What is Menstruation?

Every month, in order to create a nourishing environment for a fertilized egg, the inner lining of a woman’s uterus (the endometrium) thickens. If the egg released from the ovary is fertilized by a sperm, it implants in the uterus lining (endometrial tissue). The unfertilized egg will pass through the uterus and out of the body; the woman’s estrogen and progesterone levels decline, and the uterus lining swells up and dies. Menstruation (also known as the “period”) is the body’s expulsion of the useless lining.

Menstrual Cramps

Everyone woman knows what a menstrual cramp is and almost every man has heard of them. It may come as a surprise to many that menstrual cramps have another name. The medical term for these abdominal and pelvic pains is “dysmenorrhea”. More than 50% of women are affected each month by a certain degree of dysmenorrhea, and 15% of those women are experiencing severe cramping.

Isn’t this PMS?

No, the discomfort associated with premenstrual syndrome is different and occurs before the actual expulsion of the uterus lining, although it may seem to the woman that they are the same if they are experienced in one continual process.

Menstrual cramps are very similar to the ones a woman has during an induced labor and occur when the uterus contracts (to help expel the lining). If there are clots or bloody tissues passing through the cervix, the cramping is intensified. Women who experience menstrual cramps have 5-13 times more prostaglandin (a molecular compound found in the lining of the uterus) in their blood than women who do not. Prostaglandin (PGF2alpha) is given to women to induce labor.

Two Kinds of Cramps

Women have been dividing menstrual cramps into categories since the beginning of time: bearable and miserable. Meanwhile, the medical world has had them split into primary dysmenorrhea and secondary dysmenorrhea.

At one end of the spectrum (or should I say speculum?) the mildest form of menstrual cramps are sometimes just a minor discomfort, a heavy feeling in the abdominal region. Women suffering the most extreme menstrual cramps are sometimes forced to change their regular routine for a few days.

In primary dysmenorrhea, there is no underlying physical condition causing the pain. Secondary dysmenorrhea involves another physical condition, usually gynecological (related to a woman’s reproductive system).

Symptoms of Dysmenorrhea

The most common sign of both primary and secondary dysmenorrhea include a throbbing pain or a dull ache in the lower abdomen and pelvis that might radiate to the lower back and/or legs.

The cramps usually began shortly before the onset of the period and peak within 24 hours. Some women also experience headaches, nausea, vomiting, or dizziness. The prostaglandin found in both the uterus and intestinal tract causes smooth muscles to retract, therefore some women are prone to experience diarrhea or constipation during menstruation.

Risk Factors

Most things that put you at risk for painful periods are out of your control. You are more likely to have severe menstrual cramps if they run in your family history and/or you had an early puberty (eleven years old or younger). Anatomically (physical make-up of the body) speaking, a backwards tilting of the uterus (a retroverted uterus) and/or a very narrow cervical canal can also play a role.

Some things you do have some control over, at least partially. A sedentary lifestyle contributes to the severity of your cramping; women who exercise on a regular basis are much less likely to complain of painful periods. In some (not all) medical circles it is accepted that emotional stress can increase the discomfort of dysmenorrhea.

Treatments

If you are afflicted with primary dysmenorrhea, you can expect the intensity of the cramping to decrease as you get older. For many women, cramping decreases or disappears completely after a pregnancy. In the meanwhile, several options are available to you.

Pain control for minor cramping can often be achieved with the use of over-the-counter drugs like aspirin or acetaminophen (Tylenol). Some women combine Tylenol with a diuretic. For more painful cramps, non-steroidal anti-inflammatory drugs (NSAIDs) offer more relief. Unlike aspirin which has a very limited effect on prostaglandin, NSAIDs lower the production of prostaglandin and lessen its strength.

Some of the NSAIDs that can be purchased over the counter are naproxen sodium (Aleve), ibuprofen (Midol IB, Motrin, Nuprin, Advil), and ketoprofen (Actron, Orudis KT).

In cases of severe cramping, some doctors suggest low-dose oral contraceptives (birth control pills) to help reduce the production of prostaglandins by preventing ovulation. Sometimes women with very painful and heavy periods have the uterus lining vaporized or burned away with a heat-generating device. This process is called endometrial ablation. Others with severe cases have opted to have a hysterectomy (removal of the uterus).

It is interesting to note that menstrual cramps can be measured by the pressure within the uterus and the frequency and number of contractions. The average woman experiencing a normal menstrual period has low-pressure contractions, 15-30 second long, with 1-4 contractions per minute. A woman with menstrual cramps has contractions of a higher pressure (sometimes more than 5 times higher than her counterpart), over 90 seconds long, and often less than 15 seconds apart.

If your cramps disrupt your life for several days a month or suddenly change in location or severity from your normal monthly experience, schedule an appointment with your gynecologist. If your doctor thinks it is necessary, you will receive a pelvic exam (with a pap smear) to check for abnormal reproductive organs and infections.

If you are suffering from secondary dysmenorrhea, the underlying cause of your cramping must be treated. This may include antibiotics to treat infections or surgery to remove offending tissues. Some of the conditions that cause secondary dysmenorrhea are:

• Pelvic inflammatory disease (PID): An infection found in female reproductive organs that is usually attributed to sexually transmitted bacteria.
• Adhesions: Abnormal fibrous attachments between organs.
• Andenomyosis: The cells of the inner uterine lining invade its muscular wall (a benign condition).
• Endometriosis: A painful condition in which cells from the lining of the uterus become implanted outside of it, usually on the ovaries, fallopian tubes, or pelvis lining.
• Using an intrauterine device (IUD): A small, plastic, T-shaped birth control device that is inserted into the uterus.
• Uterine fibroids and uterine polyps: Benign (noncancerous) tumors and growths protruding from the uterus lining.

Other tests may be performed to identify the cause of secondary dysmenorrhea, such as a hysteroscopy, laparoscopy, or some sort of imaging test.

• In a hysteroscopy, a special instrument is inserted through your vagina to examine your uterus and cervical canal.
• In a laparoscopy, your doctor makes small incisions in your abdomen and inserts an instrument with a small camera lens to get a close up look at your pelvic cavity.
• Imaging tests are non-invasive ways of looking inside your body. Computerized tomography, also known as a CAT or CT scan is a highly advanced descendant of the X-ray. Magnetic resonance imaging (MRI) uses radio waves, magnetism, and a computer to get internal images.

Complementary and Alternative Medicine

There are a number of self-care strategies and holistic approaches to easing the discomfort of primary dysmenorrhea. (These things may also make symptoms of secondary dysmenorrhea easier to bear, but treating the root cause must be made the priority, otherwise it is like putting a band-aid on cancer.)

An herbalist may be able to recommend a tea, tincture, or capsule. But keep in mind that although herbal remedies may be “natural,” they can be dangerous. In addition to the allergy factor, certain herbs contain properties that cause complications when taken while on “conventional” medications. For instance, the very popular St. John’s Wort counteracts certain chemotherapy drugs. Be sure to discuss this with your regular doctor.

In 1998, the National Institutes of Health issues a statement that acupuncture may relieve menstrual cramps (and certain other pains). Soaking in a hot bath, massage, meditation, and using a heating pad on your abdomen or lower back are other things that may help you.

Remember, each woman’s body, menstrual cycle, lifestyle, and pain tolerance are different, so what works for your best friend may or may not work for you.