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Written by Nandan Roongta, Medical Expert and Gynecologist
Menstrual cramps that occur during the menstrual period can cause pain of varying degrees. Dysmenorrhea is the scientific term used to describe painful periods or uterine cramps that precede or accompany menses. The term “primary dysmenorrhea” indicates that the pain is not the result of any identifiable abnormality, while the term “secondary dysmenorrhea” indicates that the pain is being caused by an underlying and generally identifiable gynecological disorder like endometriosis etc.
The pain can vary from a dull ache to painful spasms, and often spreads to the lower back. There are other symptoms like:
These symptoms may sometime accompany the pain. In some women, dysmenorrhea is severe enough to interfere with everyday activities, and reduce the quality of life, with absence from school or work.
Menstrual cramps causing primary dysmenorrhea are likely to be related to the presence of myometrium hypercontractility and arteriolar vasoconstriction, that is by the muscles of the uterus contracting too much and a decrease in the blood supply to the uterus. The levels of prostaglandin, a natural hormone produced by cells in the uterine lining, increases in the second half of the menstrual cycle, and in turn induce an inflammatory response. This causes the uterus to contract more strongly and more often than usual, resulting in pain.
It is estimated that as many as 50% of women may suffer from primary dysmenorrhea, where no physical cause can be found, and the pain is due to severe menstrual cramps.
In primary dysmenorrhea, medications that reduce the amount of prostaglandins made by the body and lessen their effects, are used in an attempt to make menstrual cramps less severe. These include certain pain relievers, called nonsteroidal anti-inflammatory drugs (NSAIDs). They, however, have certain potential adverse effects and are contraindicated in women with:
Also, hormonal birth-control pills and other hormonal preparations are used for the same effect.
The efficacy of conventional treatments such as NSAIDs is considerable, however, the failure rate is still often 20-25%. Many consumers are now seeking alternatives to conventional medicine and research into the menstrual cycle suggests that nutritional intake and metabolism may play an important role in the cause and treatment of menstrual disorders.
Herbal and dietary therapies number among the more popular complementary medicines. Vitamin B1 or magnesium supplements may be helpful, but research is yet ongoing to prove them as effective treatments for dysmenorrhea. Other alternative therapy methods include herbal preparations, transcutaneous nerve stimulation, acupuncture, and heat therapy. Regular exercise and abstaining from alcohol and tobacco has also been shown to be somewhat helpful in relieving dysmenorrhea.
In secondary dysmenorrhea, the underlying condition causing the pain should be treated accordingly.
Magnesium, an abundant mineral in the body, is naturally present in many foods, added to other food products and available as a dietary supplement. Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation.
Magnesium is required for energy production, oxidative phosphorylation, and glycolysis. It contributes to the structural development of bone and is required for the synthesis of DNA, RNA, and the antioxidant glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm.
About 60% of the total magnesium contained in the adult body is present in the bones and most of the rest in muscles and soft tissues. Less than 1% of total magnesium is in blood serum, and these levels are kept under tight control. Magnesium homeostasis is largely controlled by the kidney, which excretes magnesium into the urine. Urinary excretion is reduced when magnesium status is low. Assessing magnesium status is difficult because most magnesium is inside cells or in bone.
Symptoms of marginal magnesium deficiency are more subtle, and the condition may be asymptomatic in some. It has been reported, however, that low magnesium status has been associated with chronic inflammatory stress conditions.
The Dietary Reference Intake for magnesium for adults is 310–420 mg/d. The intestinal absorption from the natural sources varies greatly between individuals. Large numbers of women may be at risk for magnesium deficiency. Dietary intake studies consistently show intakes of magnesium to be below that recommended in many age groups, with teenage girls and adult women among those most at risk of low intakes. Magnesium depletion can be compounded by the use of diuretics, increased alcohol and dietary fat intakes, a high intake of dairy products, stress, and malabsorption syndromes.
A growing amount of evidence suggests that magnesium deficiency may play an important role in dysmenorrhea, as also in several other conditions affecting women's health. Studies have found that intracellular magnesium concentrations are lower in women with menstrual cramps than in asymptomatic women.
The recommended oral supplementation for menstrual cramps is 360 milligrams, once daily, for three days, preferably begun one or two days before bleeding starts. However, magnesium can interact with many medications. Also, it can induce diarrhea and lower blood pressure, so oral supplementation is not always preferred, especially in those suffering from digestive problems or heart disease. Topical applications of ionic magnesium may be an effective source of supplementation. These may have to be used throughout the second half of the menstrual cycle.
The mechanism of action of magnesium may be due to the direct effect on the tone of the blood vessels and can act physiologically to control and regulate the entry of calcium into smooth muscle cells, acting as a naturally occurring calcium channel blocker. Through controlling calcium, magnesium influences the contractility, tone, and relaxation of the uterine smooth muscle. Magnesium regulates the synthesis of prostaglandins thus decreasing inflammation.
Current data suggest that magnesium is effective and may represent an effective option for the treatment and the prevention of dysmenorrhea.
Magnesium and Menstrual Cramps
~ Written by Nandan Roongta, Medical Expert and Gynecologist
