Menstrual cramps are pain or discomfort in the lower abdomen just before or during a menstrual period. Dysmenorrhea is the medical term for menstrual cramps. Dysmenorrhea can be either primary or secondary. Primary dysmenorrhea usually starts 1 to 2 years after your first period. Secondary dysmenorrhea results from a specific disease or disorder.

How does it occur?

Dysmenorrhea is related to hormonal changes during your menstrual period. Primary dysmenorrhea is caused by excessive production of or sensitivity to a group of chemicals called prostaglandins. These chemicals decrease blood flow to the uterus and cause the uterus to contract and get rid of menstrual flow. Women who have painful periods have larger amounts of prostaglandins.

Secondary dysmenorrhea tends to be caused by the following:

endometriosis (tissue from the uterus growing outside the uterus)
pelvic inflammatory disease (PID) (a bacterial infection that enters the uterus and may spread to the fallopian tubes, ovaries, and other tissues in the pelvic region; may be sexually transmitted)
cervical stenosis (narrowing of the opening to the uterus)
tumors (called fibroids) or cysts in the uterus
a change in the position of the uterus (rare).

Intrauterine devices (IUDs) can also cause cramping pain during menstruation.

What are the symptoms?

Dysmenorrhea is a cramp like pain or discomfort in the lower abdomen. You may also have:

a dull lower backache
headache
nausea
discomfort in the inner part or front of the thighs.

About 10% to 15% of women with dysmenorrhea have symptoms severe enough to interfere with their normal activities.

How is it diagnosed?

First, the doctor will usually ask the following questions:

When does the pain occur?
What do you do about the pain?
Do any nonprescription pain medications relieve the pain?
Do you have any other symptoms?
Do birth control pills relieve or intensify the pain?
Is the pain becoming more severe over time?
Do you miss school or work because of cramps?

Your doctor will give you a physical exam and pelvic exam to see if your cramps are due to primary dysmenorrhea or another medical problem. You may have blood tests, cultures, or an ultrasound to check for an infection or uterine fibroids.

How is it treated?

Menstrual cramps are often relieved by nonprescription pain relievers such as acetaminophen, aspirin, ibuprofen, or naproxen. (These last three drugs not only relieve pain but also are antiinflammatories) If you take an anti-inflammatory such as ibuprofen, make sure you take it at the first sign of bleeding or cramping. If your periods are regular and you can predict when your period will start, begin taking the ibuprofen or other anti-inflammatory one day before you expect your period. This will prevent cramping in many cases.

Taking ibuprofen or naproxen with food or milk may help to reduce the possible side effects from these drugs of nausea and heartburn. If your symptoms are severe, you may need a stronger prescription drug. Resting in bed with a heating pad or hot water bottle on your abdomen may also relieve the pain. Another form of treatment is taking birth control pills. They decrease cramping by decreasing prostaglandin production. If the pills relieve the pain, you may take them even if you do not need them for birth control. If the pain is not relieved with medication, a surgical procedure called a laparoscopy may be done to look for problems that may be causing the pain, such as a cyst or endometriosis.

How long will the effects last?

In primary dysmenorrhea the pain begins shortly before a period and usually lasts 1 to 3 days. In secondary dysmenorrhea the pain may begin several days before and last throughout your period. Primary dysmenorrhea is common during the late teens and early 20s. It often gets better after age 25 and is rare after childbirth. Primary dysmenorrhea, even though it may be painful, will not damage the uterus or affect the regularity of periods or your ability to have children.

How can I take care of myself?

Having your period does not mean that you are sick. It should not stop you from doing most of the things that you normally do. Charting the length and frequency of your periods will help you to understand better what is normal for you. Tell your doctor if there are any sharp changes from your normal period, such as much heavier or lighter flow, a much shorter or longer time between periods, or any unusual pain or clotting.

In addition, you can:

Take aspirin, acetaminophen, ibuprofen, or naproxen to relieve discomfort.
Use a heating pad or hot water bottle on your lower back or abdomen or soak in a warm (not hot) tub.
Gently massage your lower abdomen or lower back.
Do pelvic tilt exercises to help relieve menstrual pain. To do a pelvic tilt exercise:
Stand with your feet about a foot apart and your knees bent. Place your hands on your hips near the hip bone.
Rock your pelvis forward and back 10 to 15 times. This can also be done while lying on your back with your knees bent. Tilt the abdomen upward keeping the buttocks on the floor and then press the small of your back to the floor.
Avoid prolonged standing or walking on hard pavement.
Avoid foods and beverages that contain caffeine, such as coffee, tea, colas, and chocolate, just before and during your period.
Follow the doctor's instructions carefully and ask the doctor how often you should be seen for follow-up.
Have regular yearly checkups, including a Pap test.

Call your doctor if:

The pain is not at the right time for a normal period or does not seem like normal menstrual cramps.
The pain is severe.
Your discomfort lasts longer than 2 or 3 days.

What can I do to help prevent dysmenorrhea?

Get plenty of rest. If you become unusually tired, nervous, or constipated, you may be more likely to experience menstrual pain.
Exercise regularly. Exercises such as walking, swimming, or bicycling may improve blood flow and ease menstrual pain.
Eat a diet rich in whole grains and green leafy vegetables.
Drink plenty of fluids.
Avoid smoking.
Avoid excessive use of alcohol.
Avoid use of mood-altering, mind-altering, stimulant, or sedative drugs.

Robert B. McWilliams, MD

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Robert B. McWilliams, MD Reproductive Endocrinology and Gynecology

Dysmenorrhea

Robert B. McWilliams, MD
Reproductive Endocrinology
and Gynecology