Symptoms

Symptoms of menstrual cramps include:

• Dull, throbbing or cramping pain in your lower abdomen
• Pain that radiates to your lower back and thighs

Some women also experience:

• Nausea and vomiting
• Loose stools
• Sweating
• Dizziness

When to see a doctor
If you've started menstruating within the past few years and are experiencing cramps, chances are your menstrual pain is not a cause for concern. However, if menstrual cramps disrupt your life for several days a month or if you're older and just started experiencing severe menstrual cramps, see your doctor.

Causes

During menstrual periods, your uterus contracts to help expel its lining. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more severe menstrual cramps.

Many experts believe that severe contractions constrict the blood vessels feeding the uterus. The resulting pain can be compared to the angina that occurs when blocked coronary arteries starve portions of the heart of food and oxygen.

Menstrual cramps also may be caused by:

• Endometriosis. In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.
• Uterine fibroids. These noncancerous growths in the wall of the uterus rarely may be the cause of pain.
• Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.
• Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
• Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.

Risk factors

Risk factors associated with dysmenorrhea include:

• Age younger than 20
• Early onset of puberty (age 11 or younger)
• Heavy bleeding during periods (menorrhagia)
• Irregular menstrual bleeding (metrorrhagia)
• Never having delivered a baby
• Family history of dysmenorrhea
• Smoking

Complications

Menstrual cramps have no medical complications in themselves, but they often interfere with school, work and social activities.

The diseases and conditions sometimes associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems, while pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting in the tube (ectopic pregnancy) instead of in your uterus.

Preparing for your appointment

While you may initially see your family physician, he or she may refer you to a gynecologist. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do
You may want to write a list that includes:

• Detailed descriptions of your symptoms
• The dates when your last two menstrual periods began
• Information about medical problems you've had
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For menstrual cramps, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• Are there other possible causes for my symptoms?
• How do my symptoms compare with other menstruating girls or women?
• Are my symptoms likely to change over time?
• Do I need any tests?
• What treatments or home remedies might help?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to go over additional questions you may have. Your doctor may ask:

• At what age did you begin menstruating?
• How far apart are your menstrual periods, and how long do they typically last?
• How heavy is your menstrual bleeding?
• Do you ever bleed between periods?
• How would you describe your symptoms?
• Where are your cramps located?
• Do you have any other symptoms, such as nausea, vomiting, diarrhea, back pain, dizziness or headache?
• Do your symptoms typically occur along with your period?
• Do you have any symptoms between periods?
• Do your symptoms cause you to limit your activities, such as staying home from work or school or avoiding exercise?
• If you're sexually active, do you experience pain with intercourse?
• Do you have difficulty or pain with bowel movements?
• What treatments have you tried so far, if any? Has anything helped?
• What medications, vitamins and supplements do you use?
• Have you been diagnosed with any other medical conditions?
• Do any of the women in your family have a history of similar symptoms?

What you can do in the meantime
In the time leading up to your appointment, you may find relief by taking a warm bath or applying a heating pad or hot water bottle to your abdomen. Over-the-counter pain relievers, such as ibuprofen, also may help.

Tests and diagnosis

Your doctor will review your medical history and perform a physical examination, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for signs of infection.

In some cases, if your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may order one or more of the following tests:

• Ultrasound. This painless test uses sound waves to visualize internal organs. It is often used to check for abnormalities in the uterus, cervix and fallopian tubes.
• Computerized tomography (CT). A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body. This painless procedure can provide more detail than can regular X-rays.
• Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnetic field to produce detailed images of internal structures. This painless procedure may be used to check for tumors or signs of endometriosis.
• Hysteroscopy. In this procedure, your doctor inserts a thin, lighted tube through your vagina and cervix into your uterus. The hysteroscope works like a tiny telescope, allowing your doctor to look through it to check for such things as fibroids or polyps.
• Laparoscopy. In this outpatient surgical procedure, your doctor views your abdominal cavity by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. Laparoscopy can check for certain conditions, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy.

Treatment and drugs

Menstrual cramps are a treatable condition. Your doctor may recommend:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in relieving the pain of menstrual cramps. Your doctor may initially suggest taking over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), at regular doses starting the day before you expect your period to begin. Prescription NSAIDs, such as mefenamic acid (Ponstel), are also available.
• Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm or a flexible ring that you insert into your vagina.
• Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, the surgical removal of the abnormal tissue may help reduce your symptoms.

Lifestyle and home remedies

Soaking in a hot bath or using a heating pad on your lower abdomen appears to be just as effective as over-the-counter pain medication for relieving menstrual cramps.

Alternative medicine

Alternative therapeutic approaches to menstrual cramps include:

• Exercise. Studies have found that physical activity may ease the pain of menstrual cramps.
• Acupuncture. Acupuncture has been used in China to relieve pain for more than 2,000 years. Some studies have found that acupuncture effectively relieves menstrual cramps.
• Transcutaneous electrical nerve stimulation (TENS). A TENS device raises the threshold for pain signals and stimulates the release of endorphins, your body's natural painkillers. In studies, TENS has been found more effective than placebo in relieving the pain associated with menstrual cramps.
• Dietary supplements. A number of studies have indicated that vitamin E, omega-3 fatty acids, vitamin B1 (thiamine), vitamin B-6 and magnesium supplements may effectively reduce menstrual cramps.