Painful Periods

I am a 19 year old woman and have always had painful periods. What can I do to make them better?

You are not alone--around 10 percent of women have menstrual symptoms that are severe enough to miss school or work or otherwise incapacitate them. 75% of women report having mild-to-moderate emotional and physical symptoms with their periods at some time during their lives.

Interventions with limited studies to support their use include restriction of dietary salt, refined sugars, caffeine, and cardiovascular exercise. Better evidence exists for daily vitamin B6 (50-100 mg a day) or calcium carbonate (1200 mg a day).

Most women have tried using non-steroidal anti-inflammatory drugs (NSAIDS) such as Motrin or Advil. For greatest efficacy, you should start these medications around the clock one or two days before menses begin for 2-3 days into your period. If pain symptoms still persist, birth control pills usually significantly improve painful menses within 2-3 cycles. Occasionally symptoms can be severe enough that I'll recommend continuous pill therapy--this involves using only active (hormone-containing) pills from a pack each day which results in the abolition of periods altogether for most women.

Diuretics (water pills) can be helpful for women who are bothered mostly by bloating or fluid retention symptoms. A subset of women have severe moodiness and irritability from mid-cycle to onset of menses, also known as "premenstrual dysphoric disorder" (PMDD). Antidepressants like Prozac (also marketed as Serafem) are useful for these symptoms.

When periods are painful enough to require birth control pills (especially continuously), there may be something more serious going on such as endometriosis. Let your health care provider know about aspects of your periods that trouble you.

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