Doctor's Notes on Menstrual Cramps
Menstrual cramps are sharp, throbbing, or cramping pains that occur in a woman's lower abdomen caused by uterine contractions that start when the menstrual period begins and may continue for 2-3 days or longer. The uterine contractions are related to the levels of prostglandins that rise and fall during the menstrual cycle. More than half of all women experience some discomfort during their menstrual periods, but only a small percentage are disabled by the menstrual cramps symptoms.
Symptoms of menstrual cramps can range from mildly annoying to so severely painful and they interfere with daily tasks. In addition to lower abdominal cramps and pain, symptoms that may accompany menstrual cramps include lower back pain, leg pain, hip pain, nausea, vomiting, diarrhea, headaches, bloating, irritability, fatigue, feeling unwell (malaise), and in extreme cases, fainting spells.
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
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
- 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.
Drink More Water
Menstrual cramps, or primary dysmenorrhea, are an uncomfortable part of life for many women on a monthly basis. Drinking more water may help ease bloating, which makes symptoms worse. Get in the habit of drinking 6 to 8 glasses of water per day, especially during your period. Add some mint or a lemon wedge to make it more palatable. While you're at it, back off of the salt, which encourages fluid retention and bloating. Avoid alcohol, which promotes dehydration. Some women experience diarrhea in conjunction with menstrual cramps. It's important to replace lost fluids by drinking plenty of water.
Easy Ways to Get More Fluids
If you don't like the taste of plain water, there are many things you can do to increase fluid intake. Start by drinking a glass of fruit-infused water the first thing after you get up in the morning. Sip chamomile or ginger tea. Drink flavored mineral water for a new twist on hydration. Make a pitcher of cucumber, mint, or lemon water to drink throughout the day for a spa-like treat. Sip a cup of low sodium broth to increase your fluid intake. Staying well hydrated isn't just good for cramps, it's good for your overall health.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.