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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Why are some cramps so painful?

Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman's cervical canal is narrow.

The difference between menstrual cramps that are more painful and those that are less painful may be related to a woman's prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in the endometrium (uterine lining) when compared with women who do not experience cramps. Menstrual cramps are very similar to those a pregnant woman experiences when she is given prostaglandin as a medication to induce labor.

Can menstrual cramps be measured?

Yes, but measuring the strength of menstrual cramps is not routinely done in clinical practice. Researchers have demonstrated that menstrual cramps can be scientifically documented by measuring the pressure within the uterus, as well as the number and frequency of uterine contractions. During a normal menstrual period, the average woman has contractions of a low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions every 10 minutes. When a woman with dysmonorrhea has menstrual cramps, her contractions are usually of a higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.

What other factors influence menstrual cramps?

  • As mentioned above, an unusually narrow cervical canal tends to increase menstrual cramps.
  • Another anatomical factor that may contribute to menstrual cramps is a retroverted uterus (the uterus tilts backward instead of forward). 
  • Lack of exercise is now recognized to contribute to painful menstrual cramps, because exercise releases endorphins that relieve pain.
  • It has long been thought that psychological factors also play a role. For example, it is widely accepted that emotional stress can increase the discomfort of menstrual cramps.
  • Adenomyosis and endometriosis can increase the severity of menstrual cramps
  • Having uterine fibroids can worsen menstrual cramping
Medically Reviewed by a Doctor on 11/3/2015

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