Painful periods?

If your answer is yes… Girlfriend, we need to talk! Dealing with the occasional, manageable period cramping is one thing, but experiencing bothersome menstrual pain month after month and allowing it to interfere with your life is just not necessary! Yesterday on Instagram, I discussed “dysmenorrhea” (painful periods) along with detailed information regarding the two classifications that healthcare providers use in our diagnosis and treatment of it. We refer to these as “primary dysmenorrhea” and “secondary dysmenorrhea”. If you haven’t had a chance to read, I highly recommend taking a look @girlhealthco before going any further. I think you’ll find the information will even give you a clearer understanding of what we’re talking about today.

As promised, in today’s post we’ll be covering medical treatments for painful periods. Stay tuned for my next post on alternative / integrative approaches to treatment because in all honesty, I find that a multimodal approach (a combination of both integrative and traditional therapies) often tends to be the most effective when it comes to treating dysmenorrhea.

Did you know that dysmenorrhea impacts millions of women worldwide? In the U.S., studies have indicated anywhere from 50-80% of women experience painful periods each month. WOW! While dysmenorrhea is manageable and short-lived for some, it can be debilitating for others. Nonetheless, thank goodness we have safe and effective treatment options available if a patient so chooses, but I am a firm believer that if you’re going to be taking medicine, you should have at least a general understanding of why and how it works.

Step one in creating a personalized treatment plan that is effective for you is to discuss your entire health history, including details of your menstrual cycle, with a medical provider. It is important to evaluate for any underlying conditions (such as uncontrolled diabetes and thyroid disorders) that may be impacting your cycles. Surprisingly, addressing certain underlying medical conditions may actually improve your periods. Additionally, based on your age, family history, and health history, certain medications and / or supplements may be recommended or avoided.

The two main first-line medical treatment options for dysmenorrhea are nonsteroidal anti-inflammatory drugs (NSAIDs) AND hormonal contraception. Here’s how they work:

 

NSAIDs (Motrin, Ibuprofen, Advil, Naproxen, etc) 

NSAIDs have shown to be very effective at reducing period cramping (especially for primary dysmenorrhea but also in women with secondary dysmenorrhea). In fact, NSAIDs can not only help with the cramping, but may also improve the flow of your period. We have ample evidence to prove this. A Cochrane review of 73 randomized controlled trials (RCTs) demonstrated strong evidence to support nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for primary dysmenorrhea. 

  • How do NSAIDs work? 
    • The majority of pain experienced during menstruation is caused by inflammation from prostaglandins released by the uterus. NSAIDs work by reducing the body’s production of prostaglandins and lessening their effects.
  • When and how should you take them? 
    • NSAIDs are most effective when taken at the first sign of menses (as soon as you start your period). This allows them to keep inflammation levels low from the get-go. NSAIDs work much better when taken before the pain is at it’s worse. It is also best to take with food and a glass of water rather than on an empty stomach. Most women only need NSAIDs the first 1-3 days of menses, but it’s important to note that it is not recommended to take these medications for a duration of 10+ continuous days.
  • Who should avoid NSAIDs?
    • Women with bleeding disorders, asthma, liver damage, severe heartburn, stomach ulcers and GI disorders, or an aspirin allergy should avoid using NSAIDs.

 

Hormonal Contraception

Combined hormonal birth control that contains both estrogen and progesterone (i.e. combined oral contraception pills, Nuvaring, and the birth control patch) may improve period cramps by suppressing ovulation and reducing the levels of prostaglandins produced by the uterus. They also tend to reduce period flow in women taking them cyclically, contributing to reduced pain.

  • A special note… Continuous dosing of combined oral contraceptives may offer even more additional benefits, as this can completely eliminate period bleeding, thus eliminating cyclical period pain altogether. Taking birth control pills continuously (i.e. skipping the placebo week and moving right onto a new pack) absolutely does not increase risk for blood clots, uterine cancer, infertility, etc. In fact, it is a preferred choice by many women as it can greatly improve quality of life and reduce costs by avoiding tampon, pad, and menstrual cup usage.

Progesterone only based methods of birth control (i.e. progestin only pill, DepoProvera, Nexplanon implant, progesterone based IUDs (Mirena, Kyleena, Liletta, Skyla)) may also greatly reduce period pain by reducing and often eliminating period bleeding altogether. Progesterone methods work in this way by reducing endometrial lining thickening. Quite often, women notice amazing results with these methods as well.

Additional Treatments

Typically, if none of the above methods are helpful for patients, additional evaluation and treatment may be warranted. Often times, ultrasound and laparoscopy are used to investigate additional underlying causes of pain. Treatments may then be tailored to the underlying cause and consist of different types of medications such as gonodotropin releasing hormone (GnRH) agonists, removal of endometriosis adhesions, surgical removal of fibroids, uterine artery embolization (UAE) to reduce fibroid size, and even hysterectomy (removal of the uterus). 

If you enjoyed this content, stay tuned for an upcoming post covering multiple non-medication based alternative treatment options! 

Alright friend! I hope this was helpful in giving you a better understanding of available medical treatments as well as how they work to improve period pain. Again, treatment must be tailored to your individual healthcare needs. I would love to discuss your personal history and plan of care in detail at any time! Remember, you don’t even have to leave your home or office for your appointment! If you enjoyed this read, please feel free to follow along on instagram @girlhealthco and @brookesbvaughan_np for more!

Have a wonderful day!

Brookes

 

 

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