Q) I am aged 36, and am increasingly experiencing a very high level of pain and discomfort with each period. I have breast pain for a week before, and then excruci-ating pain on the day of my period, along with vomiting and diarrhoea. I have no children and I'm also having difficultly conceiving. I have tried quite a few alternative therapies to no avail, so any advice would be much appreciated.-D.S., via e-mail
A) Period pain-or dysmenorrhoea, in medical-speak-affects up to 95 per cent of menstru-ating women (Nurs Times, 2004; 100: 40-3). Cramping lower abdominal pain is common, but the pain can also extend to the lower back and thighs, and lead to nausea, vomiting, diarrhoea and fatigue (Aust Fam Physician, 2006; 35: 842-4, 846-9).
But period pain doesn't have to be simply endured, particularly if it's impacting on your lifestyle and daily activities. But before starting any treatment, you need to establish whether you are suffering from primary or secondary dysmenorrhoea. Primary dysmenorrhoea is menstrual pain without pelvic disease; secondary dysmenorrhoea is pain associated with an identifiable condition, usually endometriosis, fibroids or pelvic inflammatory disease (BMJ, 2006; 332: 1134-8).
As you are over 25 and having trouble conceiving, secondary dysmenorrhoea is a possibility, so you may wish to see your doctor for a diagnosis.
Treating the cause of the pain is more effective than treating just the pain itself. Conventional treatments usually involve non-steroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives, but these have various adverse effects and may not work in up to 25 per cent of sufferers (Cochrane Database Syst Rev, 2004; 3: CD002119).
Fortunately for you, there is a variety of alternative treatments, many with good evidence of success.
- Dietary changes and supplements. Taking 100 mg/ day of thiamine (vitamin B1) may be effective: 87 per cent of patients were cured after three months of treatment and remained pain-free two months later (Indian J Med Res, 1996; 103: 227-31). Other helpful supplements are pyridoxine (vitamin B6), magnesi-um, vitamin E and fish oil, particularly Neptune Krill Oil (BMJ, 2006; 332: 1134-8; Altern Med Rev, 2003; 8: 171-9).
Changing your diet may also bring relief. Endo-metriosis and dysmenorrhoea are known to be related to a low intake of vegetables and fruit, and a high intake of vegetarian polyunsaturated fat, ham, beef and other red meat (Eur J Obstet Gynecol Reprod Biol, 2007; 132: 140-7). Another study found a significant improvement in menstrual pain and PMS symptoms with a low-fat vegetarian diet (Obstet Gynecol, 2000; 95: 245-50).
- Herbs. A Japanese herbal formulation known as Toki-shakuyaku-san-a blend of six herbs, including angelica and peony root-reduced menstrual pain (Am J Chin Med, 1997; 25: 205-12). Together with another remedy called Shakuyaku-kanzo-to (including peony and liquorice), this combination may also help women with secondary dysmenorrhoea to conceive (Clin Exp Obstet Gynecol, 2003; 30: 95-8).
- Acupuncture. When 649 women with dysmenorrhoea received acupuncture (15 sessions over three months) in addition to their usual medical care, they saw significant improvements in pain and quality of life compared with those receiving only the usual care (Am J Obstet Gynecol, 2008; 198: 166). Other trials have also been positive, although one trial found that acupuncture worked well for primary dysmenorrhoea but was only "satisfactory" for cases of secondary dysmenorrhoea (Akush Ginekol [Sofiia], 1996; 35: 24-5).
- Transcutaneous electrical nerve stimulation (TENS). This involves stimulation of the skin using currents at various pulse frequencies and intensities to relieve pain. A number of small studies found high-frequency TENS to be effective for dysmenorrhoea (Cochrane Database Syst Rev, 2002; 1: CD002123). In one trial, 42-60 per cent of patients achieved at least moderate relief, and required the use of fewer additional analgesics (BMJ, 2006; 332: 1134-8).
- Heat. A randomized, controlled trial found that a heat patch (at 39^0 C) used for 12 hours a day was as effective as ibuprofen (400 mg three times a day) and more effective than placebo in reducing pain (Obstet Gynecol, 2001; 97: 343-9). Another study found that a heat wrap was better than paracetamol (acetamino-phen) for pain relief over an eight-hour time period
(J Reprod Med, 2004; 49: 739-45).
- Magnets. A 2700-gauss static magnet attached over the pelvic area significantly reduced menstrual pain and irritability compared with a placebo (140-gauss) magnet (J Altern Complement Med, 2005; 11: 681-7).
- Aromatherapy and massage. In a trial of 67 college students, aromatherapy (topically applied lavender, clary sage and rose) eased the severity of menstrual cramps (J Altern Complement Med, 2006; 12: 535-41). Combining aromatherapy with massage is also a good idea, as a Korean study found that women receiving abdominal meridian (Kyongrak) massage had significantly less menstrual pain than the control group (Taehan Kanho Hakhoe Chi, 2005; 35: 1325-32).
- Biofeedback. A study of nine women suggested that thermal biofeedback may be effective for painful periods (Biofeedback Self Regul, 1982; 7: 499-520). Another study reported that thermal biofeedback may be a promising treatment for menstrual pain and other symptoms related to endometriosis (Appl Psychophysiol Biofeedback, 2003; 28: 279-89).
- Relaxation techniques. High levels of stress can greatly increase dysmenorrhoea (BMJ, 2006; 332: 1134- 8), but a review of the literature suggests that relaxation techniques may help to relieve symptoms (Cochrane Database Syst Rev, 2007; 3: CD002248).