When menstrual pain strikes, many women use the painkillers they have in their medicine boxes. However, experts have discovered that stronger painkillers like the non-steroidal anti-inflammatory drugs may be more effective than paracetamol for menstrual pain.
Menstrual cramps, or dysmenorrhea (as physicians call it), are one of the most common healthcare problems that women suffer during their reproductive years. It has been estimated that as many as 30 to 50 per cent of all women suffer from pain during their menstrual period, with the incidence being highest in younger women, from teenagers to women in their 30’s.
In fact, at least 10 per cent of younger women have symptoms so severe that they are unable to handle their normal range of activities, and miss days of work and important social functions because any movement or activity is too painful. Usually, for the first day or two of menstruation, only bed rest is tolerable until the symptoms finally pass.
Period pain is thought to be caused by an excess or imbalance of certain hormones released by the body during menstrual periods, including one called prostaglandin.
Besides the lower back pain, other problems that these women experience such as headaches, mood swings, bloating and breast tenderness could be so severe that women with cramps regard their monthly period with apprehension and even dread.
Despite the many symptoms and the millions of sufferers, menstrual cramps have been traditionally considered by the medical community to be a “minor” female ailment. The problem was either ignored or else treated with powerful painkilling drugs and tranquilizers.
Luckily, the medical community’s interest in menstrual cramps has increased during the past two decades. Researchers’ understanding now of what causes menstrual cramps has led to newer, much more effective drug treatments, as well as nutritional and other lifestyle-related therapies.
Moreover, the latest Cochrane review on what works best in alleviating period pain found out that non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin may be more effective than paracetamol to relieve this pain.
The medications, collectively known as non-steroidal anti-inflammatory drugs (NSAIDs), are widely used for various aches and pains, but it has been unclear whether they are as effective as acetaminophen — the active ingredient in common painkillers such as paracetamol and a number of products marketed specifically for menstrual symptoms.
The updated review included data from 73 trials carried out in 18 different countries and involving a total of 5,156 women. The trials compared NSAIDs with placebo, with each other, and with paracetamol.
The review showed that NSAIDs are very effective for treating period pain compared with placebo. This applied to all NSAIDs tested except aspirin, for which there was only limited evidence of effectiveness.
Although a large number of different NSAIDs were tested in the trials, no one drug emerged as more safe or effective than the rest. Nevertheless, exactly why they might be even more effective than acetaminophen is unclear.
Dr. Kayode Afolabi, a consultant obstetrician and Gynecologist, University College Hospital (UCH), Ibadan, Oyo State, explained that all women that experience menstrual cramps needed to see a medical doctor to decide what was responsible for the pain.
According to him, there are two types of menstrual pain;primary dysmenorrheal and secondary dysmenorrhea. The primary dysmenorrhea is like a normal component of menstrual flow because, usually, it is mild. The pain comes a few hours or days before the menstrual flow and ceases immediately the menses starts to flow. It indicates that, for that month, that woman actually ovulated.
The secondary dysmenorrhea, which is also referred to as congestive dysmenorrhea, is a period pain that is due to one kind of disease condition or the other. These include fibroid, pelvic infection and other forms of pelvic problems such as pelvic tumour.
Dr. Afolabi stated that when the period pain is due to primary dysmenorrhea, reassurance and painkillers are usually the recipe, whereas congestive dysmenorrheal would need further investigation to know what exactly was responsible and treat it appropriately.
“If it is due to pelvic infection, painkiller and antibiotics would be the treatment of choice. If it is due to fibroid or pelvic tumour, the patient may need a surgery,” he said.
However, NSAIDs such as ibuprofen were shown to carry a significantly increased risk of adverse effects such as indigestion, headaches and drowsiness, compared to placebo, and need to be used with caution.
To help minimize side effects, women are advised to take the drugs only for a few days during each menstrual cycle, the days when pain peaks, and they should not exceed the recommended dose on the label.
Meanwhile, the reviewers reported in the 2010 Cochrane Database of Systematic Reviews that it would be interesting to see whether these side effects could be reduced, without loss of effectiveness, by combining lower doses with other drugs such as paracetamol or other therapies such as transcutaneous electrical nerve stimulation.
Nevertheless, experts have cautioned that women whose period pain go on unusually long or interfere with their normal schedule on a regular basis need to report this to their doctor.
They declared that, sometimes, menstrual cramps can be consequences of other underlying health problems such as fibroids, endometriosis, pelvic inflammatory disease (an infection of the female reproductive organs caused by sexually transmitted germs) and cervical stenosis.
In women with cervical stenosis, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.
Of course, treatment of these health problems would be based on this underlying cause, ranging from painkillers such as NSAID, hormonal birth control, to surgical interventions, a condition like endometriosis or fibroids.