TREATMENT OF MENSTRUAL CRAMPS Menstrual cramps (dysmenorrhea) affect about one half of menstruating women. The cramping pain begins a few hours before or just after the onset of menstrual flow and usually lasts 48 to 72 hours. It is characteristically strongest over the abdomen and may radiate to the back or inner thighs. Some women also experience nausea, vomiting, fatigue, diarrhea, and headache. At the onset of a menstrual period, the lining of the uterus begins to slough off. The uterus as a consequence of this process releases chemicals called prostaglandins. Prostaglandins cause increased uterine contractions and the sensation of cramps, along with many of the above listed symptoms. Treatment of cramps focuses on decreasing the production of prostaglandins. GENERAL RULES 1. Take pain medications at the first sign of cramps to help prevent them from worsening in intensity. 2. Take pain medications with food to help prevent stomach upset. 3. Take the lowest effective dose of pain medications. STEP #1: OVER-THE-COUNTER MEDICATIONS Acetaminophen (Tylenol): A pain reliever which can be offered at 500 mg-1000mg every 6 hours Ibuprofen (Midol-IB, Advil, Nuprin, Motrin): A nonsteroidal anti-inflammatory drug (NSAID) which works by blocking prostaglandin production. Starting dose is one tablet (200mg) every 4 to 6 hours. Can increase the dose up to 4 tablets (800mg) every 6 hours Naproxen (Aleve): Also a NSAID. Starting dose is two tablets (220mg x 2 = 440mg) then one tablet every 8 to 12 hours. Can increase the dose to 2 tablets every 8 to 12 hours. Designated products (Maximum Strength Midol, Pamprin, etc.): These products generally contain acetaminophen 500mg but may also contain additives such as caffeine and antihistamines. Read the product ingredient label prior to use of these over the counter products and do not exceed the recommended daily dose . STEP #2: PRESCRIPTION PAIN MEDICAITONS Ibuprofen (Motrin): Same as over the counter ibuprofen, but in prescription strength tablets. Take one tablet (800mg) every 6 hours. Naproxen (Anaprox DS): Same as Aleve, but in prescription strength tablets. Take one tablet (550mg) every 8 to 12 hours. STEP #3: OVULATION SUPPRESSION WITH ORAL CONTRACEPTIVE PILLS Birth control pills are an effective way to minimize menstrual cramps. By suppressing your own hormonal fluctuations, prostaglandin production and cramps are also reduced. In addition, birth control pills reduce the amount of menstrual flow. The pills are taken for 21 to 24 days out of the 28-day cycle (depending upon which product is prescribed). Some of the newer low dose pills are given 24 days out of 28). Once all the active ingredients have been taken, most birthc ontrol pills have a row or 4 to 7 days of a

placebo. Some of the newer pills may include iron pills or low dose estrogen pills at the end of the pack. It is best to take all of the pills in your pack. If you are supposed to start a new pack, have it available. Once a patient is cycling on the oral contraceptive pills, she may choose to take the active ingredients in a continuous manner. This is not harmful to the body. Many patients take the 21 (24) active pills for 2 months or 3 months in a row by skipping the placebo pills. This allows you to have less frequent periods, less cramping and you are in control of when to have your period!You should try to take your pills at the same time of day. every 24 hours. Try to remind yourself not to forget by setting the alarm on your cell phone or wrist watch. Many patients with severe cramping use both ovulation suppression with birth control pills and pain medications simultaneously for best symptom relief. -------------STEPS #1 THROUGH #3 WORK FOR 95% OF PATIENTS!!!!----------------- STEP #4: LAPAROSCOPY OR OTHER IMAGING TECHNIQUES If a combination of the first 3 steps fails, more serious causes of menstrual pain should be investigated. Laparoscopy is a surgical procedure performed with a fiber optic laparoscope (camera) through tiny incisions in the abdomen. The scope is used to look around the abdomen and pelvis for a cause of menstrual pain, such as endometriosis, infections, and adhesions from previous surgery, or birth defect (congenital anomalies) of the reproductive system. Once your doctor is able to diagnoses the cause of your pain it will be easier to help you.

Update 1/05/07