I’ve suffered from debilitating menstrual cramps ever since I went through puberty. Can you tell me how I can end this monthly cycle of agony?
Menstrual cramps, also known as dysmenorrhea, are most commonly the result of high levels of prostaglandins, a type of inflammatory chemical created in the uterus. Of the many different types of prostaglandins, three relate to dysmenorrhea: PGE1 and PGE3, which decrease inflammation, and PGE2, which increases it. Your goal in controlling menstrual cramps is to decrease PGE2 while increasing PGE1 and PGE3.
Conventional medical therapy for dysmenorrhea relies on the use of a group of anti-inflammatory drugs known as NSAIDs (nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen). But NSAIDs have a major shortcoming because they are nonspecific, meaning they block production of all three dysmenorrhea prostaglandins, both pro- and anti-inflammatory. By blocking production of the proinflammatory PGE2, they help reduce discomfort. But since they block production of the anti-inflammatory PGE1 and PGE3 as well, they increase the risk of gastrointestinal bleeding and hemorrhage. NSAIDs, in fact, cause 100,000 hospitalizations and 16,500 deaths in the US each year. By using nutritional methods, however, you can easily help the body get its chemistry right.
Prostaglandins are made from fatty acids. By modifying the types of fat you consume in your diet, you can manipulate your prostaglandin levels in favor of more PGE1 and PGE 3 and less PGE2. The latter comes from omega-6 fatty acids, while PGE1 and PGE 3 derive from the omega-3 fats. The precursor to PGE 2 is an omega-6 fat known as arachidonic acid (AA). The body produces AA naturally, but it also comes from dietary sources. To reduce menstrual cramps you need to cut off the supply of AA. You should begin by eliminating or sharply reducing rich dietary sources of AA such as egg yolks, beef, lamb, and high-fat dairy products. The natural production of AA in the body increases whenever you consume sugar or other high-glycemic foods such as white potatoes, white flour, and bananas. You want to minimize these foods during the second half of your cycle and during the menses as well. Eating fresh vegetables, whole grains, fruit, and moderate amounts of protein foods such as seafood and soy, will reduce AA production as well.
The anti-inflammatory/pain-reducing prostaglandins PGE1 and PGE3 come directly from the beneficial fatty acid eicosapentaenoic acid (EPA). Consuming cold water fish or fish and krill oils will increase EPA levels. Vegetarians can produce EPA indirectly from the omega-3 fats found in flax and walnuts. The two main omega-3 fatty acids found in fish oil are EPA and DHA. For general health, adult women should take a daily dose of 1,100 mg of combined EPA/DHA (1,600 mg for men). To treat menstrual cramps, you will often need to take larger doses. A teaspoon of cod liver oil contains about 1,000 mg of EPA/ DHA, and women typically need 3,000 to 5,000 mg every day to control cramps. While these doses are generally quite safe, if you find it necessary to take more than 3,000 mg a day, be aware of the possibility of blood thinning and, subsequently, increased risk for bleeding.
By Terry Grossman, MD