Menstrual Cramps

Alternate Names
dysmenorrhea



Definition of Menstrual Cramps

Menstrual cramps are the pain and cramping some women experience during their monthly periods. The term dysmenorrhea usually refers to pain and cramps severe enough to prevent normal activity or require treatment.

What is going on in the body?

About half the women of childbearing age have menstrual cramps. Between one quarter and one third of women have dysmenorrhea.

There are two kinds of dysmenorrhea:

• primary, which means there is no physical cause for it other than hormones
• secondary, which means it stems from another health problem in a woman's body

Menstrual pain is linked to a chemicals called prostaglandins. Prostaglandins stimulate uterine and tubal contractions. Women with dysmenorrhea have prostaglandin levels that are 5 to 13 times higher than normal.

What are the signs and symptoms of the condition?

Menstrual pain usually does not become severe until late in the teen years. Symptoms can begin on the first day of a period. These can include:

• diarrhea
• headache
• heavy menstrual flow
• lower abdominal tenderness
• nausea and vomiting
• pelvic cramping

What are the causes and risks of the condition?

Experts do not know what triggers high prostaglandin levels.

Secondary dysmenorrhea is caused by other disorders, such as:

• adenomyosis, or growth of the lining of the uterus into the muscles of the uterus
• endometriosis, a condition in which tissue from the lining of the uterus appears in other parts of the body such as the ovaries, bladder and lining of the abdomen called the peritoneum
• fibroids, or benign growths in the uterus
• a narrow cervix, or uterine opening
• ovarian cysts
• pelvic adhesions, or scar tissue, from past abdominal surgery
• pelvic inflammatory disease (PID)
• premenstrual syndrome (PMS)
• a uterus that is retroverted, or tipped backward

Here are some factors that increase a woman's risk for menstrual cramps:

• an intrauterine device, or IUD
• lack of exercise
• psychological and emotional factors, especially in teens
• stress

What can be done to prevent the condition?

Menstrual cramping is not always preventable. However, some women may find these interventions helpful:

• a balanced diet, low in animal fats, dairy products and eggs, while high in raw seeds and nuts (which may increase the production on beneficial prostaglandins)
• moderate exercise
• oral contraceptives
• stress management techniques
• dietary supplementation with vitamin B1 (thiamine) may be effective when used for at least 90 days
• dietary supplementation with fish oil (alone or in combination with vitamin B12) may be effective when used for at least two months.
• taking NSAID medications before and during the menstrual cycle

There is no evidence that condoms prevent dysmenorrhea.

How is the condition diagnosed?

Diagnosis of menstrual cramps begins with a medical history and physical exam, including a pelvic exam. Tests to rule out physical causes may include:

• blood tests
• cultures to check for sexually transmitted disease
• an ultrasound of the vagina and uterus
• laparoscopy, a procedure in which a small lighted tube is inserted into the abdomen, is rarely needed

If physical causes are found, secondary dysmenorrhea is diagnosed. Primary dysmenorrhea is diagnosed by ruling out possible physical causes.

What are the long-term effects of the condition?

Mild menstrual cramps and primary dysmenorrhea have no known long-term effects. The cause of secondary dysmenorrhea determines its long-term effects. These may include:

• chronic pelvic pain
• dyspareunia, or painful sexual intercourse
• infertility

What are the risks to others?

Menstrual cramps are not contagious and pose no risk to others. However, if the problem is due to an undiagnosed STD, the woman may spread this to her partner.

What are the treatments for the condition?

Treatment depends on the severity and cause of the pain. Measures that may be helpful in relieving menstrual cramping include:

• a heating pad applied to the lower abdomen
• moderate exercise
• relaxation therapy

Other therapies that man be helpful include:

• a balanced diet, low in animal fats, dairy products and eggs, while high in raw seeds and nuts (which may increase the production on beneficial prostaglandins)
• a low-fat, vegetarian diet has been shown to significantly decrease pain
• dietary supplementation with vitamin B1 (thiamine) may be effective when used for at least 90 days
• dietary supplementation with fish oil (alone or in combination with vitamin B12) may be effective when used for at least two months.
• preliminary clinical research shows that vitamin E supplementation may decrease pain.

Mild cramps can be treated with pain medicines, such as aspirin or acetaminophen (i.e., Tylenol). Some over-the-counter products combine one of these medicines with a diuretic, or water pill.

For dysmenorrhea, healthcare providers often recommend medicines that lessen the production and effect of prostaglandins. These include nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen (i.e., Advil, Motrin, ketoprofen (i.e., Orudis), ketorolac (i.e., Toradol), fenoprofen, and naproxen (i.e., Aleve, Naprosyn).

It's best to take NSAIDs on a scheduled basis. They are started 1 to 2 days before the woman's period and menstrual cramps begin. They should be continued 1 to 2 days into the woman's period.

If over-the-counter medicines or prescription NSAIDs are ineffective, the provider may prescribe prescription NSAIDs, celecoxib (i.e., Celebrex, which is not FDA approved for this indication), mefenamic acid, or (i.e., Ponstel), tramadol (i.e., Ultram).

Sometimes, low-dose oral contraceptives are prescribed to prevent ovulation and prostaglandin production. Some healthcare providers use the calcium channel blocker nifedipine (i.e., Adalat, Procardia), in low doses, or transdermal nitroglycerine, although these are not FDA approved for dysmenorrhea.

In suitable candidates, progestin-containing IUDs may be considered. In addition, some women experience relief with Transcutaneous electrical nerve stimulators (TENS) or acupuncture.

Endometrial ablation is an option for women with very painful periods or heavy menstrual flow. Dysmenorrhea is not an approved indication for endometrial ablation, although this procedure is approved for menorrhagia (excessive amount or duration of menstrual flow, at more or less regular intervals) or metrorrhagia (excessive amount or duration of menstrual flow, at irregular intervals).This procedure uses a heat-generating device to burn away the lining of the uterus.

If a woman has secondary dysmenorrhea, treatment may focus on the underlying disorder.

Leuprolide (i.e., Lupron), goserelin (i.e., Zoladex) or nafarelin (i.e., Synarel) are used to treat fibroids or endometriosis. Antibiotics will be used if PID is suspected. Surgery may be used to treat certain conditions.

What are the side effects of the treatments?

Pain medicines and antibiotics may cause stomach upset inflammation of the colon or colitis or allergic reactions. Medicines used to treat endometriosis or fibroids may cause hot flashes or headaches. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the condition?

Menstrual cramps often improve after a woman has given birth to her first child.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.