How Menstrual Cramps Are Diagnosed

True menstrual cramps are, obviously, due to your period. While you may accurately determine that on your own, it can be helpful to see your doctor for a formal diagnosis. Doing so is especially advised if your menstrual cramps remain unresolved after using self-help remedies for three months, your discomfort is interfering with daily life, or you other have significant symptoms.

The questions your doctor asks about your medical history and current symptoms, as well as the results of your physical examination and any additional testing, will help you get an accurate diagnosis.

At the very least, she'll confirm that menstruation is indeed the root of your pain and, perhaps, prescribe medication to help ease it. There's also a chance that your symptoms could be due to an entirely other condition, which can be investigated and, perhaps, treated.

Self-Checks

You can't definitely diagnose yourself, but you can monitor symptoms such as pain or heavy flow, which can help you spot patterns and help your doctor reach a conclusion. Keep a journal to log things like:

• When your period comes
• How long it lasts
• Extent of your menstrual flow (light to heavy)
• When and where pain occurs
• Extent of your pain
• What you did for relief and if it worked

Physical Exam

Like many visits to the doctor, your visit for menstrual cramps begins with a check of your weight, height, blood pressure, and temperature.

Your doctor will then ask you a series of questions, the first of which is likely the date of your last period (this is the first day you experienced any amount of bleeding). If this is your first visit to a particular doctor, you’ll also need to tell the nurse when you had your last Pap smear or if you've never had one. 

Questions to Expect

You will likely be asked to describe your pain and other symptoms. Think about descriptive words like sharp, stabbing, or burning. Be able to explain where the pain is located and if it goes anywhere else, like your lower back or upper thighs.

Bring your journal with you so you can reference it, if needed, when posed with other questions, such as:

• Does your period arrive on a predictable schedule?
• Have you always experienced menstrual cramps? When did you first experience them?
• When do you experience menstrual cramps? Do you have them before your period begins? If so, how many days ahead of time?
• Does your pain come and go or is it constant? Has your pain changed or increased?
• Do menstrual cramps stop when you begin bleeding or continue during your period? How many days into your period do menstrual cramps last? Do you experience menstrual cramps on any other days of your menstrual cycle?
• Are you sexually active? If so, do you use contraceptives? What type of contraceptives do you use?
• The last time you had your period, was the flow normal or was it heavier or lighter than usual?
• Do you bleed excessively during your period? Do you have periods that last longer than five days?
• Does your menstrual flow contain blood clots? (While having blood clots and tissue in your menstrual flow is usually normal, in some cases, your answer to this question can help your doctor determine the cause of your menstrual cramps.)
• Do you use tampons during your period? (Tampon safety has long been a subject of debate. Many women swear that they no longer experienced menstrual cramps once they stopped using tampons.)
• What have you tried to relieve your menstrual cramps? Did it provide any relief?
• Is there anything that makes the pain worse?
• Do you have any other symptoms?

Labs and Tests

Your doctor will likely perform a pelvic exam, including a Pap smear, if needed. The focus of your examination will be your lower abdominal area and pelvic region.

If you are sexually active, your doctor may take cervical cultures or blood or urine samples to look for sexually transmitted diseases (STDs) that can cause cramping, such as chlamydia, gonorrhea, and trichomoniasis.

However, don't be surprised if your doctor does not order any testing, especially if you are a teenager and not yet sexually active. 

Imaging

If she feels it is warranted, your doctor might order additional diagnostic imaging, which will allow her to examine your uterus closely. The first-line imaging method for uterine disorders is an ultrasound. Other tests that your doctor might suggest (in no particular order) include:

• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
• Laparoscopy
• Hysteroscopy
• Sonohysterogram

Differential Diagnoses

Painful cramps or heavy bleeding may be within the realm of what is normal for many women, but they can also point to other problems.

Some uterine conditions, such as endometriosis, can worsen cramping. Other possible causes of painful cramps, particularly after age 25, include fibroids, adenomyosis, and infection, including infection from some STDs.

If you have recently gotten an intrauterine device (IUD), that may be the cause of your cramping as well. Cramping due to an IUD typically goes away after the first three months.

Even if you think your symptoms are insignificant or unrelated to your menstrual cramps, be sure to tell your doctor about them if they persist or worsen.