Menstrual Cramps (Dysmenorrhea)
What are menstrual
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.
How do they occur?
Cramps are related to hormonal changes during
your menstrual period. They are caused by chemicals called
prostaglandins. These chemicals cause the uterus to contract to
pass menstrual fluid. Women who have painful periods have larger
amounts of prostaglandins or are more sensitive to these
Secondary dysmenorrhea tends to be caused by the
endometriosis (tissue from the uterus growing outside the
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.
What are the symptoms?
You have pain or discomfort in the lower abdomen.
You may also have:
dull ache in your lower back
loose bowel movements or diarrhea
discomfort in the inner part or front of the thighs.
About 10% to 15% of women with menstrual cramps
have symptoms severe enough to interfere
with their normal activities.
How is it diagnosed?
First, your health care provider will usually ask
the following questions:
When does the pain occur?
What do you do about the pain?
any nonprescription pain medicines relieve the pain?
you have any other symptoms?
you are taking birth control pills, do they relieve or the
pain or make it worse?
the pain getting worse over time?
you miss school or work because of cramps?
Your health care provider will give you 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.
How is it treated - the
medical way (by "drug") ?
Menstrual cramps are often relieved by
nonprescription pain relievers such as acetaminophen, aspirin,
ibuprofen, or naproxen. (These last 3 drugs are
anti-inflammatory drugs.) If you take an anti-inflammatory drug
such as ibuprofen, make sure you take it at the first sign of
bleeding or cramping. If your periods are regular and you can
predict when your period will start, begin taking the
anti-inflammatory drug 1 day before you expect your period. This
will prevent cramping in many cases. Taking ibuprofen or
naproxen with food or milk may help to prevent the stomach upset
that is sometimes caused by these drugs.
If your symptoms are severe, you may need a
stronger prescription drug.
Resting in bed with a heating pad or hot water
bottle on your abdomen may also relieve the pain.
Another form of treatment is taking birth control
pills. 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.
How long will the effects
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 20s. 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.
How can I take care of
Having your period does not mean that you are
sick. In most cases it should not stop you from doing most of
the things that you normally do.
Charting the length and frequency of your periods
will help you to understand better what is normal for you. See
your health care provider if there are any sudden changes in
your normal period, such as much heavier or lighter flow, a much
shorter or longer time between periods, or any unusual pain or
In addition, you can:
Take aspirin, acetaminophen, ibuprofen, or naproxen to
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.
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 and during your period.
Follow your health care provider's instructions carefully
and ask your provider how often you should be seen for
Have regular yearly checkups, including a Pap test.
See your health care provider right away if the
pain is severe.
Call your health care provider for an appointment
What can I do to help
prevent menstrual cramps?