Menstrual cramps are sharp pains in the abdomen before and during menstruation.
The pain, also known as dysmenorrhea or period pains, ranges from dull and annoying to severe and extreme. Menstrual cramps tend to begin after ovulation when an egg is released from the ovaries and travels down the fallopian tube.
Pain occurs in the lower abdomen and lower back. It usually begins 1 to 2 days before menstruation and lasts from 2 to 4 days.
Pain that is only associated with the process of menstruation is known as primary dysmenorrhea.
Here are some key points about menstrual cramps. More detail is in the main article.
- Menstrual cramps are pains felt in the lower abdomen, before and during menstruation.
- The pain can range from slight to severe.
- Emotional stress can increase the chance of experiencing menstrual cramps.
- Other symptoms include nausea, vomiting, sweating, dizziness, headaches, and diarrhea.
- Menstrual cramps can be treated with over-the-counter medicine, birth control treatments, and some home remedies.
- Secondary dysmenorrhea is when the cramps stem from another condition, such as endometriosis.
Causes and risk factors
Approximately once every 28 days, if there is no sperm to fertilize the egg, the uterus contracts to expel its lining.
Hormone-like substances called prostaglandins trigger this process.
Prostaglandins are chemicals that form in the lining of the uterus during menstruation. They cause muscle contractions and cramps that are similar to labor pains. They can also contribute to nausea and diarrhea.
The contractions inhibit the blood flow to the lining of the uterus, or endometrium. It may also happen because there are high levels of leukotrienes during menstruation.
Those who are more likely to experience menstrual pain include:
- Being younger than 20 years of age
- Starting puberty at 11 years or younger
- Menorrhagia, or heavy bleeding during periods
- Never having given birth
Conditions that can worsen menstrual cramps
Several underlying medical conditions are also linked to menstrual cramps.
- Endometriosis: the tissue that lines the uterus develops outside the uterus.
- Uterine fibroids - Noncancerous tumors and growths in the wall of the uterus.
- Adenomyosis: The tissue that lines the uterus grows into the muscular walls of the uterus.
- Pelvic inflammatory disease (PID): A sexually transmitted infection caused by a bacterium
- Cervical stenosis: The opening of the cervix is small and limits menstrual flow.
Women with delayed sleep phase syndrome are more likely to report irregular menstrual cycles and premenstrual symptoms, as well as menstrual cramps, according to researchers from Northwestern University in Chicago, Il.
Menstrual cramps usually refer to a dull, throbbing, cramping pain in the lower abdomen, just above the pelvic bone.
Other symptoms may include:
- pain in the lower back and thighs
- nausea and vomiting
- faintness and dizziness
- diarrhea or loose stools
If symptoms get progressively worse, or if they start over the age of 25 years, it is a good idea to see a doctor.
An IUD can help to reduce the symptoms of menstrual cramps.
Most women can identify menstrual cramps without the help of a physician.
If the pains are severe, the doctor should carry out a full examination of the pelvis and abdomen.
The physician will ask the patient about their medical history and perform a physical examination. This will include evaluating the size and shape of the vagina, cervix, uterus, and ovaries, and possiby an internal pelvic examination.
If the doctors suspect an underlying condition, they may order tests to gather more information about the abdominal area, uterus, cervix, vagina, and fallopian tubes.
These may include:
- computerized tomography (CT) scan
- magnetic resonance imaging (MRI)
Imaging techniques can help identify cases of endometriosis, adhesions, fibroids, ovarian cysts, and ectopic pregnancy.
Over-the-counter medication is available to treat most cases of menstrual cramps.
Anti-prostaglandins reduce cramping in the uterus, lighten the flow of blood, and relieve discomfort.
These medications may also contain pain killers, such as ibuprofen or naproxen. These are types of nonsteroidal anti-inflammatory drugs (NSAIDs).
NSAIDs are also used alone to reduce menstrual cramp pain.
If the woman is a good candidate, a physician may prescribe hormonal birth control pills to prevent ovulation and reduce the severity of menstrual cramps. These work by thinning the lining of the uterus, where the prostaglandins form. This reduces cramping and bleeding.
In some cases, birth control pills can be used continuously, without the 4 to 7-day break each month that is normally adhered to. There will be no bleeding at all, in this case.
Other types of birth control, including some types of hormonal IUD, vaginal rings, patches, and injections can all help decrease cramping.
If the cramps are due to an underlying medical condition, such as endometriosis or fibroids, surgery may be needed to remove the abnormal tissue.
Home remedies for menstrual cramps
Some non-medical options that may provide relief are:
A hot bath can be a non-medical remedy for menstrual cramps.
- Soaking in a hot bath
- Applying heat, for example, a hot water bottle, to the lower abdomen Caution, do not sleep with a heating pad to prevent burns.
- Transcutaneous electrical nerve stimulation (TENS)
Researchers at Imperial College London found that ingredients in chamomile tea may help relieve menstrual pains by relaxing the uterus.
In another study, Chinese herbal medicines were found to help reduce menstrual cramps, but the authors called for more research.
If you choose to use any herbal or supplement approaches, be cautious. The United States (U.S.) Food and Drug Administration (FDA) does not regulate herbs and supplements for quality or purity.
Getting enough rest and sleep and regular exercise may help.
Measures that may reduce the risk of menstrual cramps include:
- eating fruits and vegetables and limiting intake of fat, alcohol, caffeine, salt, and sweets
- exercising regularly
- reducing stress
- quitting smoking
If the first treatment option does not work within 2 to 3 months, the patient should return to the doctor.
A more invasive type of therapy may be available, or further investigations may be needed.