Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods.
For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities for a few days every month.
Menstrual cramps may be caused by identifiable problems, such as endometriosis or uterine fibroids. Treating any underlying cause is key to reducing the pain. Menstrual cramps that aren’t caused by an underlying condition tend to lessen with age and often improve once a woman has given birth.
Primary dysmenorrhea is thought to be caused by excessive levels ofprostaglandins, hormones that make your uterus contract during menstruation and childbirth. Its pain probably results from contractions of your uterus that occur when the blood supply to its lining (endometrium) is reduced.
Other factors that may make the pain of primary dysmenorrhea even worse include a uterus that tilts backward (retroverted uterus) instead of forward, lack of exercise, psychological or social stress, smoking, drinking alcohol, being overweight, and starting menstruating before age 11.
Secondary dysmenorrhea may be caused by a number of conditions, including:
- fibroids – benign tumours that develop within the uterine wall or are attached to it
- adenomyosis – the tissue that lines the uterus (called the endometrium) begins to grow within its muscular walls
- a sexually transmitted infection (STI)
- endometriosis – fragments of the endometrial lining that are found on other pelvic organs
- pelvic inflammatory disease (PID), which is primarily an infection of the fallopian tubes, but can also affect the ovaries, uterus, and cervix
- an ovarian cyst or tumour
- the use of an intrauterine device (IUD), a birth control method
Historical attitudes toward menstrual pain were often dismissive. Pain was often attributed to women’s emotional or psychological states or to misconceptions about sex and sexual behaviors. Although the etiology and pathophysiology of dysmenorrhea have not been fully elucidated, research has led to data supporting concrete physiologic explanations for dysmenorrhea, which discredit these prior dismissive theories.
Symptoms of menstrual cramps include:
- Throbbing or cramping pain in your lower abdomen that may be intense
- Dull, constant ache
- Pain that radiates to your lower back and thighs
Some women also experience:
- Loose stools
If you experience painful periods, check with your doctor to see whether you might have an underlying disorder that is causing secondary dysmenorrhea. You may be given a pelvic examination, and your blood and urine may be tested.
A doctor may also wish to use ultrasound to get a picture of your internal organs or even use the technique oflaparoscopy for a direct look into your uterus.
Menstrual cramps are treatable. Your doctor may recommend:
- Pain relievers. Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid (Ponstel), also are available. If you can’t take NSAIDs, acetaminophen (Tylenol, others) may lessen your pain.
Start taking the pain reliever at the beginning of your period, or as soon as you feel symptoms, and continue taking the medicine as directed for two to three days, or until your symptoms have gone away.
- Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD).
- Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, surgery to correct the problem may help reduce your symptoms. Surgical removal of the uterus also may be an option if you’re not planning to have children.