Menstrual Cramps

Menstrual cramps (dysmenorrhea) are painful or throbbing sensation in the lower abdomen that occurs just before and during a menstrual period. The pain can annoying or so excruciating that it interferes with daily activities. Pain can be reduced if any underlying condition, such as endometriosis or uterine fibroids, is treated.

Menstrual cramps, which are not caused by any underlying condition, usually reduce with age and often improve after child birth. 

The common signs and symptoms of menstrual cramps are:

• Pain in your lower abdomen that can be intense, dull and constant
• Pain often radiates to your lower back and thighs

Some women may experience nausea, headache, dizziness and diarrhea.

When to see a Doctor?

You may not need to be worried if you have had menstrual cramps within few years after the beginning of your menstruation. Visit your doctor if:

• Menstrual cramps interfere your normal activities every month
• If your symptoms continue to worsen
• If you are older than 25 and just started experiencing severe menstrual cramps

Menstrual cramps are caused by the contraction of the uterus during menstrual periods.

The uterine muscle contractions are stimulated by prostaglandins, hormone-like substances that cause pain and inflammation. Higher the level of prostaglandins, severe will be the pain and uterine muscle contraction. Severe contractions can constrict the blood vessels supplying the uterus. Menstrual cramps can also be caused by:

• Endometriosis: Endometriosis is an abnormal growth of endometrial cells outside the uterus most commonly on fallopian tubes, ovaries or the tissue lining your pelvis which results in severe pain.
• Uterine fibroids: Uterine fibroids, non-cancerous growths on the wall of the uterus, can also cause severe pain.
• Adenomyosis: In adenomyosis, the tissue lining the uterus grows into the muscular wall of uterus which could be the reason of pain
• Pelvic inflammatory disease (PID): PID is a bacterial infection of the female reproductive organs.
• Cervical stenosis: Cervical opening is so narrow that it obstructs the menstrual blood flow which increases the pressure within the uterus thereby causing excruciating pain.

No specific diagnosis is needed for menstrual cramps.

Visit your doctor or gynecologist (a doctor specializes in female reproductive system and women's health) if you have menstrual cramps.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. Note the dates of your last two menstrual periods, the severity of your symptoms and any other medical condition that you have. Make a list of the questions to ask your doctor. Some typical questions can be:

• What could be probable causes of my symptoms?
• Will my symptoms change over time?
• Do I need any tests?
• What are the treatment options and side effects of each option?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you start menstruating?
• Is your menstrual cycle regular?
• How heavy is your menstrual bleeding?
• Do you bleed between periods?
• Where do you feel the cramps?
• Do other symptoms, such as nausea, vomiting, diarrhea, back pain dizziness or headache, accompany menstrual cramps?
• Does menstrual cramp interfere your daily activities?
• If you're sexually active, do you experience pain with intercourse?
• Have you tried anything to reduce the pain? Has the remedy helped?
• Do you have a family history of similar symptoms?

What you can do in the meantime?

Menstrual cramp may be relieved by taking a warm bath or applying heat to your abdomen. Pain killers like ibuprofen may reduce the pain. Your doctor will take your medical history and perform physical exam, including pelvic examination. Your doctor, during pelvic examination, will examine whether there are any abnormalities and signs of infections in your reproductive organs. If it is suspected that your menstrual cramp is caused by some medical condition, your doctor may recommend tests which include:

• Ultra sound: It uses sound waves to create images of uterus, cervix, fallopian tube and ovaries.
• Other imaging tests: A CT scan or magnetic resonance imaging (MRI) may be used to diagnose the disorder.
• Laparoscopy: It is used in the diagnosis of underlying disorders, such as endometriosis, adhesions, fibroids, ovarian cyst and ectopic pregnancy. In this procedure, a tiny incision is made in your abdomen and a fiber-optic tube with small camera lens is inserted through the incision to view your abdominal cavity.

Menstrual cramps are treatable. Your doctor may recommend:

• Pain killer: Your doctor may suggest you to take over-the-counter pain relievers like ibuprofen and naproxen. Take the medicine a day before your period is expected. Continue taking your medicine for two to three days or until your symptoms disappear. Prescription non-steroidal anti-inflammatory drugs (NSAIDs) like mefenamic acid can also be used. If NSAIDs are contraindicated, acetaminophen may be used.

• Hormonal birth control: Hormones present in oral birth control pills not only prevent ovulation but also decrease the severity of menstrual cramp. There are several other routes through which these hormones can be given. They can be delivered through an injection, a transdermal patch to wear on your skin, an implant under the skin of your arm, a flexible ring to insert into your vagina or an intrauterine device (IUD).
• Surgery: Surgery is performed if your menstrual cramps are associated with more serious underlying conditions like endometriosis or fibroids.

Some of the alternative remedies may be useful for menstrual cramps and they include:

• Acupuncture: Insertion of thin needle through your skin at a specific point on your body can relieve menstrual cramp.
• Transcutaneous electrical nerve stimulation (TENS): It is a non-invasive procedure that measures the electrical activity in the nerves. It consists of a special device adhered to skin by adhesive patch that contains electrodes in it. These electrodes send varying level of electric currents to the nerves. TENS may work by raising pain threshold and triggering the release of your body's natural pain-killers, endorphins. TENS are found to be more effective than placebo.
• Herbal medicines: Some herbal products, such as pycnogenol, fennel or combination products, may be used to reduce pain.
• Acupressure: In acupressure, gentle pressure is applied on the skin to stimulate certain points on your body which may relieve menstrual cramps.

Following lifestyle tips may be useful to get relief from menstrual cramp:

• Exercise: Increased physical activities are found to reduce the pain of menstrual cramps.
• Heat: Applying heat to the lower abdomen with hot water bottle, heating pad or heat pad may relieve menstrual cramps. Soaking in hot bath is also believed to ease the menstrual cramps.
• Dietary supplement: Some studies suggests that vitamin E, omega-3 fatty acids, vitamin B1 (thiamine), vitamin B6 and magnesium supplements may be effective in reducing menstrual cramp.
• Avoid tobacco and alcohol: They can worsen your menstrual cramps.
• Risk and severity of menstrual cramp is likely to be increased by increase in psychological stress.

There are several risks and complications associated with menstrual cramp.

Risks

• Age: If you are less than 30, or you have started puberty at an age 11 or younger, you might be at a greater risk of menstrual cramp.
• Menorrhagia (heavy menstrual bleeding) is associated with higher risk of menstrual cramps.
• You have higher chances of having menstrual cramp if you smoke.

Complications

Fortunately, menstrual cramps don’t cause any other complications. However, they can restrict your daily activities. If complications occur, they are most likely to be caused by some underlying medical conditions. For instance, endometriosis can cause fertility problems. Complications like scarring of your fallopian tube or ectopic pregnancy (implantation of fertilized ova outside the uterus) are associated with pelvic inflammatory disease.