Menstrual Cramps

Symptoms

The most common symptoms include cramping or dull abdominal pain. In addition, numerous other symptoms may occur, such as headache, menstrual migraine, back pain, pain in the legs, loss of appetite, nausea and vomiting, diarrhea, weakness, dizziness, flushing of the skin, flushing, sleep disturbances, mood swings, depression, irritability, and nervousness. The symptoms first appear a few months after the first menstrual period in adolescence. They start just before, with the onset of, or during menstruation and last for about 1 to 3 days. The intensity varies individually from mild to very severe.

Causes

The most important cause is considered to be the increased physiological release of prostaglandins in the uterus, which are produced by cyclooxygenase from arachidonic acid. Prostaglandin F2α in particular causes severe vasoconstriction and contractions of uterine smooth muscle, resulting in ischemia and pain. Leukotrienes and the hormone vasopressin are also thought to play a role.

Complications

Severe discomfort can negatively affect quality of life and limit personal and business activities. Adolescents often miss school for short periods.

Risk factors

Younger women under 20 (24) years of age and women before their first pregnancy are more likely to suffer from menstrual cramps. Smoking, dieting, psychological problems such as depression or anxiety, loss of social network, and heavy menstruation are other risk factors.

Diagnosis

Diagnosis requires medical treatment to rule out conditions that may cause similar symptoms, such as endometriosis, cysts, or anatomic features. Premenstrual syndrome occurs before menstruation rather than during it.

Nonpharmacologic treatment

Many non-drug methods are used for treatment, such as acupuncture, acupressure, TENS, physical activity, and a low-fat diet. Heat (e.g., Chriesisteisäckli, hot water bottles), unsaturated fatty acids such as the omega-3 fatty acids, and a diet rich in fish are also thought to improve symptoms. The effectiveness of these measures has not yet been sufficiently proven scientifically.

Drug treatment

Analgesics:

  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen, mefenamic acid, or diclofenac, are considered first-line agents, are approved for this indication, and some are available without a physician’s prescription. They inhibit cyclooxygenase and thus prostaglandin synthesis, have an analgesic, antispasmodic and anti-inflammatory effect. The correct dosage and observance of precautions are important. In cases of severe symptoms, they should be taken regularly and as early as one day before menstruation to ensure stable plasma concentrations of the active ingredient. Selective COX-2 inhibitors such as celexocib or etoricoxib have not yet been approved for this indication in many countries. Paracetamol is also analgesic but weaker in efficacy because it does not inhibit prostaglandin synthesis.

Hormonal contraceptives:

  • Hormonal contraceptives (estrogens, progestins) are also well effective against the symptoms, according to the literature, because they reduce estrogen and progesterone secretion and prevent bleeding when used continuously. They reduce the growth of the endometrium, the tissue that produces prostaglandins and leukotrienes. They are administered orally, vaginally, transdermally or parenterally, among others, under medical treatment. However, they are not approved in this indication, but are often used off-label.

Anticonvulsants:

  • Anticonvulsants such as scopolamine butylbromide relieve smooth muscle spasms. They do not directly relieve pain and are therefore also combined with analgesics. In Germany, scopolamine butyl bromide is also sold in combination with paracetamol. Nitroglycerin also has a relaxing effect on the smooth muscles, but is not approved in this indication and can trigger a nitrate headache.

Other drugs:

Alternative medicine (selection):