Overview, Causes, & Risk Factors
Menstrual cramps are the pain and cramping some women experience during their monthly periods. The term dysmenorrhea usually refers to pain and cramps severe enough to prevent normal activity.
What is going on in the body?
About half the women of childbearing age have menstrual cramps. Fifteen percent of women have dysmenorrhea. There are two kinds of dysmenorrhea:
Menstrual pain is linked to a hormone that prompts ovulation. Women who ovulate, or release an egg during monthly cycles, make the hormone progesterone. This hormone boosts the body’s level of prostaglandins. Prostaglandins stimulate uterine contractions. As the uterus contracts, it sloughs off the lining. The tissue passes out of the uterus through the cervix. Women with dysmenorrhea have prostaglandin levels that are 5 to 13 times higher than normal.
Experts do not know what triggers high prostaglandin levels. Secondary dysmenorrhea is caused by other disorders, such as:
Here are some factors that increase a woman’s risk for menstrual cramps:
Symptoms & Signs
Menstrual pain usually does not become severe until late in the teen years. Symptoms can begin on the first day of a period. These can include:
Diagnosis & Tests
Diagnosis of menstrual cramps begins with a medical history and physical exam, including a pelvic exam. Tests to rule out physical causes can include:
If physical causes are found, secondary dysmenorrhea is diagnosed. Primary dysmenorrhea is diagnosed by ruling out possible physical causes.
Prevention & Expectations
Menstrual cramping is not always preventable. Here are some helpful measures to reduce symptoms:
Mild menstrual cramps and primary dysmenorrhea have no known long-term effects. The cause of secondary dysmenorrhea determines its long-term effects. These may include:
Menstrual cramps are not contagious and pose no risk to others. However, if the problem is due to an undiagnosed STD, the woman may spread this to her partner.
Treatment & Monitoring¬†
Treatment depends on the severity and cause of the pain. Measures that may be helpful in relieving menstrual cramping include:
Mild cramps can be treated with pain medicines, such as aspirin or acetaminophen. Some over-the-counter products combine one of these medicines with a diuretic, or water pill.
For dysmenorrhea, healthcare providers often recommend medicines that lessen the production and effect of prostaglandins. These include ibuprofen, naproxen, and ketoprofen. It’s best to take these on a scheduled basis. They are started 1 to 2 days before the woman’s period and menstrual cramps begin. They should be continued 1 to 2 days into the woman’s period. If over-the-counter medicines are ineffective, the provider may prescribe rofecoxib or mefenamic acid. Sometimes, low-dose oral contraceptives are prescribed to prevent ovulation and prostaglandin production.
Endometrial ablation is an option for women with very painful periods or heavy menstrual flow. This procedure uses a heat-generating device to burn away the lining of the uterus.
If a woman has secondary dysmenorrhea, treatment may focus on the underlying disorder. Leuprolide or nafarelin are used to treat fibroids or endometriosis. Antibiotics will be used if PID is suspected. Surgery may be used to treat certain conditions.
Pain medicines and antibiotics may cause stomach upset or allergic reactions. Medicines used to treat endometriosis or fibroids may cause hot flashes or headaches. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.
Menstrual cramps often improve after a woman has given birth to her first child.
Any new or worsening symptoms should be reported to the healthcare provider.