Menstrual cramps

Overview

Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen. Many women have 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.

Conditions such as endometriosis or uterine fibroids can cause menstrual cramps. Treating the cause is key to reducing the pain. Menstrual cramps that aren't caused by another condition tend to lessen with age and often improve after giving birth.

Symptoms

Symptoms of menstrual cramps include:

• Throbbing or cramping pain in your lower abdomen that can be intense
• Pain that starts 1 to 3 days before your period, peaks 24 hours after the onset of your period and subsides in 2 to 3 days
• Dull, continuous ache
• Pain that radiates to your lower back and thighs

Some women also have:

• Nausea
• Loose stools
• Headache
• Dizziness

When to see a doctor

See your health care provider if:

• Menstrual cramps disrupt your life every month
• Your symptoms progressively worsen
• You just started having severe menstrual cramps after age 25

Causes

During your menstrual period, your uterus contracts to help expel its lining. Hormonelike substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more-severe menstrual cramps.

Menstrual cramps can be caused by:

• Endometriosis. Tissue that acts similar to the lining of the uterus grows outside of the uterus, most commonly on fallopian tubes, ovaries or the tissue lining your pelvis.
• Uterine fibroids. These noncancerous growths in the wall of the uterus can cause pain.
• Adenomyosis. The tissue that lines your uterus begins to grow into the muscular walls of the uterus.
• Pelvic inflammatory disease. This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
• Cervical stenosis. In some women, the opening of the cervix is small enough to impede menstrual flow, causing a painful increase of pressure within the uterus.

Risk factors

You might be at risk of menstrual cramps if:

• You're younger than age 30
• You started puberty early, at age 11 or younger
• You bleed heavily during periods (menorrhagia)
• You have irregular menstrual bleeding (metrorrhagia)
• You have a family history of menstrual cramps (dysmenorrhea)
• You smoke

Complications

Menstrual cramps don't cause other medical complications, but they can interfere with school, work and social activities.

Certain conditions associated with menstrual cramps can have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).

Diagnosis

Your health care provider will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your provider checks for anything unusual with the reproductive organs and looks for signs of infection.

Your provider may also recommend certain tests, including:

• Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries.

• Other imaging tests. A CT scan or MRI scan provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. CT combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body.

  MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.

• Laparoscopy. Although not usually necessary to diagnosis menstrual cramps, laparoscopy can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens.

Treatment

To ease your menstrual cramps, your health care provider might recommend:

• Pain relievers. 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 can help control the pain of cramps. Prescription nonsteroidal anti-inflammatory drugs also are available.

  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 are gone.

• 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 skin patch, 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 a disorder such as endometriosis or fibroids, surgery to correct the problem might help your symptoms. Surgical removal of the uterus also might be an option if other approaches fail to ease your symptoms and if you're not planning to have children.

Self care

Besides getting enough sleep and rest, things you might want to try include:

• Exercise regularly. Physical activity, including sex, helps ease menstrual cramps for some women.
• Use heat. Soaking in a hot bath or using a heating pad, hot water bottle or heat patch on your lower abdomen might ease menstrual cramps.
• Try dietary supplements. A number of studies have indicated that vitamin E, omega-3 fatty acids, vitamin B-1 (thiamin), vitamin B-6 and magnesium supplements might reduce menstrual cramps.
• Reduce stress. Psychological stress might increase your risk of menstrual cramps and their severity.

Alternative medicine

Most alternative therapies for treating menstrual cramps haven't been studied enough for experts to recommend them. However, some alternative treatments might help, including:

• Acupuncture. Acupuncture involves inserting extremely thin needles through your skin at strategic points on your body. Some studies have found that acupuncture helps relieve menstrual cramps.

• Transcutaneous electrical nerve stimulation (TENS). A TENS device connects to the skin using adhesive patches with electrodes in them. The electrodes deliver a varying level of electric current to stimulate nerves.

  TENS might work by raising the threshold for pain signals and stimulating the release of your body's natural painkillers (endorphins). In studies, TENS was more effective than a placebo in relieving menstrual cramp pain.

• Herbal medicine. Some herbal products, such as pycnogenol, fennel or combination products, might provide some relief from menstrual cramps.
• Acupressure. Like acupuncture, acupressure also involves stimulating certain points on the body, but with gentle pressure on the skin instead of needles. Although research on acupressure and menstrual cramps is limited, it appears that acupressure may be more effective than a placebo in easing menstrual cramps.

Preparing for your appointment

If you have bothersome menstrual cramps, make an appointment with either your primary physician or a doctor who specializes in the female reproductive system (gynecologist). Here's some information to help you get ready for your appointment.

What you can do

Track your menstrual periods, when they begin and how severe your cramps are. Also, make a list of:

• Medical problems you've had and recent major stresses in your life
• All medications, vitamins or other supplements you take
• Questions to ask your doctor

For menstrual cramps, basic questions include:

• What's the most likely cause of my symptoms?
• Are my symptoms likely to change over time?
• Do I need any tests done?
• What treatments or home remedies might help?
• Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions as they occur to you.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• How old were you when you began menstruating?
• How far apart are your menstrual periods, and how long do they typically last?
• How heavy is your menstrual bleeding? Do you ever bleed between periods?
• Where do your cramps hurt?
• Do you have other symptoms with your cramps, such as nausea, vomiting, diarrhea, back pain, dizziness or headaches?
• Do your symptoms cause you to limit your activities, stay home from work or school, or avoid exercise?
• If you're sexually active, is intercourse painful?
• What treatments have you tried so far, if any? Has anything helped?
• Do women in your family have a history of similar symptoms?

What you can do in the meantime

When you have cramps, try taking a warm bath or applying a heating pad, hot water bottle or heat patch to your abdomen. Over-the-counter pain relievers, such as ibuprofen, also might help.