Merck Manual

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Some Causes and Features of Menstrual Cramps

Some Causes and Features of Menstrual Cramps


Common Features*


Heavy, painful periods, vaginal bleeding between periods, pain in the lowest part of the torso (pelvis), and a feeling of pressure on the bladder and rectum

Sometimes pain during sexual intercourse

Ultrasonography or MRI of the pelvis

In women with abnormal vaginal bleeding, sometimes a biopsy to rule out other causes of bleeding

Birth defects of the reproductive tract

Sometimes abnormalities found during the pelvic examination, such as genitals that feel or look abnormal or a lump in the pelvis

A doctor's examination

Sometimes hysterosalpingography (x-rays taken after a contrast agent is injected into the uterus and fallopian tubes), sonohysterography (ultrasonography after fluid is infused into the uterus), or MRI

Irregular or no menstrual periods, vaginal bleeding between periods, infertility, and abdominal pain that occurs in cycles

Possibly bulging of the vagina or uterus

A doctor's examination

Sometimes ultrasonography of the pelvis

Often no other symptoms

Sometimes abnormal vaginal bleeding

If cancer is advanced, sometimes indigestion, bloating, and backache

Transvaginal ultrasonography (using a handheld device inserted into the vagina)

If cancer is suspected, blood tests to measure substances produced by certain tumors

Sharp or crampy pain that occurs before and during the first days of menstrual periods


Often pain during sexual intercourse, bowel movements, or urination

A doctor's examination

Sometimes laparoscopy (insertion of a viewing tube through a small incision just below the navel)

Sometimes ultrasonography of the pelvis or MRI

Often no other symptoms

With large fibroids, sometimes pain, pressure, abnormal vaginal bleeding, or a feeling of heaviness in the pelvic area


Sometimes sonohysterography or hysteroscopy (use of a thin viewing tube to see the interior of the uterus)

If results are unclear, MRI

Pain and vaginal bleeding that often subside several months after insertion of the IUD

A doctor's examination

Usually ultrasonography of the pelvis to determine whether the IUD is correctly placed in the uterus

Pain that is

  • Typically dull and aching but sometimes sharp or throbbing

  • Worse at the end of the day and relieved by lying down

  • Worse during or after sexual intercourse

Often low back pain, aches in the legs, and abnormal vaginal bleeding

Occasionally a clear or watery discharge from the vagina

Sometimes fatigue, mood swings, headaches, and bloating

A doctor’s examination

Ultrasonography or specialized imaging techniques

Sometimes laparoscopy

Vaginal bleeding or discharge

A doctor's examination

Sometimes ultrasonography of the pelvis, sonohysterography, or hysteroscopy

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

MRI = magnetic resonance imaging.