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Menstrual Cramps Facts - Menstrual Pain Information - Painful Periods Medication - PMS Treatments
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Menstrual Pain And Menstrual Cramps Frequently Asked Questions
What are menstrual cramps?
Menstrual cramps are abdominal and pelvic area (belly) pains that are experienced by a woman around the time of her menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual syndrome (PMS) although the symptoms of both disorders can sometimes be experienced as a continual process. Many women suffer from both PMS and menstrual cramps.
Menstrual cramps are abdominal and pelvic area (belly) pains that are experienced by a woman around the time of her menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual syndrome (PMS) although the symptoms of both disorders can sometimes be experienced as a continual process. Many women suffer from both PMS and menstrual cramps.
Menstrual cramps can range from mild to quite severe. Mild menstrual cramps may be barely noticeable and of short duration - sometimes felt just as a sense of light heaviness in the belly. Severe menstrual cramps can be so painful that they interfere with a woman's regular activities for several days.
How common are menstrual cramps?
Menstrual cramps of some degree affect more than an estimated 50% of women, and among these, up to 15% would describe their menstrual cramps as severe.
Menstrual cramps of some degree affect more than an estimated 50% of women, and among these, up to 15% would describe their menstrual cramps as severe.
What is dysmenorrhea?
The medical term for menstrual cramps is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.
The medical term for menstrual cramps is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.
In primary dysmenorrhea, there is no underlying gynecologic problem causing the pain. This type of cramping usually begins at menarche (the beginning of menstruation), the time when a girl starts having menstrual periods.
In secondary dysmenorrhea, some underlying abnormal condition (usually involving a woman's reproductive system) contributes to the menstrual pain. Secondary dysmenorrhea may be evident at menarche but, more often, the condition develops later.
What causes menstrual cramps?
Each month, the inner lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. If the egg is not fertilized by a sperm, the current lining of the uterus is no longer needed. The woman's estrogen and progesterone hormone levels decline and the lining of the uterus becomes swollen and dies. It is then shed and will be replaced by a new lining in the next monthly cycle.
Each month, the inner lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. If the egg is not fertilized by a sperm, the current lining of the uterus is no longer needed. The woman's estrogen and progesterone hormone levels decline and the lining of the uterus becomes swollen and dies. It is then shed and will be replaced by a new lining in the next monthly cycle.
When the old uterine lining begins to break down, molecular compounds called prostaglandins are released. These compounds, specifically prostaglandin F2alpha (PGF2alpha), cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina.
Why are some cramps so painful?
Menstrual cramps are caused by uterine contractions. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman's cervical canal is narrow.
Menstrual cramps are caused by uterine contractions. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman's cervical canal is narrow.
The difference between menstrual cramps that are more painful and those that are less painful is apparently related to a woman's prostaglandin levels. Women with menstrual cramps have prostaglandin blood levels that are 5-13 times higher than women who do not experience cramps. Menstrual cramps are very similar to those a pregnant woman experiences when she is given prostaglandin as a medication to induce labor.
Can menstrual cramps be measured?
Yes. Menstrual cramps can be scientifically demonstrated by measuring the pressure within the uterus and the number and frequency of uterine contractions. During a normal menstrual period, the average woman has contractions of a low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions every 10 minutes. When a woman has menstrual cramps, her contractions are of a higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.
Yes. Menstrual cramps can be scientifically demonstrated by measuring the pressure within the uterus and the number and frequency of uterine contractions. During a normal menstrual period, the average woman has contractions of a low pressure (50-
What other factors influence menstrual cramps?
As mentioned above, an unusually narrow cervical canal tends to increase menstrual cramps. Another anatomical factor thought to contribute to menstrual cramps is a backwards tilting of the uterus (a retroverted uterus).
As mentioned above, an unusually narrow cervical canal tends to increase menstrual cramps. Another anatomical factor thought to contribute to menstrual cramps is a backwards tilting of the uterus (a retroverted uterus).
Lack of exercise is now recognized to contribute to painful menstrual cramps.
It has long been thought that psychological factors also play a role. For example, it is widely accepted that emotional stress can increase the discomfort of menstrual cramps.
What are the symptoms of menstrual cramps?
Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual.
Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual.
Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after the onset of the pains, and subside again after a day or two.
Menstrual cramps may be accompanied by a headache and/or nausea, which can lead, although infrequently, to the point of vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea because the prostaglandin (PGF2alpha), which causes smooth muscles to contract, are found in both the uterus and intestinal tract. Some women experience an urge to urinate more frequently.
How are menstrual cramps diagnosed?
The diagnosis of menstrual cramps is usually made by the woman herself and reflects her individual perception of pain. Once a woman has experienced menstrual cramps, usually with the adolescent onset of her menses (monthly menstrual flow), she becomes well aware of the typical symptoms.
The diagnosis of menstrual cramps is usually made by the woman herself and reflects her individual perception of pain. Once a woman has experienced menstrual cramps, usually with the adolescent onset of her menses (monthly menstrual flow), she becomes well aware of the typical symptoms.
What is the treatment for common menstrual cramps (primary dysmenorrhea)?
Every woman needs to find a treatment that works for her. Perhaps the most common treatment, especially in the past, has been to lie down at the first sign of pain. It used to be that many women's restrooms contained a cot or a couch so that a woman who felt "indisposed" could lie down. A bed in the school nurse's office served the same purpose and girls were routinely excused from physical education or other classes because of menstrual cramps.
Every woman needs to find a treatment that works for her. Perhaps the most common treatment, especially in the past, has been to lie down at the first sign of pain. It used to be that many women's restrooms contained a cot or a couch so that a woman who felt "indisposed" could lie down. A bed in the school nurse's office served the same purpose and girls were routinely excused from physical education or other classes because of menstrual cramps.
Current recommendations include not only adequate rest and sleep, but also regular exercise (especially walking). Some women find that abdominal massage, yoga, or orgasmic sexual activity help. A heating pad applied to the abdominal area may relieve the pain and congestion.
A number of nonprescription (over-the-counter) agents can help control the pain as well as actually prevent the menstrual cramps themselves. For mild cramps, aspirin or acetaminophen (Tylenol), or acetaminophen plus a diuretic (Diurex MPR, FEM-1, Midol, Pamprin, Premsyn, and others) may be sufficient. However, aspirin has limited effect in curbing the production of prostaglandin and is only useful for less painful cramps.
The main agents for treating moderate menstrual cramps are the nonsteroidal antiinflammatory drugs (NSAIDs), which lower the production of prostaglandin and lessen its effect. The NSAIDs that do not require a prescription are:
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ibuprofen (Advil, Anaprox, Midol IB, Motrin, Nuprin, and others);
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naproxen sodium (Aleve); and
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ketoprofen (Actron, Orudis KT).
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A woman should start taking one of these medications before her pain becomes difficult to control. This might mean starting medication 1-2 days before her period is due to begin and continuing taking medication 1-2 days into her period. The best results are obtained by taking one of the NSAIDs on a scheduled basis and not waiting for the pain to begin.
Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic acid (Ponstel).
What if the cramps are very severe?
If a woman's menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low dose oral contraceptives containing estrogen and progestin or long-acting edroxyprogesterone. This type of approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins which, in turn, reduces the severity of cramping and causes a light menstrual flow.
If a woman's menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low dose oral contraceptives containing estrogen and progestin or long-
Are there surgical solutions?
In the past, many women with menstrual cramps had an operation known as a D & C (dilation and curettage) to remove some of the lining of the uterus. Some women even resorted to the ultimate solution to menstrual problems by having a hysterectomy, surgery that removes the entire uterus.
In the past, many women with menstrual cramps had an operation known as a D & C (dilation and curettage) to remove some of the lining of the uterus. Some women even resorted to the ultimate solution to menstrual problems by having a hysterectomy, surgery that removes the entire uterus.
Today, when a woman's periods are very heavy and painful, her doctor may recommend endometrial ablation, a procedure in which the lining of the uterus is burned away or vaporized using a heat-generating device.
What is the treatment of secondary dysmenorrhea?
The treatment of secondary dysmenorrhea depends on its cause. There are a number of underlying conditions which can contribute to the pain including:
The treatment of secondary dysmenorrhea depends on its cause. There are a number of underlying conditions which can contribute to the pain including:
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Endometriosis (cells from the uterine lining that have escaped to other areas of the body);
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Uterine Fibroids (non-
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Adenomyosis (a benign condition in which the cells of the inner uterine lining invade its muscular wall, the myometrium);
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Pelvic inflammatory disease (PID);
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Adhesions (abnormal fibrous attachments between organs); or
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Use of an intrauterine device (IUD) for contraception.
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All of these conditions should be first diagnosed by a physician who will then recommend the appropriate treatment.
If a women begins to experience changes in her menstrual cramps, such as severity, timing, or location, she should consult her physician, especially if the changes are of sudden onset.
What is the long term outlook (prognosis) for menstrual cramps?
In general, a woman's menstrual cramps do not worsen during her lifetime. In fact, the menstrual cramps of primary dysmenorrhea usually diminish with age and pregnancy. This is thought to be due to the fact that the nerves of the uterus degenerate with age and disappear late in pregnancy, with only a portion of these nerves regenerating after childbirth.
In general, a woman's menstrual cramps do not worsen during her lifetime. In fact, the menstrual cramps of primary dysmenorrhea usually diminish with age and pregnancy. This is thought to be due to the fact that the nerves of the uterus degenerate with age and disappear late in pregnancy, with only a portion of these nerves regenerating after childbirth.
When there is secondary dysmenorrhea with an underlying condition contributing to the pain, the prognosis depends on the successful treatment of that condition.
As women have learned more about their bodies and how to maintain them in maximum health, menstrual cramps have become less a debilitating illness, and more often, merely a minor monthly inconvenience.
Menstrual Cramps At A Glance
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Menstrual cramps are periodic abdominal and pelvic pains experienced by women.
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More than half of all menstruating women have cramps.
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The cramps are severe in at least 1 in 7 of these women.
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Medically, menstrual cramps are called dysmenorrhea.
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Primary dysmenorrhea is common menstrual cramps.
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Secondary dysmenorrhea results from an underlying abnormality that usually involves the woman's reproductive system.
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Nonsteroidal anti-
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Physical exercise can help alleviate menstrual cramps.
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Menstrual cramps tend to improve with age.
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