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Painful menstrual cramps are a quality-of-life issue for many. Clinicians should know what nonpharmacologic treatment options are available.
Every month, many women experience various symptoms attributable to their menstrual cycle. One of the most common complaints among women is dysmenorrhea. The two types of dysmenorrhea are primary and secondary. Primary dysmenorrhea (PD) is characterized by painful menstrual cramps without any evident pathology. 1 Secondary dysmenorrhea is the occurrence of painful menstruation in the presence of a pelvic pathology, such as endometriosis, adenomyosis, or chronic pelvic inflammatory disease (PID).2
PD occurs in women of all ages but usually begins during adolescence, with an estimated prevalence of 40%-50%.1 PD typically presents in the adolescent years roughly six to 12 months after menarche, usually when regular ovulatory cycles are established.3 Overall, PD may affect 40%-90% of women.4 In addition to physical pain, the patient's quality of life is often affected. One in 13 sufferers is incapacitated for one to three days per month, affecting work and school attendance and making dysmenorrhea the leading cause of school absenteeism among adolescents.3,5 Symptoms vary from person to person: may include dizziness and syncope, cramping, nausea, vomiting, diarrhea, headaches, and fatigue; and may last up to 72 hours.3
Many women start treating their pain and discomfort with such pharmacologic therapies as nonsteroidal antiinflammatory drugs (NSAIDs) and hormonal contraceptives. Because of the major growth and development that occurs during adolescence, many young patients and their parents do not want to rely solely on pharmacologic treatments. Additionally, while the efficacy of pharmacologic treatments is well documented, they still have a 20% to 25% failure rate.6
Many treatments that do not involve pharmaceuticals are available and are good options for both adolescents and adults. The use of complementary and alternative medicine (CAM) has increased in the past decade.7 In one large study, as many as 48% of women reported use of CAM as an alternative to prescription medication or to enhance the effectiveness of their prescription medications.8,9
Providers need to become familiar with the various treatments their patients may use for PD. This review focuses on treatments that women suffering from PD use to alleviate their pain, with an emphasis on CAM.
Pathogenesis
It is believed that PD may be caused by abnormal increased...