The truth behind the causes of menstrual cramps?and how to prevent and manage them.Menstrual cramps are also known as dysmenorrhea. They usually do not indicate any serious condition. But the pain can be severe enough to interfere with everyday activities.

The key symptoms are:

• Cramping pains
• Background of pain in the lower abdomen radiating to the back or thigh¹
• Fatigue
• Nausea
• Diarrhea
• Vomiting
• Occasional headaches

The pain usually comes right before menstruation starts. It may last up to three days.

• Typically it affects only women 25 years of age and under.
• For reasons not well understood, menstrual cramps tend to become less severe with age.
• This is especially after the birth of a child.
• But for some women, it can persist and even become worse until menopause

What causes menstrual cramps?

The cramps come from uterine spasms. The spasms are most powerful during menstruation and temporarily deprive the uterus of oxygen.^1,2

• These spasms are triggered by prostaglandins.
• These are hormone-like substances that are released when tissue is damaged. Ovulation entails some normal injury to ovarian tissue. And the loss of hormonal support that triggers menstruation causes normal injury to the endometrium.
• Menstrual cramps can cause emotional distress.
• Some research points to a neural component in some women, with heightened sensitivity to pain^1,2.
• But menstrual cramping is not psychological in origin.

Women who have a heavy menstrual flow and a family history of dysmenorrhea may be at increased risk for the condition. But there?s no agreement about key risk factors. Some women have an underlying gynecological problem. This can include:

• Endometriosis (endometrial tissue growing outside of the uterus)
• Adenomyosis (endometrial tissue growing within the wall of the uterus)
• Uterine fibroids
• Pelvic inflammatory disease (PID)
• Pelvic tumor

What if you do nothing?

For most women, cramps are not severe.

• Most cramps end within a few days after the start of the menstrual cycle.
• Home remedies including over-the counter pain relivers may help provide relief.
• If cramps are incapacitating, you should seek treatment from your doctor.

Home remedies

For centuries women have relied on home cures for menstrual cramps. They can include hot drinks, massages, stretching exercises, and keeping warm. No specific exercise for relieving cramps exists. And there is little scientific evidence that old tried-and-true remedies 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, heat patch, or hot water bottle on the lower abdomen may relieve the discomfort of cramps³.
• See if there is a dietary connection
• There is no scientific evidence for this. But you can see if avoiding any of them helps.
• Avoid foods and beverages if you find that they induce or intensify cramps.
• These could include coffee, tea, chocolate, and soda.
• Exercise several times daily.
• Research has been mixed but has generally favored that exercise can be helpul^1,4.
• Walking, swimming, running, bicycling, and other aerobic activities may diminish cramping symptoms.
• Aerobic exercise is thought to help by increasing progesterone and decreasing prostaglandins⁴.

Pain relievers

Over-the-counter pain relievers can be very effective in reducing the intensity of cramps.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen, and naproxen are highly effective.
• They act by lowering pressure in the uterus and decreasing prostaglandins.¹
• Follow label directions.
• If you usually get menstrual cramps, you may want to begin taking an NSAID the day before you expect a period. Continue for the usual duration of your cramps.
• Studies have found no differences in the effectiveness of the different NSAIDs¹.
• Acetaminophen and aspirin may relieve the backache and mild to moderate headache that often accompany menstrual cramps.
• People respond differently to each medication. Try different types to find one that works best for you.

Birth control treatments 

Birth control methods that contain estrogen and progestin, such as the pill, the birth control patch, and the vaginal ring can be used to treat dysmenorrhea. Birth control methods that contain progestin only (pills, birth control implant, birth control injections) may be also used; however they are generally less effective than combined hormonal birth control methods⁵.

• Combined oral contraceptives that contain estrogen and progestin are often prescribed for menstrual cramps as they are a highly effective treatment for cramps⁶.
• They reduce prostaglandins released by the ovary and endometrium³.
• They prevent ovulation.
• They thin the endometrium, so less tissue is damaged during hormone withdrawal (week of inactive pills).
• Less prostaglandins are released.
• They reduce the amount of tissue loss and blood flow³.
• Contraceptive pills are available only by prescription. They must be taken on a regular basis, not only when symptoms appear.
• The combination pill is more effective at reducing the pain associated with menstrual periods than progestin-only pills⁵.
• Women with certain risk factors may be advised not to take birth control pills.

Alternative treatments

Among alternative treatments, transcutaneous nerve stimulation (TENS) stands out as having been shown to be effective. Other alternative treatments, such as aromatherapy, acupuncture, acupressure, and behavioral therapy, require more research. Evidence to support them at this time is lacking¹.

• Transcutaneous nerve stimulation (TENS) can relieve menstrual pain^1,7.
• Over-the-counter portable units are available in drug stores.
• Chiropractic therapy has been shown to be ineffective⁸.
• Acupuncture for menstrual cramps requires more research. Studies showed varied outcomes⁹.
• Other alternative treatments require more research. 

When to call your doctor

If menstrual cramps disrupt your life, here are good reasons to consult your doctor:

• Self-treatments don?t work.
• You experience painful cramping that lasts more than three days.
• You experience cramping between your menstrual periods.

You can expect your doctor to do the following:

• Take a detailed medical history.
• Perform a physical examination, including a pelvic exam.
• Perform additional workup to find reasons for your severe symptoms.
• An underlying condition such as adenomyosis or infection
• A separate cause for pelvic pain
• Consider prescribing a more powerful anti-prostaglandin medication.
• Consider prescribing an oral contraceptive.

 

References:

1. Medscape.com, August 2020.
2. Medicine Science, International Medical Journal, June 2017.
3. Archives of Pharmacy Practice, January-March 2020.
4. Medical Hypotheses, February 2019.
5. American College of Obstetricians and Gynecologists
6. Cochrane Database of Systematic Reviews, October 2010.
7. Cochrane Database of Systematic Reviews, January 2002.
8. Cochrane Database of Systematic Reviews, July 2006.
9. Cochrane Database of Systematic Reviews, April 2016.

Conditions: 

Womens Health

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