Your Guide to Menstrual Cramps

• What are the symptoms of menstrual cramps?
• What causes common menstrual cramps?
• How can I relieve mild menstrual cramps?
• What causes cramps from reproductive problems?
• How do I know if my cramps are normal?
• How will my doctor detect menstrual cramps?

Dysmenorrhea is the medical term for the painful cramps that may occur during the menstrual period. There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

Primary dysmenorrhea is common menstrual cramps. Cramps usually begin one to two years after a woman starts getting her period. Pain usually is felt in the lower abdomen or back and can be mild to severe. Common menstrual cramps usually become less painful as a woman ages and may stop entirely after the woman has a baby.

Secondary dysmenorrhea is pain caused by a disorder in the woman's reproductive organs. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.

What Are the Symptoms of Menstrual Cramps?

• Aching pain in the abdomen (Pain can be severe at times.)
• Feeling of pressure in the abdomen
• Pain in the hips, lower back, and inner thighs

When cramps are severe, symptoms may include:

• Upset stomach, sometimes with vomiting
• Loose stools

What Causes Common Menstrual Cramps?

Menstrual cramps are caused by contractions in the uterus, which is a muscle. The uterus, the hollow, pear-shaped organ where a baby grows, contracts throughout a woman's menstrual cycle. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus. Pain results when part of a muscle briefly loses its supply of oxygen.

How Can I Relieve Mild Menstrual Cramps?

To relieve mild menstrual cramps:

• Take aspirin or another pain reliever, such as Tylenol (acetaminophen) or Motrin (ibuprofen). (Note: For best relief, you must take ibuprofen as soon as bleeding or cramping starts.)
• Place a heating pad or hot water bottle on your lower back or abdomen.

You should also:

• Rest when needed
• Avoid foods that contain caffeine
• Avoid smoking and drinking alcohol
• Massage your lower back and abdomen

Women who exercise regularly often have less menstrual pain. To help prevent cramps, make exercise a part of your weekly routine.

If these steps do not relieve pain, your doctor can order medications for you, including:

• Ibuprofen (higher dose than is available over-the-counter)
• Oral contraceptives (Women taking birth control pills have less menstrual pain.)

What Causes Cramps From Reproductive Problems?

When a woman has a disease in her reproductive organs, cramping can be a problem. This type of cramping is called secondary dysmenorrhea. Conditions that can cause secondary dysmenorrhea include:

• Endometriosis, a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus
• Pelvic inflammatory disease , an infection caused by bacteria that starts in the uterus and can spread to other reproductive organs
• Stenosis of the cervix, the narrowing of the lower part of the uterus (cervix), often caused by scarring
• Tumors (also called "fibroids" ), or growths on the inner wall of the uterus

How Do I Know If my Cramps Are Normal?

If you have severe or unusual menstrual cramps, or cramping that last for more than two or three days, contact your doctor. Menstrual cramps, whatever the cause, can be treated, so it's important to get checked.

How Will my Doctor Detect Menstrual Cramps?

First, you will be asked to describe your symptoms and menstrual cycles. Your doctor also will perform a pelvic exam. During this exam, your doctor inserts a speculum (an instrument that lets the clinician see inside the vagina) and examines your vagina, cervix, and uterus. The doctor will feel for any lumps or changes, and a small sample of vaginal fluid may be taken for testing.

If the cramping you are having is not common menstrual cramps, further tests may be needed. If a medical problem is found, your doctor will discuss treatments.

Warning

If you use tampons and develop the following symptoms, get medical help right away:

• Fever over 102 degrees Fahrenheit
• Vomiting
• Diarrhea
• Dizziness, fainting or near fainting
• A rash that looks like a sunburn

These are symptoms of a condition called toxic shock syndrome, which can be life-threatening.

Reviewed by the doctors at The Cleveland Clinic Department of Obstetrics and Gynecology.
Edited by Charlotte E. Grayson, MD, Oct. 2003.

Portions of this page © The Cleveland Clinic 2000-2003

Last Editorial Review: 1/31/2005 8:18:24 AM