Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods.
For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities for a few days every month.
Menstrual cramps may be caused by identifiable problems, such as endometriosis or uterine fibroids. Treating any underlying cause is key to reducing the pain. Menstrual cramps that aren't caused by an underlying condition tend to lessen with age and often improve once a woman has given birth.
SYMPTOMS
Symptoms of menstrual cramps include:
Throbbing or cramping pain in your lower abdomen that may be intenseDull, constant achePain that radiates to your lower back and thighs
Some women also experience:
NauseaLoose stoolsHeadacheDizziness
CAUSES
During your menstrual period, your uterus contracts to help expel its lining. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more-severe menstrual cramps.
Severe contractions may constrict the blood vessels feeding the uterus. The resulting pain can be compared to the chest pain that occurs when blocked blood vessels starve portions of the heart of food and oxygen.
Menstrual cramps may also be caused by:
Endometriosis. In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.Uterine fibroids. These noncancerous growths in the wall of the uterus may be the cause of pain.Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.
COMPLICATIONS
Menstrual cramps don't cause any other medical complications, but they can interfere with school, work and social activities.
Certain conditions associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).
DIAGNOSIS
Your doctor will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for signs of infection.
If your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may recommend other tests, such as:
Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries.
Other imaging tests. A CT scan or magnetic resonance imaging (MRI) provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body.
MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.
Laparoscopy. Laparoscopy usually isn't necessary for the diagnosis of menstrual cramps, but it can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens.
TREATMENT
Menstrual cramps are treatable. Your doctor may recommend:
Pain relievers. Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid (Ponstel), also are available. If you can't take NSAIDs, acetaminophen (Tylenol, others) may lessen your pain.
Start taking the pain reliever at the beginning of your period, or as soon as you feel symptoms, and continue taking the medicine as directed for two to three days, or until your symptoms have gone away.
Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD).Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, surgery to correct the problem may help reduce your symptoms. Surgical removal of the uterus also may be an option if you're not planning to have children.
For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities for a few days every month.
Menstrual cramps may be caused by identifiable problems, such as endometriosis or uterine fibroids. Treating any underlying cause is key to reducing the pain. Menstrual cramps that aren't caused by an underlying condition tend to lessen with age and often improve once a woman has given birth.
SYMPTOMS
Symptoms of menstrual cramps include:
Throbbing or cramping pain in your lower abdomen that may be intenseDull, constant achePain that radiates to your lower back and thighs
Some women also experience:
NauseaLoose stoolsHeadacheDizziness
CAUSES
During your menstrual period, your uterus contracts to help expel its lining. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more-severe menstrual cramps.
Severe contractions may constrict the blood vessels feeding the uterus. The resulting pain can be compared to the chest pain that occurs when blocked blood vessels starve portions of the heart of food and oxygen.
Menstrual cramps may also be caused by:
Endometriosis. In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.Uterine fibroids. These noncancerous growths in the wall of the uterus may be the cause of pain.Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.
COMPLICATIONS
Menstrual cramps don't cause any other medical complications, but they can interfere with school, work and social activities.
Certain conditions associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).
DIAGNOSIS
Your doctor will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for signs of infection.
If your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may recommend other tests, such as:
Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries.
Other imaging tests. A CT scan or magnetic resonance imaging (MRI) provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body.
MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.
Laparoscopy. Laparoscopy usually isn't necessary for the diagnosis of menstrual cramps, but it can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens.
TREATMENT
Menstrual cramps are treatable. Your doctor may recommend:
Pain relievers. Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid (Ponstel), also are available. If you can't take NSAIDs, acetaminophen (Tylenol, others) may lessen your pain.
Start taking the pain reliever at the beginning of your period, or as soon as you feel symptoms, and continue taking the medicine as directed for two to three days, or until your symptoms have gone away.
Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD).Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, surgery to correct the problem may help reduce your symptoms. Surgical removal of the uterus also may be an option if you're not planning to have children.
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