QuestionI'm a senior in high school and prom is next month. I'm currently on my period, and when I calculated it out, my period is supposed to start the day before prom. Is there any way I can start taking something now so I can make my period start even a few days earlier? My mom is very old-fashioned and birth control is out of the question, although I am 18. It's just not something I can afford without her health insurance.
I'm not sexually active, and I don't plan on being sexually active either, I just have a heavy flow the first few days and very uncomfortable cramps.
I know it's unnatural to try to make your cycle do something like that, but I'm kind of desperate. Is there anything not too expensive and not completely unhealthy I can use? I've heard of drinking parsley tea 2-3 times a day, but I want something I know will work. Your help would be greatly appreciated.
AnswerMy daughter had the same problem and we worked hard to help her overcome it without resorting to birth control pills which is what most doctors want to use these days. I don't recommend that approach. She used Ponstel, which is a pain reliever. It helped as much as anything and then she lost her period for 4 years and it has just returned without the cramping. We don't know why. Here is an article with some information that might help you. Beyond this information I have not other suggestions.
[U.S. Food and Drug Administration]
This article was published in FDA Consumer magazine several years ago. It is no longer being maintained and may contain information that is out of date. You may find more current information on this topic in the agency's Office of Women's Health Website.
Taming Menstrual Cramps
by Ellen Hale
For many women "that time of the month" is one they'd rather forgo. More
than half routinely experience some form of pain associated with
menstruation, say doctors at the Mayo Clinic in Minnesota, and 1 in 10
suffers such severe dysmenorrhea--menstrual pain--she cannot function
normally without taking medication.
Throughout history, women have tried to alleviate these menstrual
discomforts themselves. But home remedies--teas, hot baths, heating pads,
and such--offered only limited help. As recently as a decade ago, when there
were far fewer products readily available for menstrual cramps than now,
some doctors prescribed powerful prescription painkillers. Others, many
women recall, told patients their problems would disappear as they grew
older or after they had children.
But today, the pain associated with menstruation is taken more seriously,
and there are new, highly effective treatments for it.
"Nearly all women--I would say 99.9 percent--should be able to function
quite well during their periods with the menstrual treatments available
now," says Charles H. Debrovner, M.D., a gynecologist in private practice
and on the faculty of the New York University School of Medicine in New York
City.
What's Causing the Pain?
There are two kinds of painful menses--primary and secondary
dysmenorrhea--and it is very important to distinguish between them so both
are treated properly, Debrovner stresses.
Primary dysmenorrhea usually starts within three years of the onset of
menstruation and lasts one or two days each month. While this type of
menstrual pain may lessen for some women as they grow older or after the
birth of children, it also can continue until menopause.
Secondary dysmenorrhea is menstrual pain caused by disease such as pelvic
inflammatory disease, endometriosis (abnormalities in the lining of the
uterus), or uterine fibroids (nonmalignant growths). Endometriosis is a
major cause of secondary dysmenorrhea. Pain from it usually starts later in
life and worsens with time, according to Debrovner. Another hint that
disease might be the cause of menstrual pain is if pain also occurs during
intercourse or during other parts of the cycle.
Primary dysmenorrhea is a result of the normal production of
prostaglandins--chemical substances that are made by cells in the lining of
the uterus. (Prostaglandins are also produced elsewhere throughout the
body.) The lining of the uterus--which has built up and thickened during the
early stages of the menstrual cycle--breaks up and is sloughed off at the
end of the cycle and releases prostaglandins, explains Lisa Rarick, M.D.,
medical officer in FDA's division of metabolism and endocrine drug products.
The prostaglandins, in turn, make the uterus contract more strongly than at
any other time of the cycle. They can even cause it to contract so much that
the blood supply is cut off temporarily, depriving the uterine muscle of
oxygen and thus causing pain. Women who suffer painful contractions may be
producing excessive amounts of prostaglandins. Or, it may be that some women
are just more sensitive to them, says Rarick.
The cramps themselves help push out the menstrual discharge. Because the
cervical opening is often widened after childbirth or years of menstruation,
cramps may lessen in severity later in life.
Most women describe their menstrual cramps as a dull aching or a pressure
low in the abdomen. The pains may wax and wane, remain constant, or be so
severe that they cause nausea, vomiting, diarrhea, backache, sweating, and
an achiness that spreads to the hips, lower back, and thighs.
Inhibiting Prostaglandins
For many years, women had little help for these symptoms. Doctors
recommended aspirin, heating pads, and hot baths. When those failed, they
often prescribed painkillers such as Demerol or Tylenol with Codeine. These
treatments were all aimed at the perception of pain rather than the cause of
it. Even tranquilizers were sometimes used, according to Debrovner.
But the advent of pain relievers that impede the production of
prostaglandins has made it possible to directly treat the cause of the
cramps. Called NSAIDs, for nonsteroidal anti-inflammatory drugs, these
medications have proven remarkably effective for many women.
Because NSAIDS inhibit synthesis of prostaglandins, and thereby the
contractions of the uterus, they may actually reduce menstrual flow. Many of
Debrovner's patients report shorter periods when they take the drugs at the
first sign of pain. He recommends taking them as early as possible after the
menstrual flow starts. Waiting too long may mean they won't be as effective.
The prostaglandin inhibitors can cause gastrointestinal distress, so most
doctors also recommend they be taken with milk and food. Labeling on the OTC
products contains this information.
While there are about a dozen prescription NSAIDs, three--ibuprofen (Motrin,
Rufen, etc.), naproxen (Naprosyn), and mefenamic acid (Ponstel)--are now
approved to treat menstrual cramps.
OTC Products
FDA approved ibuprofen for over-the-counter use in 1984. It now can be found
as the active ingredient in several OTC medications, such as Advil, Nuprin,
and Motrin IB. The OTC dose per pill is 200 milligrams. The recommended dose
is one tablet every four to six hours (or two, if one does not work), not to
exceed six in a 24-hour period. Prescription formulations come in dosages of
400 to 800 milligrams.
Aspirin--long a standard over-the-counter treatment for cramps--works as a
prostaglandin inhibitor, although probably not so powerfully as the specific
inhibitors such as ibuprofen. While aspirin is known to thin the blood and
increase bleeding, it does not appear to have this effect on menstrual flow,
according to Rarick.
Researchers are not sure if acetaminophen, an analgesic found in drugs such
as Tylenol and Datril, works to prevent prostaglandin production. If it
does, its effect appears to be milder than that of aspirin or other NSAIDs.
Doctors say, however, that it can successfully treat the headache and
backache that often accompany menstrual cramps.
Some over-the-counter menstrual pain medications, such as Midol and Pamprin,
contain a mix of ingredients that include an analgesic such as
acetaminophen, a diuretic such as pamabrom, and an antihistamine such as
pyrilamine maleate. Some newer formulations now use ibuprofen in place of
more classic analgesics such as aspirin or acetaminophen. Midol 200 Advanced
Cramp Formula, for example, contains ibuprofen as its active ingredient.
Maximum Strength Midol Multi-Symptom Formula, however, contains
acetaminophen as an analgesic. With the variety of ingredients now
available, it's wise to read the label to make sure the product is the best
one to treat your symptoms. If in doubt, consult your doctor.
Other Treatments
Women who use oral contraceptives rarely suffer menstrual cramps, so some
doctors prescribe them for women whose cramps are unrelieved by other
treatments. Contraceptive pills disrupt the normal hormonal changes of the
menstrual cycle, resulting in a thinner uterine lining and a decrease in
prostaglandins production. However, menstrual cramp relief is not considered
by FDA to be a primary reason to use oral contraceptives; rather, it is
included in the labeling as a secondary benefit.
Exercise, too, may be of some benefit, possibly because it raises levels of
beta endorphins, chemicals in the brain associated with pain relief. With
new knowledge, such as the possible roles of exercise and of prostaglandins
in preventing cramps, most women can avoid suffering the monthly anguish of
severe menstrual pain. n
Ellen Hale is a freelance writer in Washington, D.C.
Relieving PMS
Cramps aren't the only problem women suffer in their monthly cycles. For
many, premenstrual syndrome (PMS) can be just as bothersome.
PMS occurs in the last 7 to 10 days of the menstrual cycle--called the
luteal phase. The time at which these symptoms occur is very important
because it's what allows doctors to track their cyclic nature and make a
diagnosis.
While premenstrual syndrome remains a mysterious malady, there is growing
recognition that it is a true physical syndrome, and there are a number of
new treatments to help lessen its symptoms.
The American College of Obstetrics and Gynecology (ACOG) says from 20 to 40
percent of all women suffer some symptoms of PMS, which it defines as "a
recurring cycle of symptoms that are so severe as to affect lifestyle or
work." ACOG estimates that 5 percent of women have severely disabling PMS.
The variety of symptoms and combinations of symptoms are usually divided
into four major groups, according to Lisa Rarick, M.D., medical officer in
FDA's division of metabolism and endocrine drug products. Breast tenderness,
swelling, weight gain, and bloating comprise one group of symptoms. A second
group includes emotional changes such as depression, forgetfulness, crying,
insomnia, and confusion. A third group involves headaches, food cravings
(especially sweets), increased appetite, fatigue, and dizziness. The fourth
group includes anxiety, nervous tension, mood swings, and irritability.
For the most part, PMS is alleviated by treating its symptoms. For example,
for those who suffer from symptoms of water retention, diuretics may help.
They are a component of many OTC medications for PMS. In 1988, FDA
tentatively proposed that three OTC diuretics could be used in menstrual
drug products (including those that treat PMS): caffeine, ammonium chloride,
and pamabrom.
It is believed that caffeine may help relieve bloating and water retention
because it acts as a mild diuretic, and that it also may help relieve the
fatigue many women complain of in the premenstrual period. On the other
hand, excessive amounts of caffeine may aggravate anxiety and tension, and
some doctors think it may be associated with increased breast tenderness.
Some over-the-counter medications for PMS combine several ingredients. One
product, for example, contains pyrilamine maleate (an antihistamine approved
for OTC use but not specifically for PMS), pamabrom and acetaminophen. Women
should read the labels of OTC products and check with their doctors for
advice on the best treatments for the specific PMS symptoms they have.
Some doctors believe women may be able to help themselves through the
discomfort of PMS without pills by exercising, eliminating or cutting down
on smoking, and changing their diets.
"I recommend eating small frequent meals because a lot of food causes blood
sugar to swing up and down, and that may effect premenstrual problems," says
M. Yusoff Dawood, M.D., director of the Division of Reproductive
Endocrinology at the University of Texas Medical School in Houston.
To stem water retention, many doctors recommend reducing salt intake, and to
reduce headaches, avoiding liquor. No scientific studies have proven that
exercise can reduce PMS, but there is much anecdotal and indirect evidence
that it does, doctors say.
"The idea is that exercise raises levels of beta endorphins, [which] have a
positive effect on mood and behavior," says Michelle Warren, M.D.,
co-director of the Division of Reproductive Endocrinology at St.
Luke's-Roosevelt Hospital in New York City. Moreover, she believes exercise
may reduce water retention.
Vitamin B6, known as pyridoxine, is recommended by some doctors to relieve
PMS, but studies on its effectiveness have been inconclusive, according to
Dawood. Use of extreme doses of it have been associated with neurological
problems. (I used this approach for my own PMS problems and it took care of the completely. I took 1000 mg./day with no neurological problems.)
For those whose PMS is unrelieved by most common treatments, more help is
available. While not approved for these uses by FDA, some doctors prescribe
birth control pills and use of progesterone suppositories (during the
premenstrual phase) for PMS. Oral contraceptives prevent ovulation and
therefore prevent the luteal phase from occurring. Although progesterone
suppositories have proven no more successful than a placebo in controlled
studies, because they seem to help some women, Warren believes they are
worthwhile. Prescription painkillers, diuretics, tranquilizers, and
antidepressants are also prescribed by physicians in severe cases.n
--E.H.
