Menstrual mayhem: managing the monthly madness

by Marla Hardee Milling

Painful cramps. Back pain. Moodiness. Headaches. These are just a few of the symptoms many women experience each month during their menstrual cycles. Other women seem to sail through their reproductive lives without any pain—not even a cramp. What makes the difference?

Most women get their period on a consistent 28-day cycle, but that doesn't mean that the painful symptoms are the same each month. Menstrual pain (dysmenorrhea) can change throughout a woman's life, and it can be affected by such things as childbirth, exercise, pain remedies and diet.

Childbirth and menstrual pain

"Before my first child I had horrible cramps every month," says Dana Nourie of San Jose, California. "They would literally have me crying in my pillow all night long. After I had my son they became very mild. With the birth of my daughter, they returned but mildly. After my third child, they got worse, but I only get cramps every other month. In addition, now I get a really bad PMS day."

Dr. Kelly Shanahan, who practices at Woman to Woman Health Care in South Lake Tahoe, California, says one possible explanation is a change in prostaglandin receptors. "Prostaglandins are involved in menstrual cramps and changes in receptor numbers or sensitivity may lead to less cramping after childbirth," says Dr. Shanahan. "Some women may cramp because their periods are fairly heavy and their cervixes are fairly tight; the uterus has to really contract down to push the blood out through a small opening. After having a baby, the cervix is more open, so flow may be easier."

Pregnancy and breastfeeding may also bring a temporary halt to menstrual pain if it is caused by endometriosis. In women with endometriosis, the lining of the uterus is found in other areas of the pelvic region. Dr. Shanahan says that after pregnancy, it may take a while for the endometriosis to return to the point of producing pain. She adds, "With age, conditions like fibroids (benign growths of the uterine wall) may occur and contribute to more cramping."

Pain? What pain?

While millions of women suffer from various degrees of discomfort each month, other women say they've never experienced an unpleasant period. Mona Vanek of Noxon, Montana, says she's never had even a twinge of menstrual pain. Mona believes her active lifestyle—swimming, horseback riding, hunting, fishing, hiking, mountain climbing—may have kept her pain free.

"I've heard it said that people of 'peasant stock' are sturdier and less inclined to illness. Perhaps that's so. Both my maternal and paternal grandparents and great-grandparents worked in agriculture, homesteading and building up their own land," says Vanek. "I'm a do-it-yourself, self-reliant sort of person, too. Whether it's our genes or our attitudes, I'm very grateful, now that I'm aware other women are not so lucky."

"Women who experience less cramps either secrete lower amounts of prostaglandins—the chemical substance responsible for uterine contractions—or they have higher pain thresholds," says Dr. Shanahan. She also notes that regular exercise can help alleviate menstrual pain. "Exercise may help desensitize the body to prostaglandins or may help by increasing endorphin levels (endorphins are "feel good" hormones). Regular exercise three times per week is most effective, and a combination of cardiovascular (aerobic) exercise and strength training (weights) is probably best," says Shanahan.

Fighting the pain

If you suffer from monthly menstrual pain, the following suggestions may offer some relief:

• Get regular exercise.
• Use a heating pad on your lower abdomen.
• Relax in a warm bath.
• Take ibuprofen.
• Put a couple of teaspoons of apple cider vinegar in a glass of warm water and drink it two to three times a day.
• Drink a cup of herbal tea, such as chamomile, red raspberry, or ginger.
• Certain herbal oils have been used for thousands of years for the relief of menstrual cramps, including basil, chamomile, cypress, ginger, jasmine, juniper, and lavender.

Medications

• "Because cramps are mediated by prostaglandins, the most effective pain relief comes from antiprostaglandin and non-steroidal anti-inflammatory medications like ibuprofen (Motrin, Advil), naprosyn (Anaprox, Aleve) or Celebrex," says Dr. Shanahan. "Try over-the-counter preparations first, although prescription strengths are available for severe cramps. One tried-and-true trick is to take the medication from the first hint of the onset of a period, round the clock until the period is over; this prevents the cramps from ever reaching intolerable levels. Your doctor will work out what the best dose and frequency should be. Birth control pills or Depo-Provera shots may also be prescribed to relieve menstrual cramps."

Alternative therapies

• In The Menstrual Cramps Self-Help Book (see Resources section), Dr. Susan Lark recommends a massage- acupuncture technique to reduce the cramps and body aches. According to Lark, working on the side of the body that has the most discomfort seems to relieve the symptoms on both sides, because energy or information seems to transfer from one side to the other.

Diet makes a difference

What you eat can have an impact on the severity of menstrual cramps. Many women crave sweets, especially chocolate, around the time of their periods. Instead of eating a lot of sugar or salty foods, the best bet is to eat a low-fat, high-fiber diet to help keep your body in balance. Although temporarily easing your cravings, eating lots of salt will just cause you to retain more fluid and feel even more bloated.

Calcium is another important element in controlling menstrual pain, according to a recently published study in the American Journal of Obstetrics and Gynecology by Dr. Susan Thys-Jacobs, director of the Metabolic Bone Center at St.Luke's-Roosevelt Hospital Center in New York City.

"In the cells and tissues, calcium has a major function in many biochemical processes, neuromuscular activities, muscular excitability, hormonal secretion, and coagulability," says Thys-Jacobs. The revised adequate intake levels in the USA now recommend 1300 mg per day for girls 14 to 18 years old, and 1000 mg per day for women ages 19 to 50."

"Women of reproductive age, and especially those suffering with PMS, should ingest at least 1200 mg of calcium daily to relieve their symptoms," continues Dr. Thys-Jacobs. She adds that while women can add calcium through their diets, the majority of females would benefit from taking a chewable, calcium supplement such as Tums.

In terms of adding calcium to your diet, she recommends the following:

• milk
• yogurt
• cheese
• green leafy vegetables such as spinach and collard greens

Nearing menopause