storch. It will help relax the muscles that cause the cramps.

Lie on your back on the floor or a bed with your knees bent, your feet flat on the floor or bed and your arms at your sides, palms down. Lightly bounce your belly up and down for a couple of minutes, keeping the muscles loose. While you are bouncing, take short, quick panting breaths. Bounce and breathe for ten breaths. Do this series five times. Rest between series. (Quick, shallow breathing can make you dizzy.) Next, place a big, heavy, soft-covered book (a big-city phone book is fine) across your abdomen. Slowly breathe in through your nose, filling your abdomen and chest with air and pushing the book up. Hold for a count of five. On six, begin exhaling slowly through your mouth, and let the book drop slowly. Contract your stomach muscles and hold for a count of five. Continue deep relaxed breathing for a couple more minutes.

The book creates pressure that can help relieve abdominal spasms, says Dr. Storch.

Put heat where it hurts. Heat feels very good on a crampy ab- domen, says Dr. Jennings. Using a hot-water bottle or heating pad increases blood flow and circulation to your uterus and may help lessen the impact of the naturally occurring chemicals that cause the cramps, he says.

Try relaxing in a warm bath or placing a heating pad or hot-water bottle on the abdomen for 15 minutes. You might want to try gently massaging over-the-counter deep-heating creams or oils into the abdomen. (Warning: Never use these creams and a heating pad at the same time. Combining the two can cause severe burns.)

You can also warm your tummy by sipping hot liquids--clear soups, broth or a nice cup of herbal Chill out your cramps. Some women find that applying cold instead of heat eases cramps. Try putting an ice pack on your ab- domen for 15 to 20 minutes, says Dr. Debrovner. The cold constricts blood vessels, which can bring relief, he explains.

Check out calcium. "Does your diet consist mainly of low-calcium foods like fruits and vegetables? Then make a special point of seeking out low-fat yogurt and low-fat milk," recommends James G. Penland, Ph.D., a psychologist with the U.S. Department of Agriculture's (USDA) Human Nutrition Research Center in Grand Forks, North Dakota.

At least four different studies have shown that calcium offers strong relief from menstrual cramps. Yet, on average, American women tend to consume only about 600 milligrams of calcium daily. (The Recommended Dietary Allowance is 800 milligrams.)

In one USDA research project, Dr. Penland found that women who consumed 1,300 or more daily milligrams of calcium reported a reduction in menstrual cramps. Not only did they report less pain, but also less water retention, improved moods and better concentration.

"One cup of low-fat yogurt will give you about 400 milligrams of calcium, and there are about 300 milligrams in a cup of low-fat milk," Dr. Penland says.

Keep active. Don't give up your normal routines, says Dr. Jennings. If you get up and move around, it can take your mind off the cramps and divert you from the pain.

Coddle yourself a little. Anxiety can increase pain by over 30 percent, says Dr. Storch. So experiencing anything you associate with comfort and ease may help the pain. She suggests Inhibit cramps with ibuprofen. Though the naturally occurring hormone prostaglandin is a normal partner in the menstruation process, some women are extremely sensitive to it, says Dr. De- brovner. Ibuprofen drugs, such as Advil, are among the most effective prostaglandin inhibitors, he says.

Timing is critical to head off the pain of cramps, however. The earlier you take the medicine, the better it works, he says.

"Take it with food at the very first twinge or the very first sign of flow," he suggests. "Usually, ibuprofen for the first day or two of your period is all that's needed."

Love away the pain. Cramps are often accompanied by uncomfortable sensations of pelvic congestion and heaviness caused by dilated blood vessels. Having an orgasm sometimes helps ease the discomfort, says Dr. Debrovner, because the uterine contractions you experience during orgasm also contract the dilated blood vessels that cause that congested feeling.

When Professionals Can Help

If despite your efforts at home treatment, cramps continue to create discomfort every month, consider discussing the problem with your doctor. There are several treatments that might help.

Try the Anaprox antidote. Of all the prescription drugs that calm cramps, Anaprox is the drug of choice for most women, says Dr. Storch, because it's more rapidly absorbed into your system.

"And if you anticipate the cramps, you'll end up taking less medicine," she says. Do you know your period will arrive tomorrow and that heavy cramps are par for the course? "Take an Anaprox before going to bed," she suggests.

Check out biofeedback. If you'd prefer a nondrug cure for cramps, ask your doctor for a referral to a clinical psychologist or psychiatrist in your community who offers biofeedback training.

In biofeedback, you use a monitor that tells you when your muscles are tense and when they're relaxed. Gradually, you learn to identify and "create" relaxed muscles.

A study supervised by Jack May, Ph.D., a psychologist at Florida State University in Tallahassee, showed that women who received biofeedback training reported a very significant reduction of menstrual pain and discomfort.

"Ask for training for a few days at mid-cycle, to learn the techniques for reducing menstrual cramps," Dr. May suggests. "Then when your cycle begins, you can use the biofeedback for cramps control."

See also Pelvic Pain