MENSTRUAL CRAMPS
Many women have menstrual cramps (dysmenorrhea) in association with their periods. It is usually felt in the lower abdomen and/or in the lower back. Some women have cramps that are so severe that it interferes with normal activities. Rarely the cramps can be so bad that they cause nausea and vomiting or fainting. If your cramps restrict your activities at home, school or work you should consider strategies to lessen them. A healthy lifestyle is the most important treatment.
Menstrual cramps occur because of the hormonal and biochemical changes that occur during your monthly cycle. All treatments modify these directly or indirectly.
A regular exercise program is the single best remedy for cramps. You should engage in 30 to 45 minutes of vigorous exercise (running, swimming, aerobics classes, exercise bicycle...) 3 or 4 times a week. Just before your period try to exercise daily.
Alcohol and cigarettes may make cramps worse.
Over-the-counter pain pills are effective. Acetaminophen (Tylenol) is the least effective. Aspirin is better. Ibuprofen (Advil, Nuprin, etc.) is usually much better. Naproxen (Alleve) may be the best. Generic acetaminophen and ibuprofen are exactly the same as the various brands. They're much cheaper since they don't spend money on advertising. If you have medical insurance with drug coverage get these in prescription strength from you doctor. That makes them much less expensive. Narcotics like codeine are sometimes necessary.
Birth control pills greatly reduce and sometimes completely eliminate menstrual cramps.
Some women notice that having an orgasm reduces their cramps. This information should probably not be shared with men to avoid too many offers of assistance.
Menstrual discomfort that gradually increases may be due to endometriosis.
A sudden increase in cramps with more bleeding than usual may signify something else. If the period comes earlier than expected it might mean a sexually transmitted disease like chlamydia. If it comes in association with a late period it could be a miscarriage.
Other names:
Painful menstrual periods; Dysmenorrhea; Periods - painful; Cramps - menstrual
Definition
Menstruation that is accompanied by either sharp, intermittent pain or dull, aching pain in the pelvis or lower abdomen.
Considerations
Painful menstruation affects over half of menstruating women and is the leading cause of lost time from school and work among women of childbearing age. This pain may precede menstruation by several days or may accompany it, and usually subsides as bleeding tapers off.
Some pain during menstruation is normal; excessive pain is not. Dysmenorrhea refers to menstrual pain severe enough to limit normal activities and require medication.
There are several types of dysmenorrhea:
Primary dysmenorrhea refers to menstrual pain that occurs in otherwise healthy women. Prostaglandin activity is thought to be a causative factor because prostaglandin levels have been found to be much higher in women with dysmenorrhea than in women who experience only mild or no menstrual pain.
Secondary dysmenorrhea is menstrual pain that is attributed to some underlying disease process or structural abnormality either within or outside the uterus (for example, pelvic inflammatory disease, fibroids, endometriosis, adhesion, or uterine displacement). Endometriosis is the most common cause of secondary dysmenorrhea and is frequently misdiagnosed as primary dysmenorrhea.
Psychogenic dysmenorrhea may be attributed to emotional stress or true anxiety. It can also be caused by a lack of information regarding menstruation or negative attitudes about the process passed from mother to daughter.
Membranous dysmenorrhea is intense cramping caused by passage of endometrial (uterine lining) tissue being passed through an undilated cervix. This condition is quite rare.
The presence of an IUD (intrauterine device for contraception) may also be a potential cause of menstrual pain.
The incidence of menstrual pain is greatest in women in the late teens and twenties, then declines with age. It does not appear to be affected by childbearing. An estimated 10 to 15% of women experience menstrual pain each month severe enough to prevent normal daily function at school, work, or home. The majority of women will suffer this degree of disability at least once during their reproductive years. Increased risk is associated with younger age, IUD use, multiple sexual partners, and past medical history of any of the conditions associated with secondary dysmenorrhea.
Common causes
premenstrual syndrome (PMS)intrauterine devices (IUDs) used for birth control
discontinuation of birth control pills
stress and poor health
pelvic inflammatory disease
endometriosis
Home care
Ibuprofen or acetaminophen may relieve mild menstrual pain. Antiprostaglandins are quite effective in the management of moderate to more severe pain. These include higher doses of aspirin, as directed by a health care provider. However, this is sometimes hard for patients to tolerate. Other nonsteroidal anti-inflammatories may be used; ibuprofen is the most common. To work effectively, these medications must be taken at the first appearance of symptoms. Some women experience several days of pain which may require the use of narcotic pain relievers such as codeine.Some relief may be provided by applying a heating pad to the abdomen, effleurage (a light circular massage with the fingertips), drinking warm beverages, taking a warm shower, performing waist-bending and pelvic rocking exercises, and walking.
Emotional support, psychological counseling, or antidepressants may be helpful for those women who have inadequate relief of chronic pain.
If pain continues, consult your health care provider.