For many women, the onset of periods is preceded by menstrual cramps which continue throughout menstruation and only end once the menses ceases. It is common for it to recur with every cycle. In some instances it reaches a point where these women dread menstruation due to the cramps and pain. However, this is not a normal part of menstruation but are a sign of some underlying medical problem that needs to be treated.
What are menstrual cramps?
Menstrual cramps are the cramping muscular pain that some women experience during menstruation (periods). It does not affect all menstruating women, although there is some degree of discomfort during menstruation. Menstrual cramps are usually seen as part of period pain. It is important to understand that period pain is not “normal”, contrary to the common misconception.
Sometimes menstrual cramps can arise from the time of menarche (when puberty sets in) or it may start later in life. Women who experience menstrual cramps usually have a history of these cramps every time they menstruate. However, in some instances it can occur only one time or for a few periods and then not recur again. Menstrual cramping occurs during the periods but can also start before menstruation commences.
Causes of Menstrual Cramps
The uterus is a highly muscular organ and it appears that most menstrual cramps originate here. The pain is however not entirely muscular. First it is important to understand that contractions of the uterus are a normal part of menstruation. The uterine muscles push out the endometrium (inner lining of the uterus) that thickens and sloughs off as part of the menstrual cycle. This is seen as the menstrual blood (menses) which sometimes has clots.
These contractions are caused by a chemical known as prostaglandins. It stimulates the muscles of the uterus to contract. Prostaglandins are also a mediator of inflammation, where pain is a feature. In some women who have higher levels of prostaglandins, the contractions are very strong and may also lead to spasms. This is what gives rise to menstrual cramps that are very painful and can at times be debilitating.
Menstrual cramps are worse in certain conditions, such as:
- Polycystic ovarian syndrome (PCOS) where the androgen levels are higher than normal and presents with cysts in the uterus.
- Endometriosis where the inner uterine lining grows outside of the uterus and undergoes changes during the menstrual cycle.
- Uterine fibroids are benign growths that develop from the muscular layers of the uterus often during the childbearing years.
- Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that can extend all the way to the fallopian tubes and ovaries.
Some of these conditions may cause menstrual cramps and pain in women who previously did not have a problem. Therefore menstrual cramps should be investigated medically as it may be a symptom of an underlying gynecologic problem.
Signs and Symptoms
Menstrual cramps are a symptom and sometimes considered a normal part of menstruation. However, this is incorrect. Menstrual pain should not be a part of menstruation and therefore should not be seen as being normal. In fact painful periods and menstrual cramps are encompassed under the term dysmenorrhea. This is a medical problem that needs to be treated.
The discomfort of menstrual cramps can vary from a mild ache to severe pain. It may extend from the pelvis to the abdomen, lower back and thighs. In response to the pain, some women may experience nausea, diarrhea and even headaches and dizziness. Depending on the underlying cause there may be other symptoms such as heavy periods, irregular and prolonged periods and sometimes even infertility.
Treatment of Menstrual Cramps
Mild menstrual cramps that are not debilitating does not usually require treatment. The same applies to menstrual cramps that occurs for a short period of time, lasting only one or two cycles. However, when menstrual cramps are severe, recurrent for a long period of time and affects a person’s ability to manage daily life then medical treatment is strongly recommended.
Underlying causes need to first be treated appropriately. Medication may be used to manage the pain in particular. This includes ibuprofen, acetaminophen, naproxen or mefenamic acid. These drugs only help to reduce the pain. It can be started at the start of the periods even before the cramps and pain arise, and may be continued for a few days thereafter.
Hormone birth control may also be used in the form of pills, injections, implants or other devices. This medication is particularly helpful for women who have irregular periods or heavy periods as well as cramps and period pain. However, it may not always be desirable as it prevents pregnancy and therefore not an option for women who want to fall pregnant.
Surgery may be considered for the treatment of conditions like polycystic ovarian syndrome (PCOS), uterine fibroids and endometriosis, where necessary. Some women are led to believe that dysmenorrhea will subside after the first pregnancy. However, this is not always true. Medical treatment should therefore not be delayed if it is required.
Remedies for Menstrual Cramps
Many women use a hot water bottle or heat paid over the lower abdomen to help with menstrual cramps. This may be helpful but will not stop the cramps and pain. There is evidence that simple lifestyle measures and even supplementation may be beneficial to some degree. Therefore the following measures should be attempted:
- Take magnesium supplements. Certain B-vitamins, vitamin E and omega-3 fatty acid supplements may also be helpful. It is advisable to first speak to a gynecologist.
- Exercise regularly and working out when menstrual cramps are present can also help. Ensure sufficient hydration preferably with an oral rehydrating solution when working out.
- Do not smoke and minimize alcohol intake. Alcohol should never be used for pain relief. In fact alcohol, like tobacco, can worsen the cramps.
- Stress management may also be helpful. Simple techniques like exercising, meditation, yoga and even counseling may be useful for managing psychological stress, which could be a contributor to menstrual cramps.