An Overview of Menstrual Cramps

Menstrual cramps are the result of hormone-induced muscular contractions of the uterus. Cramping pain in the lower abdomen can start a day or two before you get your period. They usually last one to three days.

Cramps are a normal part of your cycle as your uterus sheds its lining each month, but significant pain or heavy flow should not be dismissed. They may have other causes and are usually treatable.

Menstrual Cramp Symptoms

Symptoms of menstrual cramps can vary by individual. Some people experience a dull, throbbing ache, while others have intense and often debilitating pain radiating to the lower back and thighs.

The pain tends to start one to three days before your period, peaks 24 hours after the onset of your period, and subsides in two to three days. Some people will also have nausea, headache, dizziness, and loose stools.

Causes

Your uterus is made up of two main layers. The outer muscular layer, the myometrium, is composed of smooth muscle cells. The inner layer, the endometrium, responds to changes in your hormone levels. The endometrium builds up in the first half of your menstrual cycle as part of preparation for pregnancy.

If a pregnancy doesn't happen, hormone changes cause the lining of the uterine wall to shed. The muscular tissue of the uterus also contracts, which causes menstrual cramps.

There are two types of dysmenorrhea. In general, the different types are based on when the cramps started and what is causing them.

Primary Dysmenorrhea

For some women, their periods have been painful from the very start. If you have always had painful periods, it is likely that your menstrual cramps are caused by an exaggerated response to your body's normal changes. Specifically, it is thought that women with primary dysmenorrhea have increased amounts of prostaglandin, the substance that causes the uterus to contract.

Secondary Dysmenorrhea

If you have developed painful periods over time, particularly after age 25, you may have developed an underlying condition aggravated by the normal changes causing uterine contractions.

Common issues that may cause secondary dysmenorrhea include fibroids, adenomyosis, infection, and the use of a copper IUD.

Diagnosis

If you have any issues with menstrual cramps, you should discuss them with your healthcare provider. Your answers to the questions your practitioner asks, and the other details you provide will begin to help determine the cause.

Your healthcare provider may or may not do a pelvic exam. You may also need additional testing depending on the other symptoms you report and the findings on the exam. However, don't be surprised if your practitioner does not order any testing, especially if you are a teenager and not yet sexually active.

Treatment

There are numerous options for treating dysmenorrhea. They range from lifestyle changes (like getting more exercise) to medication and, in rare cases, surgery. Sometimes multiple treatments are combined.

Lifestyle

If you are prone to cramping, make an effort to engage in regular physical activity when you are not having your period. The more active and regular you are with exercise, the more regular your periods will be. Regular periods often translate to a less heavy flow and fewer cramps.

Dietary changes, such as eating fresh and healthy food, may also help. Try healthier eating, focusing on the following foods:

• Calcium-rich foods, such as dried figs, ricotta cheese, broccoli, almonds, and canned sardines
• Foods high in antioxidants, such as berries, kale, tomatoes, bell pepper, and dark chocolate
• Lean proteins, including tofu and cold-water fish

By contrast, try consuming significantly less refined flour or sugar, trans-fats (hydrogenated oils), caffeine, and alcohol.

Medications

Over-the-counter pain relievers, such as Motrin (ibuprofen), aspirin, Aleve (naproxen sodium), or Tylenol (acetaminophen) are commonly used to relieve everyday pain and menstrual cramps.

If cramps are severe, the doctor may prescribe oral contraceptives to prevent ovulation and ease painful periods. A hormonal intrauterine device (IUD) can sometimes reduce menstrual cramps, too. The side effects of hormonal contraceptives depend on the type prescribed, but common side effects include abnormal bleeding and mood changes.

Complementary and Alternative Medicine (CAM)

Some studies have shown that complementary therapies, including massage, acupuncture, and yoga can help alleviate menstrual cramps, but more research is needed.

Other studies show promising results for some women who have taken certain supplements and herbs to treat their cramps. For example, one trial found that vitamin D, vitamin E, and ginger supplements significantly reduced dysmenorrhea symptoms, with ginger being most effective. But, in general, research on supplements and herbs is not yet conclusive.

Remember that taking supplements or herbal remedies can cause side effects just like pharmaceutical drugs do. If you seek medical attention for your symptoms, be sure to disclose any and all supplements you take to your healthcare provider.

A Word From Verywell

If you are missing out on school, work, sports, or any other activities for even one day every month because of painful periods, talk to your healthcare provider. Even though menstrual cramps can be a normal part of your body's function, it is not normal if they are significant enough to cause disruption of your usual daily activities. There are many safe and effective treatment options to help manage your menstrual cramps.