Menstrual Cramps (Dysmenorrhea)

What are menstrual cramps?

For decades, the medical establishment thought of menstrual cramps as an ailment that was minor at best. Doctors tended to deal with it by either dismissing the pain as a psychological problem or prescribing painkillers or tranquilizers. Today researchers have come a long way toward a fuller understanding of menstrual cramps and the pain they cause some 50 percent of women each month.

Are there different types of menstrual cramps?

Most women who have cramps are experiencing what's known as dysmenorrhea. Most often this condition is classified as primary dysmenorrhea, meaning that it isn't caused by a physical abnormality of the reproductive organs. This type of dysmenorrhea usually takes the form of sharp, spasmodic pains in your lower abdomen at the beginning of your period, or a day or two earlier, and it lasts two to three days. The condition is most common among young women in their teens and twenties; it usually moderates with age and may disappear if you give birth. According to some estimates, as many as 10 percent of young women have such severe cramps of this type that they're unable to maintain their normal schedules one or two days per month. In some women the cramping is so painful that they can't walk, and a few have compared it to the contractions of childbirth.

Another kind of menstrual pain that's common in primary dysmenorrhea feels more like a dull ache in the lower back and pelvis. It's more likely to affect older women and can sometimes get worse with age and multiple pregnancies.

Another type of menstrual cramps is a much less common disorder known as secondary dysmenorrhea, also marked by pelvic and lower-back pain. Unlike that of primary dysmenorrhea, however, the pain is a symptom of another disease or condition that may require treatment - perhaps endometriosis, pelvic inflammatory disease, uterine fibroids, and adenomyosis (in which uterine tissue grows into the wall of the uterus).

What are the symptoms?

If you have primary dysmenorrhea, you'll feel either sharp cramps or dull pelvic pain. You may also have backaches, headaches, pain in the inner thighs, diarrhea or constipation, nausea and vomiting, dizziness, bloating, weight gain, and breast tenderness. Many of these symptoms are attributed to PMS (premenstrual syndrome), but stem from the same source as the dysmenorrhea.

The symptoms of secondary dysmenorrhea include pelvic and back pain, spotting between periods, pain during or after sex, a puslike vaginal discharge, fever or chills, frequent urination, and changes in bowel movement.

What causes menstrual cramps and pain?

The cramps of primary dysmenorrhea are caused when your uterus contracts to push out the menstrual blood. Hormonal changes occurring naturally throughout your cycle can add to the pain; it's thought that imbalances between the hormones progesterone and estrogen worsen menstrual cramping. And when there's an overabundance of the hormonelike chemicals called prostaglandins, the uterus goes into spasms and racking cramps can result. (Some studies have shown that a woman with cramps has an unusually high level of the hormone prostaglandin F2 alpha in her menstrual blood.)

The use of an intrauterine device, or IUD, for birth control can markedly increase menstrual cramping.

What are my treatment options?

Cramps associated with primary dysmenorrhea can often be eased with non-prescription pain-relievers and anti-inflammatory drugs like ibuprofen and naproxen. If your cycle is regular, you may be able to avoid cramps by taking these medicines one day before your period is due to arrive.

Having a warm bath or lying down with a heating pad or hot-water bottle on your lower abdomen may also help. Exercise, believe it or not, can make you feel better; if you're up to it, a walk around the block or a few sit-ups will stimulate your muscles to release feel-good endorphins. On the other hand, if your symptoms make it hard for you to work or even sit up straight, your doctor may prescribe a stronger drug or put you on birth control or estrogen pills, which decrease your body's production of prostaglandin. Depending on what disorder is causing it, secondary dysmenorrhea is treated with drugs and possibly surgery. Your doctor may also recommend hormonal contraception, such as birth control pills or the hormonal intrauterine device, to help control the growth of the lining of the uterus so less prostaglandin is produced.

When should I see a doctor about menstrual pain?

Call your doctor for an appointment:

  • If your pain is severe or lasts longer than two to three days
  • If your cramps don't seem like normal menstrual cramps or are occurring at the wrong time of the month
  • If you feel pain during or after sexual intercourse
  • If you have an abnormal vaginal discharge
  • If something just seems wrong.

Don't be shy about asking your doctor questions during your annual gynecological exam, either.

Are there lifestyle changes I can make to lessen cramps caused by primary dysmenorrhea?

Regular aerobic exercise (like walking or swimming for 20 minutes three times a week) has been shown to decrease menstrual pain in some women. Daily calcium supplements appear to lessen symptoms of PMS, including cramping. And, a 2005 study found that diets high in calcium and vitamin D may even reduce your risk of getting cramps in the first place.

What kinds of things are likely to make my cramps worse?

Some gynecologists think that smoking, stress, lack of sleep, poor posture, caffeine (found in coffee and most soft drinks), and a diet high in fat and salt are all culprits.

Are there any alternative treatments?

Yes. Although few scientific studies have been done in this area, many women have reported benefits from massage, acupressure, acupuncture, and various other remedies, which are believed to help lessen menstrual cramps as well as the symptoms of PMS. The ancient Chinese arts of acupuncture and acupressure are based on the belief that by stimulating specific points on the body with hair-thin needles or a practitioner's hand pressure can unblock the flow of energy within the body and relieve pain.

In the supplement department thiamin may relieve menstrual cramps, according to the Mayo Clinic.

Obstetrician/gynecologist Christian Northrup, author of Women's Bodies, Women's Wisdom, also reports that dietary changes have brought her patients relief from menstrual cramps. She recommends that women can decrease their intake of eggs, red meat, and dairy products or switch to organic dairy foods, on the theory that milk containing added hormones and antibiotics may stimulate female hormones in ways we don't yet understand. Among her other recommendations:

  • Get plenty of essential fatty acids, which are found in canned sardines, salmon, flaxseed oil, and ground flaxseed, among other things (according to Northrup, this seems to moderate cramps even if you don't change your diets in other ways).
  • Take extra magnesium and a multivitamin-and-mineral supplement.
  • Take extra vitamin E during your menstrual cycles.
  • As much as you can, eliminate trans-fatty acids from your diet (these are found in foods like commercially prepared pastries, which contain margarine, solid vegetable shortening, and other partially hydrogenated oils).
  • Cut down on stress.
  • Try yoga or massage.

References

The Merck Manual of Diagnosis and Therapy, 17th Edition, p. 1933(overview)

Dysmenorrhea: A Painful Time, Gynecologic Health Center, (overview and treatment)

Virtual Hospital: Univeristy of Iowa Family Practice Handbook, 3rd edition; Gynecology: Dysmenorrhea (overview and treatment)

Premenstrual syndrome, Mayo Clinic, May 13, 1999 (overview)

Alternative Medicine Ratings Guide, Steven Bratman, M.D., Prima Publishing, 1998. (herbs)

Mayo Clinic. Evening primrose oil. January 2004.

Bertone-Johnson ER, et al. Calcium and Vitamin D intake and risk of incident premenstrual syndrome. Archives of Internal Medicine. June 13, 2005; 165 (11): 1246-52.

American College of Obstetricians and Gynecologists. Dysmenorrhea. December 2006.

Mayo Clinic. Menstrual Cramps. May 2009.

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