Menstrual cramps, also called dysmenorrhea is defined as a pain crampy that affects the lower part of the abdomen and comes just before or during menstruation.
The menstrual pain is such a common event that up to 90% of adolescents and 25% of adult women suffer from this pain every month.
Dysmenorrhea is caused by uterine contractions during menstruation, which are important to the uterus can expel all devitalized uterine tissue. In some women, however, menstrual cramps are very intense, caused by contractions so strong that even the same blood vessels supplying the uterus are compressed, causing a temporary uterine ischemia.
The goal of treatment of menstrual pain should always be to relieve pain as much as possible. If it works to eliminate pain completely, great. Unfortunately, however, the complete resolution of pain is not always achievable. In such cases, more intense cramps, the goal should be to relieve pain sufficiently so that women can make their usual tasks of everyday life.
The treatment of dysmenorrhea can be done with real drugs or just with educational measures such as exercise, proper diet, relaxation techniques and home remedies. What sets the most appropriate type of treatment is the degree of intensity of cramps. The intensity of menstrual cramps can be dividade in 4 grades:
Dysmenorrhea grade 0: menstruation does not cause pain, or does so very unobtrusively, without causing any disturbance to woman. - This kind of menstruation does not require any specific treatment.
Dysmenorrhea grade 1: menstruation causes a small gripe, that the vast majority of cases does not hinder daily activities. - This kind of bleeding rarely requires medication and household measures are more than enough to relieve pain.
Dysmenorrhea grade 2: menstruation cramps causes moderate to strong, sometimes accompanied by other symptoms such as irritability, headache and malaise. Colic can be intense enough to disrupt the execution of the routine tasks of everyday life. - This type of bleeding is usually treated with medications.
Dysmenorrhea grade 3: menstruation causes very intense cramps, often accompanied by symptoms such as diarrhea, fatigue, headache, irritation or vomiting. Colic is strong and often hinders the execution of the routine tasks of everyday life - this type of bleeding is usually treated with medication, but they do not always work.
The placebo is by definition a substance or treatment that has no direct effect on the disease, but the patient believes to be effective. And because the patient believes this false treatment is real, it can actually work in certain situations.
The placebo may simply be a pill made of flour or any vitamin. It can also be a bracelet that supposedly emits vibrations, therapy with colored lights or a homeopathic medicine.
The menstrual cramps has an interesting feature, which is high but temporary effectiveness of placebos. In the first month, 84% of women treated with a placebo report improvement of menstrual cramps. This effect, however, does not last long. In the second month, the effectiveness rate has dropped to 29% in the third month to 16% and in the fourth to 10%.
The more intense menstrual pain, the less effective the treatment with placebo.
Home treatment and non-medication of menstrual cramps
Treatment of menstrual cramps with home measurements can be made in any case, usually the only measure necessary in degrees dismenorreias 0 and 1. Below we cite the non-drug treatment options that in scientific studies showed efficacy rate superior to placebos.
a) Local Heat
The application of heat in the lower abdomen is a very effective measure to relieve cramps. Studies show that a hot water bottle can be as effective as anti-inflammatory and better until common painkillers such as paracetamol.
The application of heat in the abdomen can be used in combination with analgesics or anti-inflammatories, helping to increase the efficiency of drugs.
b) Exercise
Regular physical exercise helps to decrease the intensity of menstrual cramps. Sedentary women tend to have more severe cramping that women who regularly do some physical activity.
c) Yoga
There are many studies on the effectiveness of yoga in the treatment of dysmenorrhea, but the few that exist suggest that it is effective. In fact, any measure that helps control stress appears to be effective in controlling dysmenorrhea massage, relaxation techniques, meditation, etc.
d) Sexual intercourse
Studies show that orgasm can ease the intensity of menstrual cramps in some women. The problem is that hardly a woman have sexual desire if the pain is moderate or severe.
e) Diet
A diet low in fat and animal rich in vegetables and omega 3 can significantly reduce the intensity and duration of menstrual cramps. However, studies published to date have been made with few patients, which makes the degree of weak evidence.
f) Cigarette and alcohol
The cigarette and alcohol consumption is related to a worsening of symptoms of menstrual cramps. If you have strong cramps, avoid these two substances.
g) Acupuncture
Most studies on the effectiveness of acupuncture in dysmenorrhea is small and of poor quality. However, there are few good studies, and these show that acupuncture appears to be effective. In general, the result of acupuncture seems to be below the medications, but it is a good option for those who wish to avoid drugs. In any event, the degree of evidence is still weak.
Drug treatment of dysmenorrhea is done preferably with anti-inflammatory or hormonal contraceptives. No studies to date have proven the superiority of one over the other. Both also appear to be effective and can be used at the same time.
a) Nonsteroidal anti-inflammatory drugs (NSAIDS)
Anti-inflammatory drugs are effective in 85% of cases and unlike placebo, the effect does not diminish with time.
The NSAIDs most suitable for the control of menstrual pain are ibuprofen and mefenamic acid (better known as Ponstan�).
Common analgesics such as paracetamol have less efficacy to anti-inflammatory and therefore not usually used as first - line treatment. The only exception seems to be dipyrone (metamizol), which is an analgesic that has an important antispasmodic effect, is a good choice for the relief of cramps both uterine, intestinal or renal origin.
b) Hormonal contraceptives
Hormonal contraceptives help stabilize the menstrual cycle and control the flow and uterine contractions, helping in reducing menstrual cramps.
All forms of hormonal contraception are effective, including:
Contraceptive pill-based estrogen and progesterone (any dose)
Minipill
Contraceptive patch
Injectable contraceptive
Vaginal ring
The Mirena IUD, which is an IUD which contains small amounts of hormone also helps in treating dysmenorrhea. On the other hand, the copper IUD is not indicated, as often aggravate symptoms.
c) Vitamins and minerals
Some small studies have evaluated the efficacy of certain vitamins in the control of menstrual cramps. The best results were had to vitamin E and vitamin B1. All in all, however, the studies were small and the degree of evidence is weak. Magnesium also appears to be superior to placebo, but small and of poor quality studies do not allow us to draw conclusions.
d) Nnitrate stickers
Transdermal patches containing nitrate are an option for treatment, but their effectiveness is lower than that of NSAIDs and contraceptive, and rate of side effects such as headache is higher.
e) Nifedipine
Nifedipine is an antihypertensive drug that helps reduce the pain of dysmenorrhea. In hypertensive women, it is a good treatment option, despite being lower than NSAIDS.
Endometriosis is a hypothesis that should be considered in all women with severe menstrual cramps that do not respond well to any of the treatments mentioned above.
