Menstrual Cramps

Menstrual cramps are pain or discomfort in the lower abdomen just before or during a menstrual period.  Dysmenorrhea is the medical term for menstrual cramps.

Dysmenorrhea can be either primary or secondary.  Primary dysmenorrhea usually starts 1 to 2 years after your first period, but it may start earlier.  Secondary dysmenorrhea results from a specific disease or disorder.

Secondary dysmenorrhea tends to be caused by the following:

• Endometriosis (tissue from the uterus growing outside the uterus)
• Pelvic inflammatory disease (PID), a bacterial infection that enters the uterus and may spread to the fallopian tubes, ovaries, and other tissues in the pelvic region; may be sexually transmitted.
• Cervical stenosis (narrowing of the opening to the uterus)
• Tumors called fibroids or cysts in the uterus.
• Intrauterine devices (IUDs) can also cause cramping pain during menstruation.

Other symptoms of dysmenorrhea include:

• A dull ache in your lower abdomen
• Headache
• Nausea
• Loose bowel movements or diarrhea
• Discomfort in the inner part or front of the thighs

About 10 to 15 percent of women with menstruation cramps have symptoms severe enough to interfere with their normal activities.

To diagnose dysmenorrhea your healthcare provider may ask the following questions:

• When does the pain occur?
• What do you do about the pain?
• Do any nonprescription pain medications relieve the pain?
• If you are taking birth control pills, do they relieve the pain or make it worse?
• Is the pain getting worse over time?
• Do you miss school or work because of cramps?

Your healthcare provider may do a physical exam and pelvic exam.  You may have blood tests and cultures.  You may need an ultrasound scan of your pelvis to check your uterus and ovaries.

Menstrual cramps are often relieved by nonprescription pain relievers such as acetaminophen (Tylenol), aspirin, or ibuprofen (an anti-inflammatory). 

Your physician may prescribe birth control pills for treatment of dysmenorrhea.  They decrease cramping by decreasing prostaglandin production.  If the pills relieve the pain, you may take them even if you do not need them for birth control.  This option must be discussed with your healthcare provider.

In primary dysmenorrhea the pain begins shortly before or at the start of a period and usually lasts 1 to 3 days.  In secondary dysmenorrhea the pain may begin several days before and last throughout your period.

Menstrual cramps are common during the late teens and early 20’s.  They often get better after age 25 and are less common after childbirth.  Even though the cramps are painful, they will not hurt the uterus or your ability to have children.

Having your period does not mean that you are sick.  In most cases it should not stop you from doing most of the things you normally do.  Charting the length and frequency of your periods will help you to understand better what is normal for you.  See your healthcare provider if there are any sudden changes in your normal periods, such as much heavier or lighter flow, a much shorter or longer time between periods, or any unusual pain or clotting.

In addition, you can:

• Take aspirin, acetaminophen, ibuprofen, or naproxen to relieve discomfort.
• Use a heating pad or hot water bottle on your lower back or abdomen or soak in a warm (not hot) tub.
• Gently massage your lower abdomen or lower back.
• Do pelvic tilt exercises to help relieve menstrual pain (Stand with your feet about a foot apart and your knees bent.  Place your hands on your hips near the hip bone. Rock your pelvis forward and back 10 to 15 times.  This can also be done while lying on your back with your knees bent.  Tilt the abdomen upward keeping the buttocks on the floor and then press the small of your back to the floor.)
• Avoid standing for a long time or walking on hard pavement.
• Avoid foods and beverages that contain caffeine, such as coffee, tea, colas, and chocolate, just before or during your period.
• Follow your healthcare provider’s instructions carefully and ask your provider how often you should be seen for follow-up.
• Have regular yearly checkups, including a Pap test.

See your healthcare provider right away if the pain is severe.