The medical term for this problem is dysmenorrhea. It's a common complaint, especially among young women who have never borne children. Fifty percent of menstruating women have pelvic pain before or during their period, and 10 percent of them have cramps severe enough to incapacitate them one to three days each month. There are two types of dysmenorrhea, primary and secondary.

Primary Dysmenorrhea

In this form of the problem, there is no underlying physical abnormality. Symptoms may include sharp cramps in the lower abdomen immediately before the menstrual period or when bleeding begins. The pain, which is sometimes accompanied by nausea, vomiting, diarrhea, dizziness, headaches, a feeling of tension, and occasionally fainting, may spread to the upper legs and lower back.

The majority of women who suffer from primary dymenorrhea do not experience severe pain until the beginning of ovulation. Their menstrual cycles are usually regular, and a pelvic exam reveals no physical problems. Laboratory tests, however, usually show high levels of prostaglandins, substances which can cause both painful cramps and uterine contractions.

To relieve the cramps, most doctors prescribe prostaglandin-inhibiting medications. Aspirin is the weakest of these drugs. Motrin, Naprosyn, Anaprox, and Ponstel have proved more effective. Oral contraceptives are another alternative. By stopping ovulation and decreasing prostaglandin levels they can usually be relied on to eliminate cramps. In addition, recent research has shown that magnesium, and even electrical nerve stimulation may reduce prostaglandin-induced menstrual pain.

Secondary Dysmenorrhea

This form of the condition usually occurs in older women. It is caused by physical disorders such as fibroid tumors of the uterus, or a condition called endometriosis, in which tissue from the uterine lining (endometrium) is found in the ovaries and other locations outside the uterus. Invasion of the wall of the uterus by endometrial tissue (a condition called adenomyosis) also may be at fault. Endometrial polyps are sometimes to blame. Pelvic inflammatory disease is another potential culprit. And occassionally, the problem is due to narrowing of the opening from the cervix into the vagina.

To identify the source of the problem, your doctor will take a case history and perform a pelvic exam using a variety of instruments and techniques, possible including x-ray and ultrasound. The doctor also may perform dilation and curettage, also called D&C, a minor procedure in which the cervix is opened so that a sample of endometrial tissue can be removed from the uterus for microscopic examination.

Endometriosis is the most common cause of secondary dysmenorrhea, especially in women over 37 years old who have had no babies for five years.

If the problem is adenomyosis, surgical removal of the uterus (hysterectomy) may be necessary, though prostaglandin inhibiting drugs can alleviate the pain.

If fibroid tumors or endometrial polyps are at fault, surgery may be needed. In milder cases, prostaglandin inhibitors may suffice. If pelvic inflammatory disease turns out to be the culprit, antibiotics may provide a cure. Narrowing of the cervix requires corrective surgery. Occasionally, an IUD may be the cause. If so, the doctor may prescribe prostaglandin inhibitors, or, if necessary, recommend removing the device and using another form of birth control.

Slight bleeding from the ovary during ovulation causes some women to experience light pain for a few days in the middle of the menstrual cycle. In contrast to most forms of secondary dysmenorrhea, this pain is rarely severe enough to require medical attention. In extreme cases the doctor may prescribe birth control pills to stop ovulation.