Red Alert! How To Keep PMS From Cramping Your Style

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If you've never experienced menstrual cramps, well, count your blessings. But for those unlucky ladies who have an intimate relationship with them, they can be more than an inconvenience — they can be practically debilitating. What's worse, not everyone understands the possible severity. "A lot of people minimize cramps and say they're no big deal," says Dr. Lauren Streicher, an assistant clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine and the author of The Essentual Guide To Hysterectomy. "But, for many women, the pain can get in the way of normal activities."

Plus, she points out, modern women have it tougher than their predecessors, who experienced fewer periods in their lifetimes. "Cavewomen, because of life expectancy and always being pregnant, had 15 periods in their whole life. Now, girls get their periods at nine or 10, women don't go through menopause until age 50, and they have one or two babies." Add it up, and the modern woman can spend decades dealing with painful periods.

Most cramps are caused by prostaglandins, a group of lipid compounds that the body secretes to help the uterus contract. That keeps us from bleeding too much, but it has side effects: fatigue, cramping, nausea, and generally feeling crummy. "When we look at strategies for dealing with cramps," says Dr. Streicher, "the simplest thing is to decrease the formation of prostaglandins by taking NSAIDs." NSAIDs (short for nonsteroidal anti-inflammatory drugs) include aspirin, ibuprofen, and naproxen; when it comes to treating cramps, Dr. Streicher is a fan of ibuprofen.

The idea, she says, is to stop the pain before it starts. "Most women have the idea that you don't want to take too much medication, so they don't start medicating until things are bad." That's the worst thing you can possibly do, she says. "By the time your prostaglandin levels are high enough to lead to cramping, it's too late. Taking ibuprofen doesn't reduce the prostaglandins that are already there — it prevents them from coming in the first place." Hot water bottles, too, can help ease the pain.

For women with regular cycles, it's easy to plan ahead. "The strategy, as counterintuitive as it sounds, is to take ibuprofen before you get your period," Dr. Streicher says. "You will have a dramatic decrease in the number of cramps, but also the amount of bleeding. You'll take less ibuprofen in the long run, and it'll work better." Not on a regular cycle? The minute your period begins, pop no more than 600mg of ibuprofen. ("Underdosing is not going to serve you well," Streicher notes. "If you are taking a lot of medication for more than a few days, that can have a negative impact on your kidneys. But, if you're someone who is taking 600mg every four to six hours, one day a month, that's fine.")

Of course, you can always avoid cramps by eliminating periods completely through hormonal contraception, says Dr. Streicher. "Instead of three weeks on the pill and one week off, we eliminate the hormone-free period," she explains. "Instead of taking the hormone-free pills, you immediately start a new pack." Another option: IUDs such as Mirena or Skyla. "IUDs are a terrific way to eliminate severe menstrual cramps in a woman who also doesn't desire pregnancy," Dr. Streicher says.

Finally, it's important to note that certain kinds of cramps may be a sign of something more serious. For instance, cramps that become progressively worse with each month could be linked to endometriosis. "With true menstrual cramps, when your period is gone, cramps should be gone," says Dr. Streicher. "If that's not the case, that's a red flag to see if something else is going on." Photo: Courtesy of Null Stern Hotel