Ask Dr. Sally: What Can I Take For Painful Periods?

We received another great question and here’s our response…

I have fibroids in my uterus and they make my periods really painful.  I’m looking for something I can take for relief from the pain and I prefer natural therapies. What do you recommend?

(photo credit: TipsTimes via Flickr)

Many women suffer from painful periods.  There could be different reasons for painful periods and fibroids are a common cause.  Fibroids are benign tumors that grow in the walls of the uterus.  As a result, women with fibroids may have heavier and more painful periods.  They may also feel bloated, have lower back pain, have pain with defacation, or feel the urge to urinate.  If there are no symptoms, there is no need to treat and the fibroids will shrink on their own over time, especially after menopause when the body stops producing estrogen. If there are bothersome symptoms, then these are the treatment options that can be considered first:

  • The birth control pill.  The combination birth control pills (estrogen plus progestin hormones) work really well to have lighter and more predictable periods.  The birth control pills can also be used to suppress the period altogether.  In fact, the bleeding that women experience when they are on the birth control pill is not a natural period.  It is actually the body’s response to withdrawing from the hormones in the birth control pills during the hormone-free or placebo pills.  There is no medical or health benefit to this withdrawal bleeding and it’s safe to skip it, though some women like the reassurance of a monthly period.  If interested in skipping periods, the same pills can be taken on an extended cycle to reduce the frequency of periods to once every few months or they can be taken on a continuous cycle to skip periods for as long as desired.  Using birth control pills to reduce pain from fibroids has the added benefit of preventing pregnancy in women who are looking for that.  The birth control ring and patch work the same way as the pill.
  • Mirena intrauterine device.  This device is placed in the uterus and releases a progestin hormone for 5 years.  It helps women have lighter and less painful periods.  Up to 20% of women with a Mirena will stop having periods altogether.
  • Ibuprofen. This is the most popular medication from a class known as non-steroidal anti-inflammatory agents (or NSAIDs for short). Another option is naproxen. These medications help reduce cramping and heavy bleeding. Most women have one of these in their medicine cabinet, so it is readily accessible if needed. Ibuprofen can be taken in high doses several times a day for the first few days of menses. There are risks with taking these medications, so please consult with your healthcare provider before taking ibuprofen or another NSAID regularly. Aspirin should not be used for this purpose and can actually increase blood loss.
  • Lysteda.  This is the brand name for tranexamic acid and prevents blood loss.  It is an oral medication taken 3 times a day for up to 5 days at the beginning of menses.  Fewer doses are needed in women who have kidney problems.
  • The birth control shot. Also known as Depo-Provera.  The progestin helps counteract the estrogen and may help the fibroids shrink.  Prevents pregnancy too.
  • Oral progestin.  If a woman cannot take estrogen because of a medical contraindication, then a high-dose progestin is still an option.  Options include medroxyprogesterone and norethindrone taken on a daily basis.

If there are still bothersome symptoms after trying those medications, then these are the more aggressive treatments to consider:

  • Lupron or Zoladex.  These medications actually help shrink the fibroids that are causing the problems.  They are injections and work by reducing estrogen production.  For this reason, they can cause side effects that mimic menopause.  They are generally only used for a few months before surgery due to cost and side effects.
  • Surgery.  The fibroids can be surgically removed (myomectomy) or the entire uterus can be surgically removed (hysterectomy).  As with all other treatment options, it will be important to weigh the risks of these surgeries against the benefits.
  • Non-surgical procedures.  These procedures are an alternative to surgery.  Options are blocking uterine arterines (uterine artery embolization), removing the endometrial lining (endometrial ablation or hysteroscopic resection).

For those who prefer natural approaches to managing the discomfort, you’ll be happy to hear there are options for you.  Natural remedies may not be as effective for painful periods caused by fibroids.  Especially if the heavy periods are causing other health problems like anemia or infertility, which would have their own treatment options.  Some of the natural remedies that may generally help with menstrual cramps and pain include:

  • Heat pad.  The heat and pressure applied with a heat pad are very comforting.  Check out our handmade TheraPillow with natural contents.
  • Hot bath.  Again heat helps.
  • Magnesium.  This is essentially a salt that helps relax muscles.  You can take tablets, drink it, or soak in it.  Check out our handmade Soothing Salt satchels that can be placed in a bath.
  • Exercise.  Gets the blood flowing and brings oxygen to the muscles in your uterus to help provide some relief.  Yoga may be a good option.
  • Massage.  When doesn’t a massage help?
  • Acupuncture.  Not a lot of science behind this one either but it’s low-risk and may help.
  • Eat fruits and vegetables.  Women who eat a few servings of fruit and vegetables a day have lower rates of fibroids than women who eat one or no servings.  This finding is just an association and we can’t make any conclusions about causation.
  • Plants.  Maca root is used for many sexual and reproductive health issues, including menstrual cramps.
  • Avoid soy.  Soy products, like tofu, have phytoestrogens in them.  These compounds act like weak estrogens in the body and can theoretically contribute to fibroid growth and cramps.

I hope this information is a good start.  I’m always happy to discuss any of these treatment options further and help you make a decision.

Got a question? Send it to us.

— Dr. Sally Rafie

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