Menstrual Cramps

For Christiane Northrup, M.D., menstrual cramps have been a persistent and painful fact of life. "As a teenager, I had such severe cramps that I sometimes was sent home from school," recalls Dr. Northrup, founder of the Women to Women health center in Yarmouth, Maine, and past president of the American Holistic Medical Association. "And during my medical residency; I once had to excuse myself from surgery­that's how miserable I felt."

Such incapacitating pain is the exception rather than the rule. Still, roughly half of all women of reproductive age experience some degree of menstrual cramping every month.

Cramps are actually the result of contractions. Every month, as part of your menstrual cycle, your uterus undergoes certain changes to prepare itself for the arrival of a fertilized egg. If the egg remains unfertilized-that is, if you don't become pregnant-the uterus has no need for the blood-rich lining that would have provided nourishment for a developing fetus. So your uterus expels its lining by contracting. You experience the contractions as cramps.

Cramping causes pain by interfering with blood flow, which temporarily limits the amount of oxygen available to the uterus. The pain is made worse by hormones called prostaglandins, which are released by your uterus and uterine lining during menstruation.

For most women of reproductive age, "menstrual cramps" means 1 to 3 days of mild to moderate abdominal pain around the time of their periods. But an estimated 10 percent of women experience more severe cramping, characterized by stronger, longer-lasting, and more frequent uterine contractions. Such intense cramping may be accompanied by nausea, vomiting, diarrhea, headache, fatigue, dizziness, and nervousness.

A number of factors influence the degree of menstrual cramping that you experience. For example, the more prostaglandins you produce, the more painful your cramps are. Smoking makes cramps worse, too, by constricting blood vessels and impeding blood flow in the uterus.

Best Choices

Nutrition

Frequently feast on fish. Cold-water fish such as salmon and oil-packed sardines are rich in omega-3 fatty acids, Dr. Northrup explains. Omega-3's inhibit uterine production of prostaglandins, the hormones that contribute to menstrual cramps.

Limit fats and sweets. Meats and high­fat sweets such as cakes, cookies, and candy stimulate the production of prostaglandins. Dr. Northrup suggests eating meat no more than twice a week and cutting way back on sugary junk foods.

Ditch dairy foods. According to Dr. Northrup, some of her patients have managed to rein in menstrual cramping by eliminating dairy products from their diets. "This doesn't work for everyone," she says, "but it helps often enough to be worth a try."

Supplements

Favor fish-oil capsules. To reap the benefits of omega-3 fatty acids without eating fish, take fish-oil capsules instead. Research has shown that supplemental fish oil can relieve menstrual cramping. You can buy fish oils in health food stores and some drugstores. Follow the dosage instructions on the label.

Embrace vitamin B6. Many nutrition­minded health practitioners recommend vitamin B6 as a treatment for premenstrual syndrome. But some also prescribe the vitamin for menstrual cramps. Take 300 milligrams of B6 every day while you have cramps, advises clinical nutritionist Shari Lieberman, Ph.D. But check with your doctor first, since vitamin B6 dosages over 100 milligrams should only be taken under medical supervision.

Don't miss out on magnesium. The mineral magnesium helps relax the smooth muscle tissue of the uterus, reducing the severity of uterine contractions. Dr. Northrup suggests taking 100 milligrams of magnesium every 2 hours during your period and two or three times a day during the rest of your menstrual cycle.

Boost your intake of bromelain. An enzyme found in pineapple, bromelain also helps relax the smooth muscle tissue of the uterus, says Joseph Pizzorno Jr., N.D. He suggests taking 250 to 500 milligrams three times a day between meals for the duration of your period.

Exercise

Stay one step ahead of pain. Physical activity of any kind boosts your body's production of natural pain-relieving compounds called endorphins, explains Anne Simons, M.D. The more strenuous your workout, the more endorphins your body churns out.

Aromatherapy

Sniff soothing scents. Inhaling certain essential oils helps relax you, which reduces the intensity of menstrual cramping. Mindy Green, an herbalist in Boulder, Colorado, and coauthor of Aromatherapy: A ComPlete Guide to the Healing Art, offers the following anti-cramping "recipe": Place a few chips of rock salt in a small vial. The salt absorbs the oil, so it doesn't spill. Add the following essential oils to the vial: 4 drops of lavender, 2 drops of marjoram, 2 drops of chamomile, and 3 drops of geranium. Then when you feel cramps coming on, just uncap the vial and inhale deeply.

Herbal Medicine

Have haw. Native American women used the bark of black haw, a woody white flowered shrub, to treat gynecological complaints. The herbal remedy caught on among colonial women, who dubbed it cramp bark and relied on it to ease menstrual cramps.

You'll find black haw-sometimes called viburnum-sold in several forms in health food stores. If you buy the tincture, take 2 teaspoons three times a day, mixed into juice.

Reach for raspberry. For centuries, herbalists have prescribed raspberry leaf tea as a treatment for menstrual cramps as well as for the uterine irritability associated with pregnancy.

The beneficial compound in raspberry leaf is called oligomeric procyanidin, or OPC, says James A. Duke, Ph.D. You can get OPC in a supplement called pycnogenol, but he says that it's expensive.
Instead, Dr. Duke suggests drinking raspberry leaf tea during your period. To make the tea, add a teaspoon or two of the herb to 1 cup of boiled water. Allow to steep for 10 minutes, then strain and drink.

Feel better with black cohosh. Black cohosh contains plant estrogens, also called phytoestrogens. These suppress the secretion of luteinizing hormone, which plays a role in menstrual cramps. The herb has proved so effective for cramping that it has received the endorsement of Commission E, the German panel that evaluates the safety and effectiveness of herbal medicines.

Choose the tincture form, suggests Christopher Hobbs, L.Ac., an herbalist in Santa Cruz, California, and the author of several authoritative herb guides. Take 2 to 4 droppersful of the tincture two or three times a day for a few days before your period as well as during your period.

Chiropractic

Adjust to life without cramps. At the National College of Chiropractic in Lombard, Illinois, researchers studied 45 women who had long histories of severe menstrual cramping. Half of the women received chiropractic spinal manipulation, while the rest received treatment that mimicked chiropractic but wasn't actually spinal manipulation. Blood tests before and after the treatment sessions showed that the women in both groups experienced decreases in pain-provoking prostaglandins. But only the women who received real spinal manipulation reported less cramping.

Chinese Medicine

Get your Blood going. When treating women with menstrual cramps, Efrem Korn­gold, O.M.D., L.Ac., often prescribes one of two herbal formulas. One has pseudoginseng root as its active ingredient. The other is a combination of Chinese angelica (dang gui), peony root, turmeric root, and several other herbs.

Count on on-the-spot relief. Both the United Nations World Health Organization and the National Institutes of Health endorse acupuncture as a treatment for menstrual cramping. That's no doubt because of the compelling scientific evidence proving that acupuncture really works.

According to Dr. Korngold, an acupuncture session to relieve menstrual cramps may include stimulation of the following points.

• Spleen 6, located four finger-widths above your inner anklebone on the back inner border of your shinbone
• Liver 3, situated on top of your foot in the webbing between your big toe and second toe
• Large Intestine 4, located on the back of your hand where the bones of your thumb and index finger meet

If you prefer a do-it-yourself approach, you can stimulate each of the above points with acupressure. Apply steady, penetrating finger pressure to each point for 3 minutes, suggests Michael Reed Gach, founder and director of the Acupressure Institute.

Home Remedies

Warm your abdomen. Many women swear by heating pads, hot-water bottles, and hot baths to relieve menstrual cramping-and with good reason, according to Martin 1. Rossman, M.D. "Every kind of pain, including cramping, has an anxiety component;" he explains. "Heat is relaxing. When you feel relaxed, menstrual cramps don't bother you as much."

Drink plenty of fluids. If you become dehydrated, your brain releases a hormone called vasopressin that instructs your body to conserve water. Unfortunately, vaso pressin also increases the intensity of uterine contractions. The best way to derail this process is to drink lots of fluids so that you stay hydrated. "Sipping water, juice, or noncaffeinated tea throughout the day helps some women control their menstrual cramps," Dr. Simons says.

Furlough the tampons. It's possible that wearing tampons can aggravate menstrual cramping in some women. If you use tampons, try switching to sanitary napkins for a while and see if that helps.

Over-The-Counter Drugs

Reach for a prostaglandin inhibitor. According to the American Pharmaceutical Association, nonsteroidal anti-inflammatory drugs (NSAIDs) do the best job of all the over-the-counter medicines in relieving menstrual cramps. The NSAIDs include aspirin, ibuprofen, naproxen (Aleve), and keto­prof en (Orudis KT). All of them work by decreasing uterine production of pain-provoking prostaglandins. Of the NSAIDs, ibuprofen is your best choice, says W: Y Chan, Ph.D., a pharmacologist at Cornell University in New York City.

For an NSAID to effectively stop prostaglandin production, you should begin taking it 3 days before the expected start of your period. Continue taking the medication on a round-the-clock schedule according to label directions for the duration of your period. If your cramping has already started, you can still get relief from NSAIDs.

Other Good Choices

Homeopathy

Pick the right remedy. Homeopaths prescribe an array of medicines for women with menstrual cramps. Pulsatilla works well if your cramps are accompanied by occasional nausea, especially if your menstrual flow changes from month to month, says homeopath Dana Ullman. Belladonna is effective for intense cramps that begin suddenly. But Magnesia phosphorica or Colocynthis is a better bet if you get some relief by massaging your abdomen or applying heat.

Because homeopathic prescriptions are based on a wide array of symptoms and personal characteristics, your best bet is to visit an experienced homeopath, who can determine which medicine is best suited to you.

Ayurvedic Medicine

Bring balance to Vata. Ayurvedic practitioners view menstrual cramps as an inibalance of Vata, one of three doshas that make up your constitution, according to Raymond Rosenthal, M.D., a physician in Kona, Hawaii, who practices integrated medicine. He recommends rebalancing your Vata and nurturing your uterus and ovaries by eating more fish, getting sesame oil massages (panchakarma), and taking various medicinal herbs. One especially effective herb is called shatavari, which Dr. Rosenthal suggests using in a dosage of 3 to 6 grams a day. Shatavari is available from Ayurvedic practitioners.

Madical Measures

If none of the above therapies provides sufficient relief from menstrual cramps, your doctor may put you on stronger prostaglandin inhibitors. Even though they are sold as Motrin and other familiar brand names, these medications are available by prescription only.

As an alternative to the prostaglandin inhibitors, your doctor may give you the option of going on oral contraceptives. For some women, birth control pills effectively reduce cramping.

Red Flags

See your doctor promptly if you experience any of the following:

• A sudden increase in the intensity of your menstrual cramps
• Menstrual cramps accompanied by fever, vomiting, chills, or any unusual vaginal discharge
• A sudden increase in the volume of your menstrual flow
• Severe cramping or pain that isn't related to menstruation
• Pain radiating into your thigh