What Are Period Cramps?
Period cramps (also called menstrual cramps or dysmenorrhea) are a common occurrence in women in their reproductive years. Severe period cramps can affect a woman’s quality of life and interfere with her daily activities.
There are two categories of period cramps:
- Primary dysmenorrhea: cramping, lower abdominal pain that occurs during a woman’s menstrual period without an underlying disease that could account for the symptoms
- Secondary dysmenorrhea: the same pain symptoms, but they are due to a disorder that could account for their symptoms, such as endometriosis, adenomyosis, or uterine fibroids
What Are Symptoms of Period Cramps?
Period cramps are characterized by recurrent, crampy, lower abdominal pain that occurs during a woman’s menstrual period. Characteristics of the pain include:
- Pain starts one to two days before or with the onset of menstrual bleeding and gradually lessens over 12 to 72 hours
- Pain is recurrent and usually occurs in all or almost all menstrual cycles
- Pain is usually crampy and intermittently intense but may be a continuous dull ache
- Pain is usually confined to the lower abdomen just above the pubic area
- The pain is usually strongest in the midline, though may also occur in some women in the back and/or thigh
- The severity of the pain ranges from mild to severe
Additional symptoms that may accompany period cramps include:
How Are Period Cramps Diagnosed?
Period cramps (dysmenorrhea) are diagnosed with detailed history and physical examination to look for signs and symptoms suggestive of underlying pelvic disease, such as pelvic inflammatory disease (PID), endometriosis, adenomyosis, or fibroids.
Laboratory testing to see if menstrual cramps are due to an underlying medical issue include:
- Testing for gonorrhea and chlamydia in sexually active patients as well as in patients suspected of having cervicitis or pelvic inflammatory disease (PID)
- Urine testing for urinary tract infection (UTI)
Imaging tests to see if period cramps are due to an underlying medical issue include:
What Is the Treatment for Period Cramps?
There are several different treatments for period cramps not due to any underlying medical condition (primary dysmenorrhea), depending on the severity.
The quickest ways to get rid of period cramps are to take an over-the-counter (OTC) pain reliever, do some light exercise, and apply heat to the lower abdomen.
For women who do not wish to take medication, treatment for period cramps includes:
- Heat application to the lower abdomen (heating pad, hot water bottle, hot towel, or heat wrap)
Medications used to treat period cramps include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Acetaminophen (Tylenol)
- Hormonal contraceptives
If medications do not work to alleviate the pain of menstrual cramps, other interventions include:
- Transcutaneous electrical nerve stimulation (TENS)
- Empiric GnRH analog or antagonist therapy
- Laparoscopy for women who have not had adequate relief after three to six months of NSAIDs and/or hormonal contraception
Supportive therapies may help some patients to reduce the pain of period cramps, though these treatments for dysmenorrhea have not been adequately studied. However, the risk from these interventions is low and women may wish to try them as adjuncts to pain medications or hormone therapy.
Behavioral counseling that teaches patients strategies to modify the way they think about their pain (e.g., desensitization-based procedures, hypnotherapy, imagery, coping strategies) and efforts to modify the response to pain (e.g., biofeedback, electromyographic training, Lamaze exercises, relaxation training)
- Complementary or alternative medicine
- Diet and vitamins
- Low fat vegetarian diet
- Increased dairy intake
- Vitamin E (500 units per day or 200 units twice per day, beginning two days before the period and continuing through the first three days of bleeding)
- Vitamin B1 (100 mg daily), vitamin B6 (200 mg daily), and fish oil supplement (1080 mg eicosapentaenoic acid, 720 mg docosahexaenoic acid, and 1.5 mg vitamin E)
- A single large dose of vitamin D3 (oral, 300,000 international units/1 mL) given five days prior to the expected first day of the menstrual cycle (the safety of this is not known)
- Consumption of 750 to 2000 mg of ginger powder on days 1 to 3 of the menstrual cycle
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