Menstrual Cramps (Dysmenorrhea)

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What is dysmenorrhea?

The medical term for painful menstrual periods is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.

In primary dysmenorrhea there is no underlying gynecologic pathology causing the pain. This type of cramping may begin within six months to a year following menarche (the beginning of menstruation). Menstrual cramps typically are not experienced until ovulatory menstrual cycles (when an egg is released from the ovaries) begin. Menstrual bleeding usually begins before the onset of ovulation. Therefore, an adolescent girl may not experience dysmenorrhea until months to years following the onset of menstruation.

In secondary dysmenorrhea, some underlying abnormal condition (usually involving a woman's reproductive system) contributes to the menstrual pain. Secondary dysmenorrhea may be evident at menarche, but more often, the condition develops later.

What causes menstrual cramps?

Each month, the inner lining of the uterus (the endometrium) normally builds up in preparation for a possible pregnancy. After ovulation, if the egg is not fertilized by a sperm, no pregnancy will result and the current lining of the uterus is no longer needed. The woman's estrogen and progesterone hormone levels decline, and the lining of the uterus becomes swollen and is eventually shed as the menstrual flow. It is replaced by a new growth of lining during the next monthly cycle.

When the uterine lining begins to break down, molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine contractions squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina. Other substances known as leukotrienes, which are chemicals that play a role in the inflammatory response, are also elevated at this time and may be related to the development of menstrual cramps.

Medically Reviewed by a Doctor on 11/3/2015

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