- What Is It?
What are menstrual cramps? What is premenstrual syndrome (PMS)?
Menstrual cramps are pains in the abdomen and pelvic areas that can be experienced by a woman because of menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual syndrome (PMS), although the symptoms of both disorders can sometimes be experienced as a continuous process. Many women suffer from both PMS and menstrual cramps.
Menstrual cramps can range from mild to quite severe. Mild menstrual cramps may be barely noticeable and of short duration. They are sometimes felt as just a sense of heaviness in the abdomen. Severe menstrual cramps can be so painful that they interfere with a woman's normal activities for several days.
What are the symptoms of menstrual cramps?
- Menstrual cramps usually begin before the onset of the menstrual period, peak within 24 hours after the onset of the bleeding, and subside again after a day or two.
- Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs.
- Menstrual cramps can be quite painful or simply a dull ache.
- The pain can be periodic or continuous.
- Pain may be felt in the inner thighs or hips.
Menstrual cramps may be accompanied by a headache and/or nausea, which can lead, although infrequently, to vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea, because the prostaglandins, which cause smooth muscles to contract also affect the intestinal tract. Some women experience an urge to urinate more frequently.
How long do menstrual cramps last? Why do they cause severe pain?
Menstrual cramps are caused by 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 prostaglandins as medication to induce labor.
Usually, the strength of menstrual cramps is not measured. 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 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 dysmenorrhea has menstrual cramps, her contractions are usually of higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.
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.
What other factors cause severe pain with menstural cramps?
- 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 forwarding).
- 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
How are menstrual cramps diagnosed?
Menstrual cramps to some degree affect an estimated 84% of women, and among these, up to 25% would describe their menstrual cramps as severe. Surveys of adolescent girls show that over 90% report having menstrual cramps.
How are menstrual cramps diagnosed?
The diagnosis of menstrual cramps is usually made by the woman herself and reflects her individual perception of pain. Once a woman has experienced menstrual cramps, usually with the adolescent onset of her monthly menstrual flow (menses), she becomes well aware of the typical symptoms. If there are other medical conditions contributing to menstrual cramps (secondary dysmenorrhea), the doctor may suggest diagnostic testing including imaging studies.
What is the treatment for menstrual cramps?
Every woman needs to find a treatment that works for her. There are several possible remedies for menstrual cramps.
Current recommendations include not only adequate rest and sleep but also regular exercise (especially walking). Some women find that abdominal massage, yoga, or orgasmic sexual activity may bring relief. A heating pad applied to the abdominal area may relieve the pain and congestion.
Several nonprescription (over-the-counter) agents can help control the pain as well as actually prevent the menstrual cramps altogether. For mild cramps, aspirin, acetaminophen, or acetaminophen plus a diuretic may be sufficient. However, aspirin has a limited effect in curbing the production of prostaglandin, and it is only useful for less painful cramps.
The main agents for treating moderate menstrual cramps are nonsteroidal anti-inflammatory drugs (NSAIDs) which lower the production of prostaglandin and lessen its effect. The NSAIDs that do not require a prescription are:
A woman should start taking one of these medications before her pain becomes difficult to control. This might mean starting medication 1 to 2 days before her anticipated period is due, and then continuing taking the medication for the first one to two days of her period. The best results are obtained by taking one of the NSAIDs on a scheduled basis and not waiting for the pain to begin.
What pain relief treatments are used for severe menstrual cramps?
If a woman's menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low doses of birth control pills (oral contraceptives) containing estrogen and progestin in a regular or extended cycle. This type of approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins, which in turn, reduces the severity of cramping.
Use of an IUD that releases small amounts of the progestin levonorgestrel directly into the uterine cavity, has been associated with a 50 percent reduction in the prevalence of menstrual cramps. In contrast, IUDs that do not contain hormones, such as those containing copper, may worsen menstrual cramps.
Can surgery cure menstrual cramps?
In the past, many women with menstrual cramps had an operation known as a D & C (dilation and curettage) to remove some of the lining of the uterus. This procedure is also sometimes used as a diagnostic measure to detect cancer or precancerous conditions of the uterine lining. Some women even resorted to the ultimate solution to menstrual problems by having a hysterectomy, a surgical procedure in which the entire uterus is removed.
Today, when a woman has abnormally heavy and painful uterine bleeding, her doctor may recommend endometrial ablation, a procedure in which the lining of the uterus is destroyed by various devices.
What are the treatments for secondary dysmenorrhea (painful periods)?
The treatment of secondary dysmenorrhea depends on its cause. Several underlying conditions can contribute to the pain including:
- Endometriosis (cells from the uterine lining are located in other areas of the body outside of the uterus)
- Uterine fibroids (non-cancerous uterine growths that respond to estrogen levels)
- Adenomyosis (a benign condition in which the cells of the inner uterine lining invade its muscular wall, the myometrium)
- Pelvic inflammatory disease (PID)
- Adhesions (abnormal fibrous attachments between organs)
- Use of a copper intrauterine device (IUD) for contraception.
All of these conditions should be first diagnosed by a physician who will then recommend the optimal treatment.
If a woman begins to experience changes in her menstrual cramps, such as in their severity, timing, or location, she should consult her physician, especially if the changes are of sudden onset.
What is the prognosis for menstrual cramps?
In general, a woman's menstrual cramps do not worsen during her lifetime. In fact, the menstrual cramps of primary dysmenorrhea usually diminish with age and after pregnancy.
When there is secondary dysmenorrhea with an underlying condition contributing to the pain, the prognosis depends on the successful treatment of that underlying condition.
As women have learned more about their bodies and how to maintain them in optimal health, menstrual cramps have become less debilitating, and more often, merely a minor monthly inconvenience.
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