Smart Shopping for Menstrual Pain Relievers

Primarily, menstrual pain can be traced to late adolescent years. Menstrual cramps are also common among those who entered puberty at age 11 or earlier, bleed heavily during menstruation, are depressed or anxious, have never delivered a baby and smoke.

Called "dysmenorrhea" in medical parlance, the condition has been attributed to substances called prostaglandin PGF2alpha and arginine vasopressin (VP).

Common pain relievers are available over the counter or by prescription, but in 75 percent of the cases, nonsteroidal anti-inflammatory drugs (NSAIDs) are effective. NSAIDs such as ibuprofen, naproxen and mefenamic acid are the most effective. Oral contraceptives (OCs) reduce the strong uterine contractions, blood flow and sensitivity of the uterus to Pgf2alpha and VP. A January 2008 study in The Journal of Clinical Pain reported that "rofecoxib and diclofenac potassium, when taken in recommended doses, were equally effective in alleviating pain associated with primary dysmenorrhea."

Secondary onset of menstrual cramps occurs in women around age 30. It might be due to abnormal uterine conditions like endometriosis or an inserted uterine device (IUD). Approach a doctor for complete relief, although NSAIDS can usually relieve pain.

What to Look for

Depending on the nature of your menstrual cramps, you should exercise your treatment options. If your condition is secondary dysmenorrhea, it is relieved with antibiotics to treat infection. If it is due to endometriosis, surgical excision of fibroids or polyps is the solution.

Look for OCs that have low dose of estrogen. Indeed, for severe cramps, the FDA-approved Lybrel, which supplies a daily low dose of levonorgestrol and estradiol with no inactive pills, taken daily for a year, completely eliminates monthly menstrual periods. For more powerful effects, you may want to try calcium channel-blocking agents and beta 2 adrenoceptor stimulating drugs when other treatments fail, but do watch out for side effects.

Common Pitfalls

Although conventional treatment with NSAIDs can lead to good results, you should not be disappointed if they fail to work. In fact, the failure rate is still often 20 to 25 percent. In addition, when used long-term, they have associated side effects, including the risk of gastrointestinal bleeding and ulcers, heart attacks and stroke. Due to the estrogen component, combination OCs can lead to headache, nausea, bloating, breast tenderness and bleeding between periods. OCs can increase the risk for migraine, stroke, heart attack and blood clots. If you smoke, or have a history of high blood pressure, heart disease or diabetes, or polycystic ovarian syndrome, you need to be extra cautious.

Given the risk of failure and safety concerns, many consumers are now seeking alternatives to conventional medicine. Herbal and dietary therapies number among the more popular complementary medicines. Preliminary data suggest that vitamin B1 could an effective treatment for menstrual cramps taken at 100 milligrams daily. Similarly, magnesium therapy looks promising, although dosing is still unclear. Chinese Herbal Medicine looks promising, as well, for primary condition.