Dysmenorrhea - Menstrual Cramps

Overview, Causes, & Risk Factors

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.

What is going on in the body?

About half the women of childbearing age have menstrual cramps. Fifteen percent 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 hormone that prompts ovulation. Women who ovulate, or release an egg during monthly cycles, make the hormone progesterone. This hormone boosts the body's level of prostaglandins. Prostaglandins stimulate uterine contractions. As the uterus contracts, it sloughs off the lining. The tissue passes out of the uterus through the cervix. Women with dysmenorrhea have prostaglandin levels that are 5 to 13 times higher than normal.

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

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

Symptoms & Signs

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

Diagnosis & Tests

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 can include:

abdominal exploration surgery

blood tests

cultures to check for sexually transmitted disease

a dilatation and curettage (D&C)

laparoscopy, a procedure in which a small lighted tube is inserted into the abdomen

an ultrasound of the vagina

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

Prevention & Expectations

What can be done to prevent the condition?

Menstrual cramping is not always preventable. Here are some helpful measures to reduce symptoms:

a balanced diet, following the food guide pyramid

moderate exercise

oral contraceptives

safer sex practices

stress management techniques

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.

Treatment & Monitoring

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

yoga

Mild cramps can be treated with pain medicines, such as aspirin or acetaminophen. 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 ibuprofen, naproxen, and ketoprofen. It's best to take these 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 are ineffective, the provider may prescribe rofecoxib or mefenamic acid. Sometimes, low-dose oral contraceptives are prescribed to prevent ovulation and prostaglandin production.

Endometrial ablation is an option for women with very painful periods or heavy menstrual flow. 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 or nafarelin 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 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.