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Cramps are very common before and during menstruation, but they can also occur after the period has ended. This is not usually a cause for concern, but it can indicate an underlying condition.
In this article, we cover 10 possible causes of cramps after menstruation:
- ectopic pregnancy
- uterine incapacity
- ovarian cysts
- uterine fibroids
- cervical stenosis
- pelvic inflammatory disease (PID)
We also look at symptoms and ways to relieve the pain caused by period cramps.
Cramps that occur directly before and during the period are caused by the uterus contracting as it sheds its lining. This is called primary dysmenorrhea, and it usually lasts for 48 to 72 hours.
Cramps caused by anything other than menstruation are called secondary dysmenorrhea. They can occur at any time in the menstrual cycle.
Secondary dysmenorrhea may be normal, or it may need to be diagnosed and treated by a doctor or specialist.
Below are some possible causes of cramps that occur after menstruation.
A woman may feel cramps during ovulation — when an ovary releases an egg. Ovulation occurs around the middle of the menstrual cycle. These cramps are called mittelschmerz.
Ovulation is a part of most regular menstrual cycles. A person may or may not be able to feel it happening.
Ovulation cramps often affect one side of the body. They may last for a few minutes or a couple of days and will go away on their own.
Mild uterine cramps can be a very early sign of pregnancy. These cramps are associated with implantation — when a fertilized egg or embryo attaches itself to the uterus lining.
Implantation-related cramps are mild and temporary, and often accompany dark red or brown spotting, known as implantation bleeding. This bleeding occurs around the time that the next period would be due.
Other symptoms of pregnancy may occur during this time, such as breast heaviness, increased urination, and mood changes.
The best way to test for pregnancy is to take a test at home or in a doctor’s office.
An ectopic pregnancy occurs when the fertilized egg attaches itself anywhere outside the uterus.
Ectopic pregnancies begin like regular pregnancies, but a woman may soon experience severe cramping and pain in the uterus.
Other symptoms may include:
- abnormal bleeding
- sharp, often severe pelvic pain
- shoulder pain
The pressure involved in an ectopic pregnancy can cause the fallopian tube to rupture. This can result in heavy bleeding, which may lead to fainting, shock, or feeling lightheaded. A ruptured fallopian tube requires emergency medical care.
Ectopic pregnancies are not common, occurring in around 2 percent of pregnancies.
4. Uterine incapacity
In some cases, an amount of blood will remain in the uterus after the period has ended. When this happens, the uterus contracts to remove the extra blood.
These contractions can cause cramping and may also result in brown or black spotting as the old blood is pushed out.
Symptoms will usually go away within a few days as the body gets rid of the leftover blood.
Endometriosis is a condition that causes uterine tissue to grow outside the uterus. Endometriosis can be managed, but there is currently no cure.
Associated pain may occur 1 to 2 weeks before menstruation. Pain can be unusually intense 1 to 2 days before the period begins.
Other symptoms of endometriosis include:
- heavy periods
- painful ovulation
- pain in the lower abdomen or back
- pain during or after sex
Constant pelvic pain or abdominal cramps that get worse during menstruation should be discussed with a doctor.
Adenomyosis causes endometrial tissue to grow in the muscles of the uterus, rather than in the uterine lining.
This makes the uterine walls thicker, which can lead to especially heavy menstrual bleeding and prolonged cramping.
Adenomyosis is treated with medication. In some extreme cases, a hysterectomy may be required.
7. Ovarian cysts
Cysts forming in the ovaries can cause cramps and bleeding after the period has ended.
Most cysts will clear up on their own, but if they are especially large, they may cause other symptoms.
Ovarian cysts can make the abdomen and pelvis feel bloated or heavy. There may also be some spotting or bleeding before or after their period.
Ovarian cysts are typically treated with medication or surgery.
8. Uterine fibroids
Fibroids are benign, noncancerous growths that can form anywhere in the uterus. Symptoms differ based on the location, size, and number of fibroids in the uterus.
Uterine fibroids may cause symptoms such as:
- irregular bleeding
- especially heavy menstruation
- long-lasting menstruation
- pressure or pain in the pelvis
- difficulty urinating or frequent urination
In some cases, uterine fibroids can cause infertility. They are often treated with medication, surgery, or a combination of the two.
9. Cervical stenosis
Some women have a smaller opening in their cervix. This is called cervical stenosis, and it can slow down the menstrual flow, which may cause painful pressure in the uterus.
Cervical stenosis can be treated with medication or surgery. Alternatively, an intrauterine device (IUD) may relieve symptoms.
10. Pelvic inflammatory disease (PID)
Pain in the uterus or vagina accompanied by foul-smelling discharge can be a sign of a vaginal or uterine infection. This may cause PID if the bacteria move into other areas of the reproductive system.
Symptoms may not be obvious at first, and may begin with a sudden and persistent cramp-like pain in the abdomen. PID can become life-threatening if not correctly treated.
Other symptoms of PID include:
- heavy or abnormal vaginal discharge
- abnormal menstrual bleeding
- general fatigue
- flu-like symptoms, such as a fever or chills
- pain, discomfort, or bleeding during intercourse
- difficult or painful urination
Most uterine cramps will feel similar, regardless of when they occur.
When cramping follows menstruation, it may be felt in the lower abdomen and lower back, though it can spread to the hips and thighs.
The strength of these cramps varies from person to person, but they may be more severe than typical menstrual cramps.
Many people experience symptoms that accompany their cramps, including:
Each woman experiences menstrual cramps differently. Some may have severe cramping throughout their period, while others notice only mild discomfort before menstruation.
Cramps that follow menstruation are treated in the same way as most uterine cramps.
The severity of cramping can be reduced, using the following methods:
- taking painkillers or anti-inflammatories
- placing a heating pad or hot water bottle on the abdomen
- lightly massaging the area
- Increasing water intake
- eating a diet high in whole foods, such as fruits and vegetables
- reducing stress levels
- reducing tobacco and alcohol intake, or avoiding it altogether
- doing light exercises, such as biking or walking
Healthy lifestyle choices and self-care routines can result in less severe period cramps.
Heating pads are available for purchase online.
Cramps that follow a period are often not a cause for concern.
In some cases, cramps may be a sign of pregnancy or an underlying condition, so it may be important to take note of how and when they appear. Treatment will depend on the underlying cause.
If cramps are severe, do not improve, or appear with other symptoms, consult a doctor for diagnosis and medical treatment.