Menstrual Pain

What Is Menstrual Pain?

Menstrual pain or cramps are pains in your lower abdomen that happen when your menstrual period begins (or just before). This pain may continue for 2 to 3 days. Cramps may be throbbing or aching, and they can be dull or sharp. Symptoms can range from a mild discomfort to serious pain that interferes with your normal activities.

Menstrual cramps are the leading cause of absenteeism in women younger than 30. Although over half of people who have menstrual periods feel some discomfort, 10% are temporarily disabled by symptoms.

Causes of Menstrual Pain

Prostaglandins are chemicals the body makes that cause many of the symptoms associated with menstrual discomfort. The tissue that lines the uterus makes these chemicals. Prostaglandins stimulate the uterine muscles to contract. People who have high levels of prostaglandin may have more intense contractions of their uterus and more pain. Prostaglandins may also be responsible for vomiting, diarrhea, and headaches that accompany painful periods.

Other menstrual-type cramps can be caused by conditions of the reproductive tract, such as the following:

If you have had menstrual pain ever since your periods started, the condition is called primary dysmenorrhea. If a physical condition such as pelvic inflammatory disease or endometriosis has developed and is causing the pain, this is called secondary dysmenorrhea. Once the medical condition is treated, the menstrual pain usually goes away.

Risk factors for menstrual pain

You may be more likely to have menstrual cramps if:

  • You had your first period at an early age (younger than 11).
  • Your menstrual periods are heavy.
  • You are overweight or obese.
  • You smoke cigarettes or drink alcohol.
  • You have never been pregnant.

Symptoms of Menstrual Pain

Besides cramps in the lower abdomen, you may also have some of these symptoms with menstrual cramps:

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Menstrual Pain Diagnosis

The doctor will ask about your medical history, as well as questions about the menstrual pain and symptoms. Be prepared to talk about these details:

  • The timing of the cramps in relation to the start of the period
  • Type of pain
  • Your age when the cramps first started
  • Any recent change in the pain
  • Irregular periods
  • Vaginal discharge
  • Pain with intercourse
  • Infertility
  • History of pelvic infections
  • Age when your first period happened
  • Current medications
  • What things seem to improve or worsen the pain

The doctor will perform a pelvic exam to check for any problems. If there are concerns about a possible infection, cervical cultures and a blood test will confirm the diagnosis. You might get these tests, too:

  • The doctor may order a pregnancy test if your periods are irregular or you are not using birth control regularly.
  • An ultrasound exam is necessary if the doctor discovers any abnormal masses during the pelvic exam or there is a new onset of menstrual pain.
  • A doctor may recommend a laparoscopy, which is a minor surgical procedure allowing the doctor to look directly into the pelvic cavity with a fiber-optic scope. This is an outpatient procedure using very small incisions.
  • A hysteroscopy is another possible procedure. By inserting a hysteroscope (a thin lighted tube) through the vagina, the doctor can see inside the cervix and the inside of the uterus without incisions. This can be done in a doctor's office or a hospital.

Menstrual Pain Treatment

There are different types of treatment.

Medications for menstrual pain

The best way to relieve painful menstrual cramps is to take an anti-inflammatory medication. Ibuprofen, ketoprofen, and naproxen are available without a prescription and are effective at blocking the effects of prostaglandins.

  • These drugs work better if taken before the start of menstruation and can be continued as long as needed. If one type does not relieve the pain, try another, because these medications do not work the same in everyone.
  • These medicines can be harsh on the stomach. If you have had kidney problems or stomach problems (such as ulcers or reflux), tell your doctor before starting this type of medication. Taking the pills with meals may help prevent an upset stomach.
  • Starting some form of hormonal birth control is another option to control or stop menstrual cramps. This can be a pill, an injection, a transdermal patch, or a hormone-containing IUD. These methods can reduce or eliminate the menstrual flow leading to less pain.

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Menstrual pain home treatment

If anti-inflammatory medicine is not an option or if more relief is needed, you can try these things to relieve menstrual cramps:

  • A heating pad to the pelvic area
  • Massage to the back and lower abdomen
  • Exercise, especially prior to the start of a period
  • Thiamine (100 milligrams daily)
  • Low-fat vegetarian diet
  • Calcium (1,200 milligrams daily)​​​​​​​

Menstrual pain surgery

Surgery can treat some causes of menstrual cramps such as fibroids, polyps, ovarian cysts, or endometriosis.

  • D&C is used to remove uterine polyps.
  • Laparoscopy is used to treat pelvic endometriosis or ovarian cysts.
  • Endometrial ablation destroys the lining of the uterus.
  • Hysterectomy completely removes the uterus.

Alternative therapies for menstrual pain

If taking hormonal birth control is not an option because of health problems or it doesn’t help, there are some other alternatives.

  • Acupuncture
  • Wearing a TENS unit, a small electrical device that interferes with pain signals as they travel to the brain

Menstrual Pain Complications

Most people have significant improvement with home care. But you should call your doctor in these situations:

  • Your menstrual cramps continue to be painful for longer than usual.
  • The pain is suddenly worse or different.
  • Bleeding is excessive, requiring more than one pad or tampon per hour.
  • Signs of infection, such as fever, chills, and body aches, happen with your.
  • You think you might be pregnant and any of these symptoms happen.

Your doctor can help manage most symptoms. But you should go to a hospital's emergency department if any of the following problems occur:

  • You faint.
  • You get dizzy when standing up.
  • A sudden, intense pelvic pain causes you to double over.
  • Tissue is passed in the menstrual flow. Tissue often appears silvery or grayish.
  • You are pregnant and have severe menstrual-type pain.

Menstrual Pain Prevention

Prevent painful menstrual cramps with these techniques:

Outlook for Menstrual Pain

Anti-inflammatory drugs are 80% effective at getting rid of menstrual cramps. Hormonal birth control decreases the pain 90% of the time. Cramps also tend to decrease in intensity as you age. Cramps may disappear after your first pregnancy.

WebMD Medical Reference Reviewed by Neha Pathak, MD on August 26, 2020

Sources

SOURCES: Mayo Clinic. Cleveland Clinic.

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