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Most women have painful menstrual cramps (dysmenorrhea) from time to time. Menstrual cramps are one of the most common reasons for women to seek medical attention. The pain from menstrual cramps can range from mild to severe and can involve the lower belly, back, or thighs. You may also have headaches, nausea, dizziness or fainting, or diarrhea or constipation with your cramps.

During the menstrual cycle, the lining of the uterus produces a hormone called prostaglandin. This hormone causes the uterus to contract, often painfully. Women with severe cramps may produce higher-than-normal amounts of prostaglandin, or they may be more sensitive to its effects.

Cramping is common during the teen years, when a young woman first starts having periods. Primary dysmenorrhea is a term used to describe painful menstrual cramping with no recognized physical cause. It is seen most commonly in women between the ages of 20 and 24. It usually goes away after 1 to 2 years, when hormonal balance occurs.

Secondary dysmenorrhea is a term used to describe painful menstrual cramping caused by a physical problem other than menstruation. Physical problems that can cause this type of cramping include:

  • A condition in which cells that look and act like the cells of the lining of the uterus (endometrium) are found in other parts of the abdominal cavity (endometriosis) or grow into the muscular tissue of the uterine wall (adenomyosis). Pain usually occurs 1 to 2 days before menstrual bleeding begins and continues through the period.
  • Growths in the pelvis that are not cancerous (benign growths), such as ovarian cysts, cervical or uterine polyps, or fibroids.
  • Pelvic infections. Your risk for developing an infection is higher after menstrual bleeding has begun because the opening to the uterus (cervical canal) widens during menstruation. But pelvic infections, especially those caused by sexually transmitted infections, can occur at any time.
  • Using an intrauterine device (IUD). An IUD may cause increased cramping during your period for the first few months of use. If menstrual cramping persists or gets worse, you may need to consider having the IUD removed and choosing another birth control method.
  • Problems with pregnancy.
  • Structural problems that were present at birth (congenital), such as narrowing of the lower part of the uterus that opens into the vagina (cervix).

Menstrual-type cramps may occur after a medical procedure, such as cautery, cryotherapy, conization, radiation, endometrial biopsy, or IUD insertion.

Other menstrual symptoms, such as weight gain, headache, and tension, that occur before your period begins, can be caused by premenstrual syndrome (PMS). For more information, see the topic Premenstrual Syndrome (PMS).

Check your symptoms to decide if and when you should see a doctor.

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  Menstrual Cycle: Dealing With Cramps

Try the following home treatment to help manage your menstrual cramps:

  • Use heat, such as hot water bottles, heating pads, or hot baths, to relax tense muscles and relieve cramping. Be careful not to burn yourself.
  • Drink herbal teas, such as chamomile, mint, raspberry, and blackberry, which may help soothe tense muscles and anxious moods.
  • Exercise. Regular workouts decrease the severity of cramps. For more information, see the topic Fitness.
  • Empty your bladder as soon as you have the urge to urinate.
Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your fever or pain:
  • Acetaminophen, such as Tylenol
  • Nonsteroidal anti-inflammatory drugs (NSAIDs):
    • Ibuprofen, such as Advil or Motrin
    • Naproxen, such as Aleve or Naprosyn
  • Aspirin (also a nonsteroidal anti-inflammatory drug), such as Bayer or Bufferin
Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • You become pregnant.
  • Pain is getting worse.
  • Menstrual cramps are lasting longer than your period.
  • Other symptoms develop, such as fever.
  • Symptoms become more severe or frequent.

You may be able to prevent menstrual cramps.

  • Eat a balanced diet that includes plenty of fruits and vegetables and is low in fat. Limit your intake of alcohol, caffeine, salt, and sweets. For more information, see the topic Healthy Eating.
  • Begin or maintain a moderate exercise schedule. For more information, see the topic Fitness.
  • Reduce stress in your life. Although stress does not cause menstrual cramps, reducing stress can make your symptoms less severe. For more information, see the topic Stress Management.
  • Do not smoke or use other tobacco products.
  • Try biofeedback or yoga. Both therapies teach relaxation skills.
  • Try acupuncture or acupressure.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What were the dates of your last two menstrual periods?
    • If you are a teen, do you have regular cycles, such as a period every 21 to 45 days?
    • If you are an adult, do you have regular cycles, such as a period every 21 to 35 days?
    • If you have been through menopause, how long ago was your last menstrual period?
  • Has your menstrual flow been heavier bleeding than usual?
  • What is your menstrual pattern?
    • Is it regular, with approximately the same number of days in between periods?
    • Is it irregular? What is the range from the longest to the shortest time interval between your periods?
  • What method of birth control do you use? It is especially important to tell your doctor if you use an intrauterine device (IUD).
  • Have you done a home pregnancy test? If so, when did you do the test and what was the result?
  • Have you been under increased psychological or physical stress?
  • Have you recently gained or lost more than 10 pounds for no known reason?
  • What prescription and nonprescription medicines are you taking?
  • How does your pain differ from your typical menstrual cramps?
  • Do you engage in high-risk sexual behaviors?
  • Do you have any health risks?
  • Abdominal Pain, Age 11 and Younger
  • Abdominal Pain, Age 12 and Older
  • Female Genital Problems and Injuries

By: Healthwise Staff Current as of: June 13, 2013
Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine
H. Michael O'Connor, MD - Emergency Medicine

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