What are menstrual cramps?

If you're a woman, chances are you've dealt with menstrual cramps — even if you've never heard of "dysmenorrhea," the medical term for them. Menstrual cramps are dull or throbbing pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods. For some women, the discomfort is merely annoying. For others, it can be severe enough to interfere with everyday activities for a few days every month.

Menstrual cramps are classified as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea involves no physical abnormality and usually begins six months to a year after you begin menstruating. Secondary dysmenorrhea involves an underlying physical cause, such as severe pain or non-cancerous tumors that develop within or attach to the wall of the uterus.

If you have primary dysmenorrhea, there are some measures you can take to ease the discomfort. You can also be rest assured that cramps tend to decrease in intensity as you get older and often disappear after pregnancy. For secondary dysmenorrhea, managing your cramps involves treating the underlying cause.

Signs and symptoms

Most women experience menstrual cramps at some time in their lives. Whether it's primary or secondary, dysmenorrhea can be severe enough to disrupt your day-to-day routine.

If you have primary dysmenorrhea, you most likely developed it within a year after you started menstruating. You may continue to have cramps through your 20s or until you have a baby. Then, for unknown reasons, they're likely to become less intense. With secondary dysmenorrhea, cramps may start or return later in life, but can begin anytime after you begin menstruating.

Signs and symptoms of dysmenorrhea may include:

• Dull or throbbing pain in your lower abdomen
• Pain that radiates to your lower back and thighs


Other signs and symptoms that can occur along with menstrual cramps include:

• Nausea and vomiting
• Loose stools
• Sweating
• Dizziness

Causes

During menstrual periods, your uterus contracts to help expel its lining. Prostaglandins, hormone-like substances involved in pain and inflammation, trigger the uterine muscle contractions. No one knows for sure, but many experts believe that prostaglandins are the direct cause of primary dysmenorrhea. Increased leukotriene levels — substances involved in inflammation — also may be a contributing factor.

A number of conditions can cause secondary dysmenorrhea. They include:

• Endometriosis. In this painful condition, the type of tissue that lines your uterus becomes implanted outside your uterus, most commonly on your .fallopian tubes, ovaries or the tissue lining your pelvis.

• Adenomyosis. In this condition, the tissue that lines your uterus begins to grow within the muscular walls of the uterus.

• Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.

• Use of an intrauterine device (IUD). These small, plastic, T-shaped birth control devices are inserted into your uterus. They may cause increased cramping, particularly during the first few months after insertion.

• Uterine fibroids and uterine polyps. These noncancerous tumors and growths protrude from the lining of your uterus.

Risk factors

Risk factors associated with dysmenorrhea include:

• Age younger than 20
• Early onset of puberty (age 11 or younger)
• Heavy bleeding during periods (menorrhagia)
• Depression or anxiety
• Attempts to lose weight (in women age 14 to 20)
• Never having delivered a baby
• Smoking

When to seek medical advice

If you've started menstruating within the past few years and are experiencing cramps, chances are your menstrual pain is primary dysmenorrhea and not a cause for concern. However, if menstrual cramps disrupt your life for several days a month or if you're older and just started experiencing severe menstrual cramps, see your doctor. If you have secondary dysmenorrhea, pinpointing the underlying cause is the first step to successful treatment.

Screening and diagnosis

Your doctor will review your medical history and perform a physical examination, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for indications of infection.

To rule out other causes of your symptoms or to identify the cause of secondary dysmenorrhea, your doctor may request diagnostic tests, such as:

Imaging tests. These noninvasive tests enable your doctor to look for abnormalities inside your pelvis. The imaging tests most often used to diagnose the cause of secondary dysmenorrhea include ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI).

Laparoscopy. In this surgical procedure, your doctor views your abdominal cavity by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens.

Hysteroscopy. In this procedure, your doctor inserts a direct-viewing instrument through your vagina and your cervix to examine your cervical canal and the inside of your uterus.

Complications

The complications of secondary dysmenorrhea depend on the underlying cause. For instance, pelvic inflammatory disease can scar your fallopian tubes and compromise reproductive health. The scarring can lead to an ectopic pregnancy, in which the fertilized egg stays in the fallopian tube rather than traveling through the tube to implant in your uterus, or it implants somewhere else outside your uterus. Endometriosis, another possible cause of secondary dysmenorrhea, can lead to impaired fertility.

Treatment

For secondary dysmenorrhea, you'll need treatment for the underlying cause. Depending on that cause, treatment could include antibiotics to treat infection or surgery to remove fibroids or polyps or to treat endometriosis.

You may be able to reduce your discomfort from dysmenorrhea by using an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). Self-care strategies also may help relieve discomfort. For severe cramping, your doctor might recommend low-dose oral contraceptives to prevent ovulation, which may reduce the production of prostaglandins and therefore the severity of your cramps.

Self-care

You can try a number of self-care strategies to reduce the discomfort of primary dysmenorrhea. Once the pain begins, soaking in a hot bath or using a heating pad on your abdomen may ease your cramps. You can also make some lifestyle changes to improve your overall health and possibly decrease the severity of your cramps. Try these tips:

• Exercise regularly. Exercise results in an increased release of endorphins, your body's natural painkillers.

• Get adequate rest. Your body may be less vulnerable to pain when you're well rested.

Complementary and alternative medicine

Some women find relief through massage, yoga or meditation, all stress-relieving activities that may help to lessen pain and aren't likely to harm you. Some women find acupuncture helpful for pain relief.