What are the alternative therapy options?

Common Pain Relievers for Cramps

Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be sufficient for about 75% of women with endometrial pain. NSAIDs block prostaglandins (the substances that increase uterine contractions). They are effective painkillers and also have other properties that act against inflammatory factors.

Aspirin is the most common NSAID, but there are dozens of others available over the counter or by prescription. Among the most effective NSAIDs for menstrual disorders are ibuprofen, naproxen and mefenamic acid.

For maximum benefit, they should be taken seven to 10 days before a period is expected.

It should be noted, however, that long-term use of any NSAID, can increase the risk for gastrointestinal bleeding and ulcers.

COX-2 Inhibitors.

Celecoxib, rofecoxib and valdecoxib are known as cyclooxygenase-2 (COX-2) inhibitors.These agents are effective painkillers and are being used with some success for menstrual cramps. They have actions that are similar to those of NSAIDs, but theoretically COX-2 inhibitors should be less harmful to the GI tract than standard NSAIDs

Dietary Factors

Some women report relief by avoiding dairy products and having a diet rich in fiber and low in saturated (animal) fats. Fiber-rich foods (such as fruits and vegetables) along with plenty of fluids (water or juice, not caffeine) are not only healthy but help prevent constipation, which can intensify symptoms. If women choose a diet that limits dairy products, they should be sure to have sufficient calcium from other sources.

Certain fat compounds called omega-3 fatty acids, which are in fish oils, may have specific anti-inflammatory effects. They are found in certain oily fish (sardines, mackerel) and can be obtained in supplements. Supplements may be labeled either omega-3 fatty acids or EPA-DHA (which are the important compounds). Evening primrose oil and black currant oil, found in health food stores, contain similar fatty acids that may be helpful.

Some evidence suggests that soy products (e.g., tofu, soy milk) may protect against endometriosis. Soy contains estrogen-like compounds that may actually protect against problems that are triggered by a woman's own estrogen. More research is needed.

People with endometriosis should avoid alcohol, caffeine, and chocolate. Women who drink large amounts of beverages with caffeine appear to have an increased risk for endometriosis, possibly because caffeine contributes to increased levels of the estrogen, estrone. Heavy alcohol use (which also increases estrogen levels) is also associated with endometriosis.

Exercise

Exercise may be very helpful for women with endometriosis. It relieves stress and tension and may reduce hormonal levels that could contribute to endometrial growth.

Alternative Treatments

Certain integrative methods may be helpful for relieving menstrual cramps, especially techniques that ease muscle and joint pain and inflammation throughout the body. It is not clear if these approaches have any benefits for women with endometriosis, however. Patients should always approach alternative treatments that involve untested herbal or so-called natural remedies with caution,

Acupuncture and Acupressure.

Some studies, including a small well-conducted trial, have reported relief from pelvic pain after acupuncture or acupressure, a technique that applies small pins or pressure to specific points on the body. It is believed to work by exciting nerve receptors in those locations that interact with pain blockers in the brain. Some women report relief with reflexology, an acupuncture technique that uses manual pressure on acupuncture points on the ears, hands, and feet.

Transcutaneous Electrical Nerve Stimulation.

Transcutaneous electric nerve stimulation (TENS) applies electrodes to certain parts of the body and administered low-level electrical pulses to those locations. Researchers suggest that it works by altering the body's ability to receive pain signals. The standard approach is to give 80 to 100 pulses per second, for 45 minutes, three times a day; patients are barely aware of the sensation. A major 2002 analysis of a number of small studies suggested that this approach can help some women with dysmenorrhea. There may be some minor side effects.

Yoga and Meditative Techniques.

Yoga and meditative techniques that promote relaxation may also be helpful for menstrual cramps.

Chiropractic.

Some women with primary dysmenorrhea have sought help from chiropractors trained in spinal manipulation. One study compared a high-force spinal manipulation technique with a low-force maneuver used as a placebo technique. Both showed lower scores on tests that measure pain, perhaps indicating that a simple back rub by a sympathetic partner or friend may be helpful.