The following circumstances may make a woman more likely to experience menstrual cramps:
She started her first period at an early age (younger than 11 years).
Her menstrual periods last five days or longer.
She is overweight or obese.
She smokes cigarettes or uses alcohol.
She has never been pregnant.
Causes of Menstrual Pain
Prostaglandins are chemicals a woman's body produces that cause many of the symptoms associated with menstrual discomfort. The tissue that lines the uterus makes these chemicals. Prostaglandins stimulate the uterine muscles to contract. Women who have high levels of prostaglandin may experience more intense contractions of their uterus and more pain. Prostaglandins may also be responsible for vomiting, diarrhea, and headaches that accompany painful periods.
Other menstrual-type pain can be caused by conditions of the reproductive tract, such as the following:
Endometriosis -- Uterine tissue that appears outside the uterus
Fibroids and adenomyosis -- Non-cancerous (benign) growths in the uterus
Infections in the reproductive organs
Abnormal pregnancy, such as an ectopic pregnancy (pregnancy in the tubes, outside the uterus)
IUD (intra-uterine device) used for birth control
Ovarian cyst
Narrow cervix
Classes of Menstral Pain
If a woman has had menstrual pain ever since her periods started, the condition is classified as primary dysmenorrhea. If some physical condition such as pelvic inflammatory disease or endometriosis is causing the menstrual pain, this is called secondary dysmenorrhea. Once the medical condition is treated, the menstrual pain usually goes away.
Symptoms of Menstrual Pain
In addition to cramps in the lower abdomen, a woman may also experience some of these symptoms with menstrual cramps:
Lower back pain
Leg pain, radiating down the legs
Nausea
Vomiting
Diarrhea
Headaches
Irritability
Weakness
Fainting spells (in extreme cases)
When to Seek Medical Care
Most women have significant improvement with home care. However, a woman should call her health care provider in these situations:
-Menstrual cramps continue to be painful for longer than usual.
-The pain is suddenly worse or different from what she may have experienced before.
-Bleeding is excessive, requiring more than one pad or tampon per hour.
-Signs of infection, such as fever, chills, and body aches, are present at the time of the period.
-Menstrual cramps began in a woman older than 25 years.
-The woman suspects she may be pregnant and any of these symptoms occur.
The woman's doctor can help her manage most symptoms. However, she should go to a hospital's emergency department if any of the following problems occur:
-She faints.
-She experiences repeated dizziness when standing up.
-A sudden, intense pelvic pain causes her to double over.
-Tissue is passed in the menstrual flow. Tissue often appears silvery or grayish.
-She thinks she might be pregnant and has menstrual-type pain.
Exams and Tests
The health care provider will ask for medical history details, as well as questions about the menstrual pain and symptoms. Be prepared to discuss these details:
The timing of the cramps in relation to the start of the period
Type of pain
Age when the cramps first started
Any recent change in the pain
Irregular periods
Vaginal discharge
Pain with intercourse
Infertility
History of pelvic infections
Age when first period occurred
Current medications
What things seem to improve or worsen the pain
The doctor will perform a pelvic exam to check for any problems. If there are concerns about a possible infection, cervical cultures and a blood test will confirm the diagnosis. Additional tests may be ordered.
The doctor may order a pregnancy test if the periods are irregular or the woman is not using birth control regularly.
An ultrasound exam is necessary if the doctor discovers any abnormal masses during the pelvic exam. The doctor may order other imaging tests, such as magnetic resonance imaging (MRI), which shows the internal structures.
A doctor may recommend a laparoscopy, which is a minor surgical procedure allowing the doctor to look directly into the pelvic cavity with a fiber-optic scope. This is an outpatient procedure using very small incisions.
A hysteroscopy is another possible procedure. By inserting a hysteroscope (thin lighted tube) through the vagina, the doctor can see the cervix and inside the uterus without incisions. This can be done in a doctor's office or a hospital.
Menstrual Pain Home Remedies
The best way to relieve painful menstrual cramps is to take an anti-inflammatory medication. Ibuprofen (Advil is a familiar brand name), naproxen (Aleve, Naprosyn), and ketoprofen (Orudis) are available without a prescription and are effective at blocking the effects of prostaglandins.
These drugs work better if taken before the start of menstruation and can be continued as long as needed. If one type does not relieve the pain, try another, because these medications do not work the same in everyone.
Anti-inflammatory drugs like this can be harsh on the stomach. If there is a history of kidney problems or stomach problems (such as ulcers or reflux), consult with the health care provider before starting this type of medication. Taking the pills with meals may help prevent upset stomach.
If anti-inflammatory medicine is not an option or if additional relief is needed, the following strategies may help relieve menstrual cramps:
-A heating pad to the pelvic area
-Massage to the back and lower abdomen
-Exercise, especially prior to the start of a period
-Thiamine 100 mg daily
-Low-fat vegetarian diet
-Calcium 1200 mg daily
Medications for Menstrual Pain
If a woman with menstrual cramps is not already taking an anti-inflammatory medication, the health care provider may advise her to take one of the over-the-counter pain relievers or prescribe an anti-inflammatory drug.
Starting some form of hormonal birth control is another option to control or stop menstrual cramps. This can be a pill, an injection, a transdermal patch, or a hormone-containing IUD. These methods can reduce or eliminate the menstrual flow leading to less pain.
Surgery for Menstrual Pain
Surgery can be used to treat some causes of menstrual cramps such as fibroids, polyps, ovarian cysts, or endometriosis.
D&C: This procedure is used to remove uterine polyps.
Laparoscopy: This procedure is used to treat pelvic endometriosis or ovarian cysts.
Endometrial ablation: This procedure destroys the lining of the uterus.
Hysterectomy: This surgical procedure completely removes the uterus.
Other Therapy for Menstrual Pain
If taking hormonal birth control is not an option because of health problems or the woman is among the 10% of women who do not respond to this treatment, there are some other alternatives.
Acupuncture
Nitroglycerin patch
Wearing a TENS (transcutaneous electrical neural stimulation) unit, a small electrical device that interferes with pain signals as they travel to the brain
Preventing Menstrual Pain
Prevent painful menstrual cramps with these techniques:
Maintain a normal body weight.
Do not smoke.
Do not drink excessively.
Exercise regularly.
Outlook for Menstrual Pain
Often, it is possible to eliminate menstrual cramps effectively. Anti-inflammatory drugs are 80% effective. Hormonal birth control decreases the pain 90% of the time. Cramps also tend to decrease in intensity as a woman ages. Cramps may disappear after a woman's first pregnancy.
