An Overview of Menstrual Cramps

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Menstrual cramps are the result of hormone-induced muscular contractions of the uterus. They are often heaviest during the first day or two of your period, and usually subside within a few days. Cramps are a normal part of your cycle as your uterus sheds its lining each month, but significant pain or heavy flow should not be dismissed. They may have other causes and are always treatable.

Symptoms

As any woman who has been through labor can tell you, the uterus is a strong muscle capable of very intense contractions. What you may not know is that the normal changes that cause you to bleed each month also cause the uterus to contract. These contractions—menstrual cramps—aren't as strong as they are during labor and can be quite mild, but for many, the discomfort can be severe.

Menstrual cramps are generally experienced as pain, dull throbbing, and discomfort in the lower abdomen and pelvic area, though pain can extend to the thighs and lower back. Cramping may start a few days before your period and is often most difficult during the heaviest flow of menstruation.

Some women also experience bloating, gas, and other digestive issues—possibly even nausea, headaches, and dizziness—alongside cramping.

Causes

Your uterus is made up of two main layers. The outer muscular layer, the myometrium, is composed of smooth muscle cells. The inner layer, the endometrium, responds to changes in your hormone levels. The endometrium builds up in the first half of your menstrual cycle as part of preparation for pregnancy.

If a pregnancy doesn't happen, hormone changes cause substances known as prostaglandins to be released from the endometrium. These make the muscle of your uterus, or the myometrium, contract, resulting in the shedding of the endometrial lining. This shed lining is a big part of your menstrual flow. 

Sometimes menstrual contractions are intense enough to interfere with the usual blood flow to your uterus. This decreased blood flow triggers a pain response called dysmenorrhea. It can be significant enough to interrupt your usual activities. 

There are two types of dysmenorrhea. In general, the different types are based on when the cramps started and what is causing them.

  • Primary dysmenorrhea: For some women, their periods have been painful from the very start. If you have always had painful periods, it is likely that your menstrual cramps are caused by an exaggerated response to your body's normal changes. Specifically, it is thought that women with primary dysmenorrhea have increased amounts of prostaglandin, the substance that causes the uterus to contract.
  • Secondary dysmenorrhea: If you have developed painful periods over time, particularly after age 25, you may have developed an underlying condition that is aggravated by the normal changes causing uterine contractions. Common issues that may cause secondary dysmenorrhea include fibroidsadenomyosis, infection, and the use of a copper IUD.

Diagnosis

If you have any issues with menstrual cramps, you should discuss them with your doctor. Your answers to the questions your doctor asks and the other details you provide will begin to help her determine the cause.

Your doctor may or may not do a pelvic exam. You may also need additional testing depending on the other symptoms you report and the findings on exam. However, don't be surprised if your doctor does not order any testing, especially if you are a teenager and not yet sexually active.

Treatment

There are numerous options for treating dysmenorrhea. They range from lifestyle changes (like getting more exercise) to medication and, in rare cases, surgery. Sometimes multiple treatments are combined.

If your doctor suspects that you have primary dysmenorrhea, it is likely that she will suggest a three-month trial of nonsteroidal anti-inflammatory drugs (NSAIDs) or a hormonal contraceptive before doing any additional testing.

Complementary and alternative treatments are another option. Some herbs, such as chasteberry, have been used for this purpose for centuries, and others, such as ginger and fennel, may be worth trying as well. Supplements such as calcium, magnesium, B vitamins, and omega-3 fatty acids may also help.

Coping

Heat can improve blood flow and reduce pain, so try using a heating pad or taking a warm bath for additional relief. You may also find it helpful to lie down and bring your knees to your chest.

No matter what, don't suffer in silence: painful periods are not something that you have to live with. Dysmenorrhea can often be successfully treated.

A Word From Verywell

If you are missing out on school, work, sports, or any other activities for even one day every month because of painful periods, talk to your doctor. Even though menstrual cramps are a normal part of your body's function, it is not normal if they are significant enough to cause disruption of your usual daily activities. There are many safe and effective treatment options for you to live well with menstrual cramps.

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