Menstrual cramps are painful sensations in a woman's lower abdomen and sometimes lower back, which occur when her menstrual period begins or just before. It usually begins 1 to 2 days before menstruation and lasts from 2 to 4 days.
Menstrual pain as it is sometimes called is common and a normal part of a woman’s menstrual cycle. Most women experience it at some point in their lives. Menstrual cramps are the leading cause of absenteeism in women younger than 30. More than half of all menstruating women have cramps. The cramps are severe in at least one in seven of these women.
The pain, also known as dysmenorrhoea or period pains, ranges from dull and annoying to severe and extreme, that interferes with normal activities. They may be throbbing or aching. Menstrual cramps tend to begin after ovulation when an egg is released from the ovaries and travels down the fallopian tube.
Pain that is only associated with the process of menstruation is known as primary dysmenorrhoea.
If the cramping pain is due to an identifiable medical problem such as endometriosis, uterine fibroids, or pelvic inflammatory disease, it is called secondary dysmenorrhoea.
Menstrual cramps can be treated with over-the-counter medicine, birth control treatments, and some home remedies.
What Causes Menstrual Cramps?
Once in every menstrual cycle (approximately 28 days, which varies from person to person) if there is no sperm to fertilize the egg, the uterus contracts to expel its lining.
Hormone-like substances called prostaglandins trigger this process.
Prostaglandins are chemicals that form in the lining of the uterus during menstruation. They cause muscle contractions and cramps that are similar to labour pains. They can also contribute to nausea and diarrhoea.
The contractions inhibit the blood flow to the lining of the uterus (endometrium). It may also happen because there are high levels of leukotrienes during menstruation.
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 when compared with women who do not experience cramps.
Many women commonly have heavy flow days and cramps when they have their period. But it’s not common to have the medical condition known as menorrhagia, which means “heavy periods.”
If you have this problem, your flow will be so heavy that you’ll need to change your tampon or pad every hour for at least an entire day, and you’ll also have cramps so severe that they’ll stop you from doing your usual activities.
There are many reasons why some women have heavy periods. These are some common causes:
Hormone problems. Every month, a lining builds up inside your uterus (womb), which you shed during your period. If your hormone levels aren’t balanced, your body can make the lining too thick, which leads to heavy bleeding when you shed the thicker lining. If you don’t ovulate (release an egg from an ovary), this can throw off the hormone balance in the body, too, leading to a thicker lining and a heavier period.
Growths in the uterus (womb). Polyps are growths within the lining of the uterus. Fibroids are benign (non-cancerous) tumours that grow within the uterus. Both can make your periods much heavier or make them last longer than they should.
Some female cancers. It’s rare, but cancer of the uterus, cervix, or ovaries may cause excess bleeding in some women, which may appear to be a heavy period.
Bleeding disorders. They’re not common. Bleeding disorders, which run in families, make it hard for someone to stop bleeding when they’ve been cut. They can also make a woman’s period heavier and make it last longer.
Those who are more likely to experience menstrual pain include:
being younger than 20 years of age
starting puberty at 11 years or younger
never having given birth
In addition to cramps in the lower abdomen and lower back just above the pelvic bone, a woman may also experience some of these symptoms with menstrual cramps:
Pain in the hips or thighs, sometimes radiating down the entire legs
Diarrhoea or loose stools
Fainting spells (in extreme cases)
If symptoms get progressively worse, it is a good idea to see a doctor.
When to see a Doctor
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.
The woman suspects she may be pregnant and any of these symptoms occur.
Exams and Tests
The doctor 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
Pain with intercourse
History of pelvic infections
Age when first period occurred
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 or there is a new onset of menstrual pain.
A doctor may recommend a laparoscopy, which is a minor surgical procedure allowing the doctor to look directly into the pelvic cavity with a fibre-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 inside the cervix and the inside of the uterus without incisions. This can be done in a doctor's office or a hospital.
Over-the-counter medication is available to treat most cases of menstrual cramps.
Anti-prostaglandins reduce cramping in the uterus, lighten the flow of blood, and relieve discomfort.
These medications may also contain pain killers, such as ibuprofen or naproxen. These are types of non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are also used alone to reduce menstrual cramp pain.
If the woman is a good candidate, a physician may prescribe hormonal birth control pills to prevent ovulation and reduce the severity of menstrual cramps. These work by thinning the lining of the uterus, where the prostaglandins form. This reduces cramping and bleeding.
In some cases, birth control pills can be used continuously, without the 4 to 7-day break each month that is normally adhered to. There will be no bleeding at all, in this case.
Other types of birth control, including some types of hormonal IUD, vaginal rings, patches, and injections can all help decrease cramping.
If the cramps are due to an underlying medical condition, such as endometriosis or fibroids, surgery may be needed to remove the abnormal tissue.
If anti-inflammatory medication is not an option, or if additional relief is needed, the following natural therapies strategies may help relieve menstrual cramping and pain:
Lay a heating pad over the pelvic area
Taking a warm bath
Massage to the back and lower abdomen
Practicing relaxation techniques or yoga
Raising your legs or lying with your knees bent
Wearing a TENS (transcutaneous electrical neural stimulation) unit, a small electrical device that interferes with pain signals as they travel to the brain.
Do not sleep with a heated pad as it could cause burns.
Some dietary options, including herbs and vitamin supplements, may help. Some examples are lavender, fennel, and pycnogenol. These have very little risk.
One study suggests that ginger powder may help if taken during the first 3 to 4 days of the menstrual cycle.
If you choose to use any herbal or supplement approaches, be cautious. Getting enough rest and sleep and regular exercise may help.
Conditions that can worsen menstrual cramps
Several underlying medical conditions are also linked to menstrual cramps.
Endometriosis: The tissue that lines the uterus develops outside the uterus.
Uterine fibroids: Noncancerous tumours and growths in the wall of the uterus.
Adenomyosis: The tissue that lines the uterus grows into the muscular walls of the uterus.
Pelvic inflammatory disease (PID): A sexually transmitted infection caused by a bacterium
Cervical stenosis: The opening of the cervix is small and limits menstrual flow.
Women with delayed sleep phase syndrome are more likely to report irregular menstrual cycles and premenstrual symptoms, as well as menstrual cramps, according to researchers from Northwestern University in Chicago, Il.
Measures that may reduce the risk of menstrual cramps include:
eating fruits and vegetables and limiting intake of fat, alcohol, caffeine, salt, and sweets
keeping a normal body weight
Yoga or acupuncture and acupressure help, but more research is needed.
Prognosis for Menstrual Cramps
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.