Do muscle relaxers help with period cramps

The roses were a gift from a grateful patient to Dr. Béla Schick in the summer of 1919. When the flowers arrived, the doctor asked his maid to place them in water. She hesitated but took them at his insistence. The next day, the blooms had wilted. The servant admitted she should not have handled them because she was menstruating, and during those days of the month, her touch could be lethal.

Intrigued, Dr. Schick — a renowned physician in Vienna — began investigating the mysterious killer poison. In 1920, he published the results of an experiment in which he asked women to hold blossoms at different times of the month. "The skin of menstruating women did in fact excrete substances that hasten the death of flowers," he reported solemnly. Public and medical lore at the time contended that the touch of a menstruating woman could not only wither plants but could turn wine sour and keep dough from rising.

This imaginary threat was even given a name — menotoxin — and doctors debated its existence as recently as the 1970s. In 1977, a group of researchers writing in The Lancet wondered if the elusive menotoxin was in fact related to prostaglandins, hormone-like chemical messengers produced by the body that may be elevated during a woman's period. They were on to something, but not in the way they thought. Studies throughout the late '70s and '80s determined that prostaglandins could trigger uterine contractions and menstrual pain. More significantly, research determined that nonsteroidal anti-inflammatory drugs, or NSAIDs, blocked prostaglandins and offered relief.

About three-quarters of all women are thought to experience some kind of menstrual pain. Among young women, it is the leading single cause of lost time from school or work. "If you compare women and men in terms of their ability to influence society, how much unrealized potential is lost from women because they have to deal with insufficiently treated pain?" asks ob-gyn Frank Tu, M.D., of NorthShore University HealthSystem in Chicago.

Early treatment could be vital. Recent studies have found potential links between the severity of menstrual cramps in younger life and the risk of developing chronic pain in later years. Severe cramps make cells in the central nervous system more sensitive, says Pamela Stratton, M.D., who studies endometriosis, a condition that can lead to painful periods, at the National Institutes of Health. "We've found that women with endometriosis are more sensitive to pain and stay more sensitive," she says.

Yet it's typical for a woman to go five to eight years without an endometriosis diagnosis, Dr. Stratton says, and by then, treatment may not be as effective. "They accept the pain as part of their periods," she says. "Women are sometimes told by their doctors that it is all in their head or it is normal." As many as 30 percent of gynecological patients overall are suffering severe, recurring period pain, according to a study released in August. And when symptoms are treated, the standard advice has changed little in three decades. It is one of the most significant health problems for which there is almost no public discussion and little research.

NSAIDs — which include OTC drugs like ibuprofen, naproxen, and aspirin as well as prescription meds like Celebrex — were a breakthrough treatment. After that, much of medical science took a victory lap and declared the problem conquered. If you search for research focused on menstrual pain, as Dr. Tu recently did, "it seemed to just get quiet around the mid to late '80s," he says. "People were no longer interested." That means we haven't had a significant advance since Duran Duran released "Notorious."

When Richard Legro, M.D., of Penn State College of Medicine applied for a grant to study primary dysmenorrhea — period pain that is not tied to another cause — he reviewed all ongoing projects backed by the National Institutes of Health. "There's not one that is developing or testing a treatment to improve painful periods," he says. To be fair, tax money does support research for endometriosis and a related condition, adenomyosis. Great effort goes into basic lab studies about chronic pain — but research published this summer in Nature Neuroscience reported that experiments are overwhelmingly conducted on male rodents and that male and female mice may experience pain differently on a biological level.

Without new research into why period pain persists in so many women despite NSAIDs, drug companies hesitate to invest in developing a treatment, says John LaMattina, a former head of research and development at Pfizer. A 2011 report from PhRMA, a pharmaceutical industry group, lists 851 products in development for conditions that tend to affect women. Only three address endometriosis, and none specifically targets cramps.

It might seem like a sexist conspiracy, but there are lots of reasons scientists don't get that excited about menstruation. In the research world, Fatal Scary Problems attract grant money and launch careers. No one ever died from cramps. "You're not going to get big dollars or prestige for researching menstrual pain," says Jennifer Bump, M.D., of Baylor College of Medicine, in Houston.

Further hampering progress, there's no public outcry. Men — and women with easier periods — may find it hard to empathize. Menstruation remains a culturally awkward topic, driven into the shadows. "Throughout history, women were shunned or locked away in their little hut when they were on their period," Dr. Bump says. "There is this idea that this is a curse, and it somehow is shameful." PMS is a subject fraught with stereotype and ridicule — witness Donald Trump versus Megyn Kelly. Women themselves can struggle with frank conversations about menstrual pain. Says Dr. Bump, "I still have patients who, for lots of different reasons, don't want to talk about it."

Kathryn Jones, a 33-year-old occupational therapist who lives near Boston, had excruciating periods starting in her teens. On the first day of her cycle, she could do little more than curl up. "I would not even be able to answer my phone," she says. "I found myself holding my breath because the pain came in such waves."

She sought one doctor after another. "The only thing they would say was, 'Oh if you have bad cramps, go on birth control.'" She tried the pill but didn't like the side effects. After that, she says, "they just said deal with it — get a heating pad, stay hydrated. I stopped bringing it up after a while. I wasn't going to ask the same question a million times."

Soon she stopped talking about it altogether. "You're not going to say, 'I don't feel good today because I'm on my period.' I mean, people blush, they look away. Unless you're a woman with this same experience, no one wants to hear about it."

Stephenie Combs, 28, of Houston, lived with similar frustrations. The cramps in her early teens were tolerable, she says, but "once I hit 25, something really happened to my hormones. I felt like my own body hated me." She would soak in hot baths, then sit on the couch clutching a glass of wine. She tried two doctors, both of whom told her pain was normal. "They're like, 'Doesn't every woman cramp?' I was popping naproxen like candy and thinking, this can't be good for me."

A lot of women do get better with NSAIDs. A review published this summer by the Cochrane research group found that women taking 20 varieties of NSAIDs were about twice as likely overall to get relief compared with women who took a placebo. But according to the Food and Drug Administration, NSAIDs can cause stomachaches, diarrhea, an increased risk of heart attack, and over the long haul, kidney problems. And for as many as half of women with severe pain, the Cochrane report noted, NSAIDs don't do any good at all.

That doesn't mean you're stuck though. Lyubov Fetsenets, a 27-year-old school nurse who lives outside Chicago, had cramps that would radiate down into her upper thighs. She had trouble even walking and often called in sick. "I went to a really prestigious doctor, and he told me to just take a few ibuprofen before it starts," she says. It didn't work.

She ended up in the office of Dr. Tu at NorthShore after she was told he was an expert in gynecologic pain. He spent almost two hours discussing her issues. He eventually advised her to take a prescription muscle relaxant the first few days of her period — a use that hasn't been studied or FDA-approved but has had a lot of anecdotal success, he says.

The pain isn't gone, but it doesn't disrupt her life as much. And she was glad she didn't give up seeking help. "Keep looking for a doctor," she says, "until you find someone who will actually take time to listen to you."

Kathryn Jones found her solution through unconventional means: a girls' getaway trip to a massage therapist who noticed that her lower vertebra were fused. This caused her to favor one side while she walked, throwing the muscles in her hips out of balance. One side was almost locked in a constant spasm, which got worse during her period. A physical therapist helped her learn how to relax the tightened muscles in her pelvis, hips, and glutes as well as rebalance them through strengthening exercises, which significantly decreased her period pain. "I still feel uncomfortable, but I'm not curled up in a ball," she says.

Stephenie Combs got relief by changing her birth control to a progestin-emitting IUD, which lightened her periods without dramatically adding extra hormones in the rest of her body. "It changed everything tremendously," Combs says. Dr. Bump feels the hormonal IUD is an underused game-changer for a lot of women. It won't help everyone though. Rarely, cramps can get worse on a hormonal IUD, although the effect tends to wane after a few months.

Nothing will truly cure menstrual pain until we understand where it comes from. Cramps don't begin and end just with prostaglandins. They cause the uterus to contract, and those contractions help the inner lining to shed. But this same process occurs in everyone who menstruates. "So why does one woman experience it as painful and another doesn't? We just don't know," says Laura Payne, PhD, of the David Geffen School of Medicine at UCLA. "It's not just the contractions. There's some interaction happening there, and we don't totally know what it is."

To move forward, the cultural aversion to honest and serious discussion must end, Payne says. "There have been these taboos about talking about menstruation and really bringing it to the forefront as an issue that women deal with," she says. "It's not the type of thing people think of as a real problem."

This article was originally published as "Does Your Period Have to be This Bad?" in the November 2015 issue of Cosmopolitan, on newsstands now. Click here to subscribe to the digital edition!

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