If you are one of the many women who suffer with menstrual cramps every month, you are not alone. For some women the situation is so severe that their normal routines are disrupted. Find out why some of us suffer more than others, and what can be done to get relief.
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
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
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
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 secondarydysmenorrhea.
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.
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.
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 controlfor 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
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:
disease (PID): An infection found in female reproductive organs that
is usually attributed to sexually transmitted bacteria.
fibrous attachments between organs.
cells of the inner uterine lining invade its muscular wall (a benign
painful condition in which cells from the lining of the uterus become
implanted outside of it, usually on the ovaries, fallopian tubes, or
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
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
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.