Menstrual Cramps

More than 50% of women with dysmenorrhea have primary dysmenorrhea. In about 5 to 15% of these women, cramps are severe enough to interfere with daily activities and may cause them to miss school or work.

Experts think that primary dysmenorrhea may be caused by release of substances called prostaglandins into the blood or tissues during menstruation. Prostaglandin levels are high in women with primary dysmenorrhea. Prostaglandins may cause the uterus to contract (as occurs during labor), reducing blood flow to the uterus. These contractions can cause pain and discomfort. Prostaglandins also make nerve endings in the uterus more sensitive to pain.

Anxiety may also contribute to the pain.

Secondary dysmenorrhea is caused by abnormalities in the reproductive system. It is commonly caused by

There are many less common causes of secondary dysmenorrhea Some Causes and Features of Menstrual Cramps . They include

IUDs that release copper are often associated with painful periods. Those that release a progestin (a synthetic form of the female hormone progesterone) usually do not cause painful periods.

In a few women, pain occurs because the passageway through the cervix (cervical canal) is narrow. A narrow cervical canal (cervical stenosis) may develop after a procedure, as when a precancerous condition (dysplasia) of the cervix is treated.

In women with dysmenorrhea, certain symptoms are cause for concern:

Women with any warning sign should see a doctor as soon as possible (usually the same day).

If women without warning signs have more severe cramps than usual or have pain that lasts longer than usual, they should see a doctor within a few days.

Other women who have menstrual cramps should call their doctor. The doctor can decide how quickly they need to be seen based on their other symptoms, age, and medical history.

Doctors or other health care practitioners ask about the pain and the medical history, including the menstrual history. Practitioners then do a physical examination. What they find during the history and physical examination may suggest a cause of menstrual cramps and the tests that may need to be done (see table ).

For a complete menstrual history, practitioners ask a woman

Practitioners also ask the woman the following:

The woman is asked whether she has or has had disorders and other conditions that can cause cramps, including use of certain drugs (such as birth control pills) or an IUD. Practitioners ask whether she has had any surgical procedures that increase the risk of pelvic pain, such as a procedure that destroys or removes the lining of the uterus (endometrial ablation).

A pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more is done. Doctors check for abnormalities, including discharge, tenderness, polyps, and fibroids.

Doctors also gently feel the abdomen to check for areas of particular tenderness, which may indicate severe inflammation in the abdomen (peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more ).

Testing is done to rule out disorders that may be causing the pain. For most women, tests include

If pelvic inflammatory disease is suspected, a sample of secretions is taken from the cervix, examined under a microscope, and sent to a laboratory to be tested.

If results of these tests are unclear and symptoms persist, one or more of the following tests is done:

For hysterosalpingography, x-rays are taken after a substance that can be seen on x-rays (radiopaque contrast agent) is injected through the cervix into the uterus and fallopian tubes. If results are unclear, magnetic resonance imaging (MRI) may be done.

For sonohysterography, ultrasonography is done after fluid is infused in the uterus through a thin tube inserted through the vagina and cervix. The fluid makes abnormalities easier to identity.

For hysteroscopy, doctors insert a thin viewing tube through the vagina and cervix to view the interior of the uterus. This procedure can be done in a doctor's office or in a hospital as an outpatient procedure.

For laparoscopy, a viewing tube is inserted through a small incision just below the navel and is used to view the uterus, fallopian tubes, ovaries, and organs in the abdomen. This procedure is done in a hospital or surgical center. Laparoscopy enables doctors to directly view structures in the pelvis.

Moist heat applied to the abdomen may help.

Getting enough sleep and rest and exercising regularly may also help.

Other measures that have been suggested to help relieve the pain include a low-fat diet and nutritional supplements such as omega-3 fatty acids, flaxseed, magnesium, vitamin B1, vitamin E, and zinc. There is not much evidence to support the usefulness of diet or these nutritional supplements, but most have few risks and so some women may try them. Women should talk to their doctors before using these supplements.

If pain is bothersome, NSAIDs, such as ibuprofen, naproxen, or mefenamic acid, may help. NSAIDs should be started 24 to 48 hours before a period begins and continued 1 or 2 days after the period begins.

If NSAIDs are ineffective, doctors may recommend also taking birth control pills Oral Contraceptives Contraceptive hormones can be Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings) Applied to the skin (patch) Implanted under the skin read more that contain a progestin (a synthetic form of the female hormone progesterone) and estrogen. These pills prevent the ovaries from releasing an egg (ovulation). Women who cannot take estrogen can take birth control pills that contain only a progestin.

Other hormone treatments may be used if NSAIDs or birth control pills do not relieve symptoms. They include progestins (such as levonorgestrel, etonogestrel, medroxyprogesterone, or micronized progesterone, taken by mouth), gonadotropin-releasing hormone (GnRH) agonists Drugs used to treat endometriosis (such as leuprolide and nafarelin), GnRH antagonists (such as elagolix), an IUD that releases a progestin, or danazol (a synthetic male hormone). GnRH agonists and antagonists help relieve menstrual cramps due to endometriosis. Danazol is not frequently used because it has many side effects.

If a woman may have endometriosis and medications have not worked or if she has infertility, doctors may do laparoscopic surgery to confirm the diagnosis of endometriosis and remove endometrial tissue (tissue from the lining of the uterus) that is located outside the uterus.

If women have severe pain that persists despite all other types treatment, doctors may do a procedure that disrupts the nerves to the uterus and thus blocks pain signals. These procedures include the following:

The procedures to disrupt the nerves may be done using a laparoscope. When these nerves are cut, other organs in the pelvis, such as the ureters, are occasionally injured.

Some alternative treatments for menstrual cramps have been suggested but have not been studied well. They include behavioral counseling (such as systematic desensitization and relaxation and pain management training), acupuncture Acupuncture Acupuncture, a therapy within traditional Chinese medicine, is one of the most widely accepted CAM therapies in the Western world. Licensed practitioners do not necessarily have a medical degree... read more , and acupressure. Hypnosis is being studied as treatment.