Symptoms and Signs of Menstrual Cramps

Menstrual Cramps Symptoms

In addition to cramps in the lower abdomen, a woman may also experience additional symptoms. These symptoms may include:

• Lower back pain
• Leg pain and/or hip pain
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Bloating
• Irritability
• Fatigue or malaise
• Fainting spells (in extreme cases)

Menstrual Cramps Causes

Menstrual cramps or primary dysmenorrhea occurs in the absence of any significant pathologic cause for the pain. This type of menstrual pain is most commonly seen in young women during the years following the onset of menstruation.

Secondary dysmenorrhea refers to painful menstrual cramps that occur as a result of a true pathological condition (for example, endometriosis). This condition is more commonly seen in older women (30-45 years of age).

Prostaglandins and menstrual pain: Prostaglandins are chemicals that a woman's body produces that cause many of the symptoms associated with menstrual discomfort. The tissue that lines the uterus (endometrium) produces these chemicals, and they are released with the onset of menses when the uterine lining breaks down. Prostaglandins stimulate the uterine muscle to contract. Women who have high levels of prostaglandins experience more intense contractions of their uterus, and these produce more pain. Prostaglandins also may be responsible for vomiting, diarrhea, and headaches that frequently accompany painful periods.

What causes secondary dysmenorrhea?

Other menstrual-type pain or secondary dysmenorrhea can be caused by conditions of the reproductive tract, such as the following:

• Endometriosis: uterine tissue that appears outside the uterus
• Fibroids: non-cancerous (benign) tumors that involve the uterus
• Adenomyosis: migration of endometrial glands downward into the muscular wall of the uterus
• Infections: infections involving the reproductive organs
• Ectopic pregnancy: a pregnancy that occurs outside of the uterus such as in the Fallopian tubes
• IUD (intra-uterine device) used for birth control
• Ovarian cysts
• Narrow cervix: cramps due to passing clots of blood and tissue through an anatomically narrow cervical canal
• Stress

The healthcare professional will take a detailed medical history, and will inquire specifically about the menstrual cramps and related symptoms. A woman should anticipate questions regarding:

• The timing of the cramps in relation to the start of the menstrual period
• Type and duration of pain
• The age when the cramps first began and age of the onset of menstruation
• Any recent change in the pain
• History of irregular periods
• Any unusual vaginal discharge
• Any history of pain with intercourse
• Infertility
• Any history of pelvic infections
• Current medications including birth control measures

The doctor will perform a pelvic exam to explore any problems. If there are concerns in regard to a possible infection, a culture of the cervix and a blood test may confirm the diagnosis. Additional tests may be ordered.

• The doctor may order a pregnancy test if the menstrual periods are irregular, or if the woman is not using birth control on a regular basis.
• An ultrasound examination is necessary if the doctor discovers any abnormal masses during the pelvic exam. The doctor also may order special imaging tests, such as magnetic resonance imaging (MRI), if a pelvic ultrasound is not helpful.
• A doctor may perform a laparoscopy, a minor surgical procedure allowing the doctor to look directly into the pelvic cavity with a fiber-optic scope.
• A hysteroscopy is another possible procedure. By inserting a hysteroscope (lighted instrument) through the cervix, a doctor can visualize the cervix and interior of the uterus.

Some of above tests may assist in ruling out certain causes of menstrual pain and cramping such as an ectopic pregnancy, pelvic inflammatory disease (PID), or other abnormalities.