Menstrual pain often disrupts the daily life of women, causing significant discomfort. Although many women struggle with cramps, there are effective strategies for managing this monthly challenge. Joanna Lewis, PharmD, MBA, 340B program director at Baptist Health, delves into the nuanced world of menstrual pain relief, exploring pharmaceutical and natural approaches to alleviating symptoms. From understanding the role of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen to exploring the potential of targeted supplements, she provides a roadmap for women seeking to minimize menstrual discomfort and improve their quality of life.
Joanna Lewis, PharmD, MBA, discusses effective strategies for managing menstrual pain, including nonsteroidal anti-inflammatory drugs and supplements to enhance comfort and quality of life. | Image Credit: T Mdlungu/peopleimages.com – stock.adobe.com
Drug Topics®: What are the primary classes of OTC medications used for menstrual cramp pain, and what are some of the most common medications that are used for this type of pain?
Joanna Lewis, PharmD, MBA: The main class of medications used for menstrual cramp pain are the NSAIDs, which are nonsteroidal anti-inflammatory medications like Advil, which is ibuprofen, or Aleve, which is naproxen. These work by reducing the prostaglandins and chemicals in the body which cause uterine contractions, thus reducing cramps. Aspirin is also an NSAID that is less commonly used but still effective for some people. Tylenol [acetaminophen] can also be used. It is not an anti-inflammatory, but it is good for pain relief for cramps, or if you have other menstrual cycle symptoms, like headaches. There are also combination over-the-counter products out there, like Midol Complete or Pamprin multisymptom. These help patients who have other symptoms related to cramps or their menstrual cycle, like fatigue, bloating, and irritability, and then some people use over-the-counter lidocaine patches. Just place them on their stomach, and that’s how they get a little relief.
Drug Topics: What is the pharmacist’s role in counseling patients on the proper use of an NSAID for menstrual pain, including dosing, timing, and potential adverse effects? What contraindications should they screen for?
Lewis: So the first thing a pharmacist needs to do is educate the patient on how to take the medication, and it’s best for these NSAIDs to take the medication as soon as you feel the first sign of cramps. It really works better when you get ahead of the pain. Some people actually even start taking an NSAID 1 to 2 days before they know that their period is going to start. So for ibuprofen and Aleve, you should follow the package directions. Ibuprofen for menstrual cramps is 400 milligrams every 6 hours, and then Aleve is 220 milligrams every 8 to 12 hours. Then, as a pharmacist, I would make sure to counsel not to exceed the max dose because that can make you more susceptible to [adverse] effects. As far as [adverse] effects for the NSAIDs, the main [adverse] effects are stomach upset, nausea, heartburn, or indigestion, and then some people get headaches or dizziness. Then there are instances where you should not take an NSAID, or you should take it with caution or under the direction of a medical professional, if you have an allergy, if you have had an allergic reaction in the past, definitely don’t take an NSAID if you have current symptoms of GI [gastrointestinal] bleeding or an active ulcer, if you have NSAID-induced asthma, or if you have any kidney disease or heart failure, or if you are on an anticoagulant or steroid that can also increase your bleeding risk.
Drug Topics: How would you address a patient’s concerns about the potential adverse effects of NSAIDs, such as gastrointestinal upset or kidney issues?
Lewis: So that’s a very valid concern for patients. NSAIDs are known to cause GI upset. So if a patient came to me and said, “How can I avoid that?” I would say take it with food, even if you’re nauseous; even a little bit, like a cracker or some milk, can help with your stomach upset. I would also choose a tablet that’s coated, or enteric coated, because that really helps a sensitive stomach, and then I would also stick to the normal dosing schedule. You don’t want to go above the recommended amount of tablets; that can make you more prone to the [adverse] effects. I would avoid combining the medication with other stomach irritants too, like caffeine, spicy foods, or acidic foods. As far as kidney issues in young, healthy patients, that’s very unlikely for an NSAID to cause that. It’s more prevalent in adults over 65 or people with underlying conditions, but if you are a young adult who has an underlying kidney, liver, or heart disease, I would definitely speak to your medical provider before you move forward.
Drug Topics: A patient has tried ibuprofen with limited success. What other OTC options could pharmacists recommend, and what are their benefits?
Lewis: If someone had tried ibuprofen and didn’t get a lot of benefit from it, my first recommendation would be to switch to Aleve, which is naproxen. It’s also an NSAID, but it has a longer duration of action, and many people feel that it is superior for menstrual pain than ibuprofen. Again, this is very individual specific, but I think that would be a good next step to try and then, if that does not work, one of the Tylenol products or combination products, in addition to some nonpharmacological options that we’re going to talk about. What I would recommend is [there is] some evidence that certain supplements may help ease pain and symptoms. The thing with supplements is you need to take it daily, and you usually need to take the supplement for 1 to 2 cycles before you start to see some symptom relief.
Drug Topics: How can pharmacists counsel patients on the evidence and safety of herbal supplements to help manage pain and menstrual symptoms?
Lewis: So magnesium can be taken to help relax contractions and reduce cramp intensity and duration. Omega-3 fatty acids, they can have an anti-inflammatory effect that reduces prostaglandins. Vitamin B1, which is thiamin, has been shown to reduce menstrual cramp pain when taken at 100 milligrams daily. Vitamin E reduces prostaglandin production, and then some studies have actually shown that it decreases pain when it’s taken at 200 to 400 [mg] a day. Then, zinc also has anti-inflammatory and antioxidant effects. The most evidence-based combination for supplements is magnesium plus omega-3 plus B vitamins. Then, as always, I would always counsel the patients to remember that supplements are not regulated and to choose one that has been either NSF or USP certified.
READ MORE: Women’s Health Resource Center
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