Menstrual Cramps

Overview

Menstrual cramps, also known as dysmenorrhea, are throbbing or cramping pains in the lower abdomen that many women experience before and during their menstrual periods. The discomfort can range from mild to severe and may interfere with daily activities for a few days each month. Menstrual cramps are typically caused by uterine muscle contractions triggered by hormone-like substances called prostaglandins. Factors that may increase the risk of menstrual cramps include starting puberty early, heavy menstrual bleeding, a family history of menstrual cramps, and smoking. While menstrual cramps don't cause other medical complications, associated conditions like endometriosis or uterine fibroids may lead to further complications.

Understanding the disease

Symptoms

Menstrual cramps are characterized by throbbing or cramping pains in the lower abdomen, typically experienced just before and during menstrual periods. Symptoms may include:

• Throbbing or cramping pain in your lower abdomen that can be intense
• Pain that starts 1 to 3 days before your period, peaks 24 hours after the onset of your period and subsides in 2 to 3 days
• Dull, continuous ache
• Pain that radiates to your lower back and thighs
• Some women also have nausea.

Risk Factors

The risk factors for developing menstrual cramps include being younger than age 30, starting puberty early (age 11 or younger), heavy bleeding during periods (menorrhagia), irregular menstrual bleeding (metrorrhagia), having a family history of menstrual cramps, and smoking.

Development

Menstrual cramps develop as a result of uterine muscle contractions during the menstrual period. Hormone-like substances called prostaglandins trigger these contractions. Higher levels of prostaglandins are associated with more severe menstrual cramps. Certain conditions can contribute to the development of menstrual cramps, such as endometriosis, uterine fibroids, adenomyosis, pelvic inflammatory disease, cervical stenosis, and smoking. These conditions can cause or exacerbate pain by affecting the uterus, its surrounding tissues, or the hormonal balance in the body.

Assessment and Diagnosis

Triage

You should see a doctor if menstrual cramps are disrupting your life every month or if your symptoms progressively worsen. Additionally, consult a doctor if you experience severe menstrual cramps after age 25 or have other concerning symptoms such as nausea, loose stools, headache, or dizziness.

Diagnosis

To diagnose menstrual cramps, a health care provider will typically start by reviewing your medical history and performing a physical exam, including a pelvic exam. During the pelvic exam, the provider checks for any unusual findings with the reproductive organs and looks for signs of infection. The provider may recommend certain tests, such as an ultrasound, which uses sound waves to create an image of the uterus, cervix, fallopian tubes, and ovaries. Other imaging tests like a CT scan or MRI can provide more detail and help diagnose underlying conditions. If an underlying condition is suspected, laparoscopy may be performed to view the abdominal cavity and reproductive organs.

Management and Treatment

Prevention

Menstrual cramps can be prevented to some extent through certain measures. Drinking plenty of fluids every day and stretching your muscles before and after using them can help prevent cramps. Light exercise, such as riding a stationary bicycle for a few minutes before bedtime, might also help prevent cramps while you sleep. However, menstrual cramps themselves are not preventable as they are directly linked to conditions like endometriosis, uterine fibroids, or other causes.

Home Remedies

Home remedies for menstrual cramps include:

1. Heat therapy: Apply a heating pad or warm compress to your lower abdomen to help alleviate cramping. You can also take a warm bath or shower to relax your muscles.
2. Massage: Gently massage the affected area to help reduce pain and cramping.
3. Exercise: Engaging in light to moderate exercise, such as walking, swimming, or yoga, can help relieve menstrual cramps.
4. Relaxation techniques: Practice deep breathing, meditation, or other relaxation techniques to reduce stress and alleviate pain.
5. Over-the-counter pain relievers: Consider taking over-the-counter pain relievers like ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to help manage menstrual cramps. Consult your healthcare provider for appropriate dosage and potential side effects.
6. Diet and nutrition: Maintain a balanced diet, including complex carbohydrates, and avoid excessive caffeine intake. Limit or avoid alcohol and caffeine, as they can worsen cramps.
7. Herbal remedies: Some women find relief with herbal remedies, such as chamomile or peppermint tea, or supplements like magnesium. However, consult your healthcare provider before using herbal remedies, as they may interact with other medications or have side effects.
8. Acupuncture: Some studies suggest that acupuncture may help relieve menstrual cramps. Consult a licensed acupuncturist for more information.

Treatment

Treatments for menstrual cramps may include:

1. Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate pain and reduce inflammation associated with menstrual cramps.
2. Heat application: Applying a heating pad or warm compress to the affected area may help relax the uterine muscles and reduce pain.
3. Stress-reduction techniques: Practicing relaxation techniques such as deep breathing exercises, yoga, or meditation may help alleviate menstrual cramps.
4. Herbal remedies: Some women find relief with herbal remedies like chamomile, dandelion, or ginger. Consult with a healthcare professional before taking any herbal supplements.
5. Birth control pills: For some women, hormonal birth control pills can help reduce the severity and frequency of menstrual cramps by regulating hormonal fluctuations.
6. Prescription medications: In some cases, prescription medications may be recommended for more severe menstrual cramps, such as the oral contraceptive drug Trumenba or antidepressants that help regulate hormones.
7. Surgery: In rare cases, surgical intervention may be necessary for conditions like endometriosis or uterine fibroids that are causing menstrual cramps. It's important to consult a healthcare provider to determine the best course of treatment based on individual circumstances and underlying causes of the menstrual cramps.

Preparing for medical consultation

To prepare for an appointment for menstrual cramps, you can track your menstrual periods, noting when they begin and how severe your cramps are. Make a list of medical problems you've had, recent major stresses in your life, all medications, vitamins, or other supplements you take, and questions to ask your doctor. It may also be helpful to take along a record of your menstrual cycles, including the first and last date of bleeding for each cycle and the flow's intensity. Additionally, consider bringing a family member or friend to the appointment for support and to help remember important details discussed during the visit.