For most women, menstruation creates no medical problems: even the most uncomfortable symptoms are not permanent, nor do they usually indicate any serious underlying condition. But for some women the pain is severe enough to interfere with everyday activities.
The Greek-derived word dysmenorrhea, meaning painful menstrual flow, is a term for what most women call cramps. Besides pain in the lower abdomen or back, women may also experience nausea, diarrhea, vomiting, and occasional headaches. When it occurs, pain always comes at the beginning of a menstrual period and may last up to three days. It chiefly affects women 25 years of age and under; for reasons not well understood, dysmenorrhea tends to vanish as women grow older, especially after the birth of a child. However, for some it can continue until menopause.
Symptoms of Menstrual Cramps
- Irregular, sharp, cramping pain in the uterus, lower abdomen, or lower back, sometimes with pain that shoots down the thighs
- Backache, nausea, vomiting, or diarrhea
- Hot and cold sensations
- Occasional headache
- Frequent urination
- May or may not be accompanied by PMS (premenstrual syndrome)
What Causes Menstrual Cramps?
Although it can cause emotional distress, dysmenorrhea is not psychological in origin. The discomfort comes from uterine spasms, which are most powerful at this time and temporarily deprive the uterus of oxygen. These spasms are triggered by prostaglandins, hormonelike substances that the body sometimes releases in excess during menstruation. The high level of progesterone is what triggers the prostaglandins. Thus, cramps are a fairly sure sign that ovulation has taken place.
What If You Do Nothing?
For most women, cramps are not severe and vanish within a day or two of the start of the menstrual cycle. Home remedies can help provide relief. If cramps are incapacitating, you should seek treatment from your doctor.
Home Remedies for Menstrual Cramps
For centuries women have relied on home cures for cramps—hot drinks, massage, stretching exercises, keeping warm. No specific exercise for relieving dysmenorrhea exists, and there is no scientific evidence that any of the old tried-and-true remedies really work. Yet personal experience cannot be discounted; different things work (or don’t work) for different people. Here are some common self-help measures.
- Take a bath. The hot water may help relax the uterus.
- Apply heat. Placing a heating pad or hot water bottle on the lower abdomen may relieve the discomfort of cramps.
- Drink plenty of water. Dehydration can worsen menstrual cramps.
- Exercise several times daily. Walking, swimming, running, bicycling, and other aerobic activities may help diminish cramping symptoms by inhibiting prostaglandin release and contributing to the release of endorphins, the body’s own natural pain relievers.
- Take a pain reliever. Acetaminophen may be effective in relieving the mild to moderate headache and the backache that often accompany menstrual cramps. Researchers aren’t sure if acetaminophen affects prostaglandin production, but if it does, it is a milder drug than NSAIDs (aspirin, ibuprofen, or naproxen), which are also effective. If acetaminophen doesn’t provide relief, you may want to try one of the NSAIDs, which suppress prostaglandins. Follow label directions. If you usually have menstrual cramps, you may want to begin taking an NSAID (as an antiprostaglandin) the day before you expect a period and to continue for a day or two. The medication may help relieve pain by decreasing the severity of uterine contractions. People respond differently to each medication, so you may need to try different types to find one that works best for you.
- See if there is a dietary connection. Some women complain that certain foods and beverages—including coffee and tea, chocolate, and soda—induce or intensify cramps. There is no scientific evidence for this, but you can see if avoiding any of them helps.
- Get plenty of rest. If you find that you are prone to regular cramping during menstruation and you become unusually tired or nervous, napping occasionally during the day and maintaining regular sleeping patterns may prevent or help reduce the severity of cramping.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician if you don’t achieve appreciable relief after trying the various self-treatments. Also contact your doctor if you experience painful cramping that lasts longer than three days, or if any cramping occurs in between your menstrual periods.
What Your Doctor Will Do
A detailed history and pelvic exam may uncover a possible cause of recurrent, painful menstruation. Your doctor may prescribe a more powerful antiprostaglandin medication or an oral contraceptive. Oral contraceptives are a highly effective treatment for cramps, since they prevent ovulation and hence high levels of progesterone and prostaglandin production. They are available only by prescription and must be taken on a regular basis, not just when symptoms appear. (Smokers and women over 35 must consider other risks in taking oral contraceptives.)
If your doctor suspects secondary dysmenorrhea—when painful periods are caused by a disease or disorder such as endometriosis or pelvic inflammatory disease—appropriate treatment for the disorder will be recommended.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media