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What are menstrual cramps? Menstrual cramps, also called dysmenorrhea, are pains that you may feel in your lower abdomen prior to and during your period.  They are usually finished by the 2nd or 3rd day of bleeding.  Not all women experience menstrual cramps, and the level of pain, as well as the length of time that the pain occurs, varies from woman to woman.  They are sometimes described as a sensation of heaviness or pressure, a dull ache, a throbbing pain, or sometimes sharp pain.  Sometimes cramps are felt in the center of the lower abdomen.  Other times, they may be felt in the lower back.  They can come and go, or they can be continuous..

What causes menstrual cramps?  Each cycle, the uterus grows a thick lining of endometrium inside of it incase a fertilized egg comes along to land on it and burrow in.  If this does not happen, the lining must be shed off in order for a new cycle to begin.  As the cycle draws to a close, molecules known as prostaglandins are released by the uterus.  (These prostaglandins are specifically known as prostaglandin F2-alpha or PGF-2 alpha.)  These molecules react with the muscles within the uterine walls and cause them to contract.  This muscle contraction is what causes the feeling of a menstrual cramp.  The contractions stop blood flow to the lining and push the lining off of the walls of the uterus, through the cervix, and out of the vagina. 

Why are some cramps so painful?  Sometimes, cramps are made worse when the lining is especially thick or when there are clots of blood that need to be pushed out.  If a woman has a narrow cervix, cramps can be more severe.  However, most women have more severe menstrual cramps because their levels of prostaglandin are higher than those of other women.  Women with very low levels of prostaglandin may not feel their cramps at all, while women with very high levels of prostaglandins may be doubled over in pain from their cramps.

What other symptoms can occur with menstrual cramps? Sometimes a headache, increased urination, nausea, and even vomiting can occur with menstrual cramps.  More commonly, diarrhea or constipation will occur with menstrual cramps since the prostaglandins that affect the uterus can also affect the intestinal tract.

What is the treatment for common menstrual cramps?  There are various treatments that can be helpful in treating menstrual cramps, and you need to find what works best for you. A heating pad applied to the abdomen can help to relieve the pain.  Gentle massage of the abdomen and/or lower back can also help.  Over-the-counter medications such as acetaminophen (Tylenol), acetaminophen plus a diuretic (Midol or Pamprin), or ibuprofen (Motrin) can all help.  The most effective over-the-counter medicine is probably ibuprofen, since it lessens the effect of prostaglandins.  If you routinely have cramps, you may want to start taking the ibuprofen before your cramps start in order to reduce or avoid them altogether. 

What if the cramps are very severe? If your cramps are severe and you cannot control them with one of the above methods, call your doctor.  Your doctor's office will be able to assess if it is menstrual cramping or something else, and they may request to see you in the office.  Your doctor may prescribe a medication to ease the pain.  In addition, he or she may suggest low-dose birth control pills or medroxyprogesterone to minimize your cramping.  If there is an underlying cause for your severe menstrual cramps (such as endometriosis, fibroids, or pelvic inflammatory disease), the disorder will need to be addressed and treated in an attempt to reduce your cramps.

Menstrual Cramps