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You're Probably Taking the Wrong Meds to Treat Your Period Cramps
When really bad period cramps kick in, you probably take the first painkiller you can get your hands on, whether it's a Motrin from a coworker or a rogue Aleve from the bottom of your bag. But a cavalier approach to taking OTC meds could delay your relief, aggravate your stomach, and chip away at your health, according to Dr. Kimberly Sackheim, DO, a pain management specialist at NYU Langone's Rusk Rehabilitation center.
"Because over-the-counter painkillers are easy to get, they're easy to abuse, and that makes them dangerous," Dr. Sackheim says. In the worst-case scenario, this could land you in a major surgery or even threaten your life. It doesn't help that most people can't tell the difference between ibuprofen and acetaminophen if their lives depended on it (which it sort of does). So, first things first:
Acetaminophen vs. Every Other Common Pain Killer
If you remember one thing, let it be the difference between acetaminophen (aka Tylenol) and other common pain relievers. Acetaminophen poses special risks because it's broken down by and can seriously damage your liver, a vital organ that filters out toxins including alcohol. You should never,everchase acetaminophen with booze, which could stress out of the liver and contribute to irreversible damage.
That said, there is a time and place for acetaminophen, which targets the areas of the brain responsible for processing pain and body temperature. But Dr. Sackheim warns that acetaminophen isn't quite as effective as NSAIDs at treating period cramps. (NSAIDs, or nonsteroidal anti-inflammatory drugs, are all over-the-counter painkillers other than acetaminophen.) Acetominophen doesn't mess with your stomach, so it's suitable for treating period cramps accompanied by an upset stomach, which can go hand in hand with PMS because life isn't fair. Just mind your dosage (no more than two pills every six hours as needed, and no more than six pills per day).
Apart from cramps, if you're suffering from a fever, taking acetaminophen as directed will do you a solid. But it won't reduce inflammation in, say, a sprained ankle.
What You Need to Know About NSAIDs
NSAIDs provide relief by chilling out the nerve endings that process pain. NSAIDs include ibuprofen (found in Advil and Motrin), naproxen (found in Aleve), celecoxib (aka Celebrex), and aspirin. They don't include acetominophen or multiple-symptom medications that contain it, like DayQuil, Midol, and Excedrin.
Unlike acetaminophen, NSAIDs reduce inflammation to reduce joint and muscle pain. And because NSAIDs are metabolized by the kidneys, they pose no risks to the liver whatsoever.
That said, NSAIDs can suppress an enzyme that protects the lining of the stomach, potentially triggering acid reflux, general stomach upset, and internal bleeding. It's one reason why you shouldn't drink alcohol, another stomach irritant, before or after takinganyOTC painkiller. NSAIDs also thin your blood, which slows blood clotting and reduces the risk of heart attack and stroke. (It's not a bad perk regardless of whether these conditions are top of mind.)
So, What Should You Take?
The American College of Obstetricians and Gynecologists (ACOG) NSAIDs are the best defense against painful cramps. (Another bonus: Some studies have found these drugs can actually lighten super-heavy bleeding better than placebo — just not as well as hormonal birth control, so don't gettooexcited.)
Among your NSAID options:
- Aspirinis most likely to irritate your stomach and won't necessarily do the trick when the struggle is real: "A lot of patients tell me that ibuprofen or naproxen works better than aspirin for period cramps," Dr. Sackheim says. In other words, it's far from your best option.
- Ibuprofencan effectively put you out of your misery, assuming your kidneys are fully functioning and you don't have a particularly sensitive stomach. Just be sure to take it with food to prevent any issues.
- Naproxen, like ibuprofen, is considered highly effective. Because naproxen can provide some sweet relief that's longer lasting than other over-the-counter anti-inflammatories, it's particularly good for cramps that last all freaking day, according to Dr. Sackheim.
- Celecoxibis the drug you've probably never heard of since it's typically associated with arthritis relief and available only by prescription. But if your PMS tends to trigger cramps and stomach issues simultaneously, it could be your best bet. A new study on long-term use of over-the-counter NSAIDs for arthritis pain that was recently published injust made this option lookreallygood: It caused fewer kidney issues than the other NSAIDs with no greater risk of stroke or heart attack, a formerly suspected side effect that's long deterred doctors from recommending celecoxib in the first place. While taking too much celecoxib (i.e., multiple doses every day of the month) can ultimately cause stomach ulcers too, the formula is less likely than other NSAIDs to block enzymes protecting your stomach. It's why celecoxib generally goes easier on your insides — a good thing at the onset of your period, when your body often needs some extra TLC.
And as for acetaminophen:
- Acetaminophencan certainly help with cramps if you find yourself in pain in a place where acetaminophen's the only option or have a super sensitive stomach. But don't even if you plan on drinking. "Medically speaking it is best not to take any medications when drinking alcohol," Dr. Sackheim says. But if it's absolutely necessary to drink and treat cramps with medicine (i.e., it's girls' night out and you've tried alternative remedies, like heating pads and exercise and self massage, to no avail), it's better to take a low-dose NSAID, like an ibuprofen a few hours before ingesting alcohol. The only exception is when you're dealing with chronic health issues, including high blood pressure, in which case talk to your doctor.
And then there's always the stronger stuff:
- Prescription opioidscould be your ticket to sweet relief if acetaminophen and most NSAIDs typically upset your stomach, but your cramps are no joke. If hormonal birth control, which can make periods less painful, isn't an option, Dr. Sackheim might recommend a prescription opioid painkiller. "Everything you put into your body has a risk and a benefit," she says, of their addictive nature. "If taken appropriately, taking one to two stronger pills a month is safer for the kidneys and liver than taking 30 Advil." (That said, for the average person with no existing kidney or liver issues, it's no big deal to take any NSAID a couple times a month.)
If you end up treating cramps with whatever's sitting in your medicine cabinet out of laziness or desperation, be sure to use it only on an as-needed basis as opposed to prophylactically. In other words, if the bottle's directions say to take one dose every six to eight hours as needed, that doesn't mean you should be taking pills that often, lest you damage your insides. "If you're really not feeling well six to eight hours later, you'reallowedto take them," Dr. Sackheim clarifies. Another thing: Make note of what you've taken. Otherwise, "if you have side effects, you won't know what caused them, and if you feel better, you want to know what helped," she says.
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