Greetings!
Happy New Year! I wish you a happy, healthy and prosperous new year. Do you have any resolutions for 2010? Perhaps losing weight? Spending more time with family? Finding more balance between work and personal time? These are honorable goals. Let me know if I can be of help as you embark on these changes in your life. Integrative medicine and holistic nursing have a lot to offer and there are many wonderful resources in the community to help you meet your goals.
In this month's newsletter I talk about how to relieve menstrual pain using an integrative approach. |
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Ask Dr. P
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Dysmenorrhea is the medical term for painful cramping during the menstrual period. Most women who have dysmenorrhea have had it since their first period or it occurred within the first year. This is called primary dysmenorrhea. When women develop menstrual cramps later in life it is usually due to a problem like endometriosis or uterine fibroids. When it is due to another cause it is called secondary dysmenorrhea. Menstrual cramps can be very disruptive to a woman's life. Some women will have backache, nausea, vomiting or diarrhea with their cramps. Severe pain and other symptoms can limit a woman's ability to participate in daily activities such as work and school. The good news is there are many very good conventional and alternative treatments for dysmenorrhea.
Although oral contraceptive pills are often times used to treat dysmenorrhea, there is little evidence to support its effectiveness. A 2009 Cochrane review of the research literature found there was little evidence for pain improvement when the oral contraceptive pill was used to treat primary dysmenorrhea. Oral contraceptive pills and other hormonal methods of contraception are most useful when they are used to suppress menstrual periods so that dysmenorrhea does not occur. Avoiding menstrual periods can be a very helpful strategy for women who suffer from severe dysmenorrhea and are interested in hormonal contraception.
The most common and effective treatment for dysmenorrhea used in conventional medicine is NSAIDs (non-steroidal anti-inflammatory drugs). Ibuprofen (advil or motrin), naproxen sodium (aleve), and aspirin are examples of NSAIDs. The reason they help alleviate menstrual cramping is because they are anti-prostaglandins. Anti-prostaglandins inhibit the release of prostaglandins that are responsible for contraction of the uterine muscle. In addition, anti-prostaglandins can decrease the amount of menstrual blood. This can be very helpful for women who also suffer from menorrhagia or heavy menstrual bleeding (see the newsletter Ebbing the Flow). As you may know, NSAIDS can cause stomach upset and potentially cause cardiac problems in some people. They should always be taken with food.
Fortunately, there are natural anti-prostaglandins that can be used to treat menstrual cramps as well. One example is ginger root. In a 2009 double blind comparative trial (Ozgoli et al.), 250 mg of ginger rhizome powder taken 4 times a day was just as effective as mefenamic acid or ibuprofen. Ginger is also a very good treatment for nausea. Turmeric is another aromatic herb that has anti-prostaglandin effects. Studies have shown that it has a relaxant effect on uterine muscle. Both of these herbs are excellent options for the treatment of dysmenorrhea.
Research studies have found that heat successfully treats dysmenorrhea too. Many women intuitively apply heat to the lower abdomen or back when they are experiencing menstrual cramping. The application of heat can be very soothing. One study compared the application of an abdominal heat patch to ibuprofen and found them equally effective (Akin, 2001). Another study compared the use of acetaminophen to a wearable heat wrap and found the heat wrap was superior to acetaminophen.
According to a 2008 Cochrane review, Chinese herbal medicine has shown promising results for the treatment of primary dysmenorrhea. The studies were not of high quality but they found a significant improvement in pain relief, overall symptoms and use of additional medications. The herbs were found to be more effective than acupuncture and heat compression.
We are recruiting for a new study testing an integrative treatment for primary dysmenorrhea. The intervention is a small injection of Vitamin K into an acupuncture point. We are recruitng women 18-25 years old who have menstrual cramps. If you know of anyone who might be interested have them call Steff at 415-353-7356.
As you can see, there are many different effective treatments for menstrual cramping. It is a common problem that can be treated quite successfully using an integrative approach. Let me know if I can help.
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| About WHH |
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Women's Health & Healing believes that women want to explore and understand all of the health care options available to them; conventional, alternative and complementary.
Blessings for the coming year.
Priscilla Abercrombie, RN, NP, PhD
Women's Health & Healing
415-457-1451
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