WOMEN'S HEALTH

Periods:

HOW TO TURN A MONTHLY FOE INTO A FRIEND

Dinah Olson

Is your “monthly friend” not very friendly? Do you wish she would quit stopping by every single month? Whatever you call that time of the month: Aunt Flo, Mother Nature, Strawberry Week, Shark Week, Girl Flu; it does not have to be such an unwelcome visitor.

In both primary care and gynecologic specialty offices women often seek care because they are unable to function for one or more days every month due symptoms associated with their menstrual periods. They may have pain and or bleeding that interrupts school, work, athletic or social activities.

Often patients have suffered for years without seeking help because they thought, or were told, that it is a normal part of being a woman. While the menstrual cycle is indeed a normal bodily function, disruption of your life is not. The idea that women should just learn to live with menstrual symptoms that interrupt their lives is outdated and dismissive.

Too painful?

Are your periods painful? Do you find yourself stuck in bed clutching a heating pad or with your skin shriveling up from long hot baths? You have dysmenorrhea, which is the medical term for menstrual cramps that originate in the uterus. Sometimes pain may radiate into the back or down the legs.

For some women the pain is a minor inconvenience. For others, symptoms are severe enough to result in the complete loss of one more days of functionality every single month.

Why are some women more affected by menstrual pain than others? Research indicates prostaglandin levels may be elevated in women who suffer from primary dysmenorrhea. Prostaglandins are chemicals made by our own cells and are involved in the body’s inflammatory response and regulation of contraction and relaxation of muscles. This includes the very strong muscles that are contained in the uterus.

It is important to distinguish between two main types of dysmenorrhea. Primary dysmenorrhea refers to the condition of painful periods without any known physical problem that may cause pelvic pain. Onset for most women is when ovulatory menstrual cycles begin, usually within six to 12 months of menarche (the very first menstrual period).

Secondary dysmenorrhea refers to painful menses or pelvic pain due to pelvic pathology or a recognized medical condition. Those condition include pelvic infection, endometriosis, adenomyosis, ovarian cysts, uterine fibroids or other pelvic structural abnormalities. By seeing your healthcare provider you can determine which category you fall into and what treatment approach is best for you.

Too heavy?

Do you refer to your friend as Bloody Mary, Red Wedding, Code Red? Are you spending too much money on feminine hygiene products and replacing ruined clothing? Then you may suffer from heavy menstrual bleeding (HMB). HMB is the medical

term used to refer to menstrual bleeding that comes on a regular cyclic interval and is heavy or prolonged. Any of the following is considered to be heavy menstrual bleeding: • Bleeding that lasts longer than seven days. • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row. • Needing to wear more than one pad at a time to control menstrual flow. • Needing to change pads or tampons during the night. • Menstrual flow with blood clots that are as big as a quarter or larger.

What to do about painful or heavy periods

Fear not, there are many treatments available for primary dysmenorrhea and heavy menstrual bleeding. But first, consider seeing your primary care or gynecologic health care provider. Tell your story. They can help determine if there are secondary causes for your dysmenorrhea or worrisome causes for heavy menstrual bleeding.

Treatment for primary dysmenorrhea

Nonsteroidal anti-inflammatory drugs (NSAIDS). The most common first line of treatment for painful periods are NSAIDS. Remember the inflammatory factors called prostaglandins we talked about earlier? Bingo! That’s why we first try medications such as over the counter ibuprofen or naproxen. There are also prescription NSAIDS available. See your health care provider about what the best medication and dosing strategy is safest for you.

Other medications. Aspirin (another NSAID) and acetaminophen (not an NSAID) are pain relievers that may be helpful but appear to be less effective than non-aspirin NSAIDS. There is some evidence that montelukast, a medication that is used for asthma and allergies may help some patients.

Hormonal mediation. A frequent next step if NSAIDS are not effective is hormonal medications. These are most commonly birth control methods. • Birth control pills - taken by mouth once daily. There are a wide variety of pills available so if one isn’t right for you there are others to try. • Contraceptive patch - worn on the skin of the upper arm, lower abdomen, upper or lower back. It is changed weekly. • Vaginal ring - is worn in the upper vagina. Currently there are two versions available. One that you discard every month and one that is reusable for 13 cycles.

Using the pill, patch or ring most people have a monthly period but they usually experience less painful periods. Some treatment may be prescribed as extended cycling (have a period every three months) or continuous cycling (no period at all). With fewer or no periods, women have less pain. • Medroxyprogesterone acetate, a.k.a. “the shot” - is given by injection every 11 to 13 weeks, so about every three months. Commonly women using this method stop menstruating all together and thus, do not have pain associated with bleeding. • Contraceptive subdermal implant - inserted under the skin of the upper arm by your trained healthcare provider. Some women using this method experience fewer menstrual cramps. • IUD with hormones - the intrauterine devices are placed in the uterus by your trained healthcare provider.

Many women using this method experience fewer menstrual cramps.

Big pharma is not my thing. Any other options?

Studies are somewhat limited on the use of complimentary and alternative medicine (CAM) treatments for primary dysmenorrhea. There is some evidence the following may be helpful and generally thought to be of low risk. • Low fat vegetarian diet • Increased dietary dairy • TENS unit (transcutaneous electrical nerve stimulation) • Acupressure (including self acupressure-there’s an app for that) • Acupuncture • Relaxation techniques • Traditional Chinese herbal medicine • Thiamine • Vitamins such as E, B1, B12, D • Fish oil supplements • Ginger powder

Treatment for heavy menstrual bleeding

Hormonal methods. The pill, patch, vaginal ring, depo provera and hormonal IUD described above are all treatment options for most women with heavy menstrual bleeding. The subdermal implant may help some women with heavy bleeding. After evaluation of your bleeding, your healthcare provider can help you choose the option best for you.

Nonhormonal medications. For those women who do not need birth control and only want to take medication on the days they bleed, Tranexemic acid may be an option to treat heavy menstrual bleeding. Use requires evaluation and prescription from your healthcare provider.

Whatever your situation is, there is help available. You do not have to suffer from painful and heavy periods. Keep the friends you love and say goodbye to monthly dread. Say hello to being your best self every single day of the month. SWM

Dinah Olson is a physician’s assistant at Oswego County Opportunities Centers for Reproductive Health.