Every healthy woman menstruates, or has a period. But every woman’s period is different. And a woman’s period can change throughout her lifetime. Menstruation usually begins when a girl is between 9 and 16 years old and continues until she is 45 to 55. Even if you have had your period for a while, you may still have questions about what’s normal
What are menstrual cramps?
Menstrual cramps are pains in the belly and pelvic areas that are experienced by a woman as a result of her menstrual period. Menstrual cramps can range from mild to quite severe. Mild menstrual cramps may be barely noticeable and of short duration. Sometimes they are felt just as a sense of light heaviness in the belly. Severe menstrual cramps can be so painful that they interfere with a woman’s regular activities for several days. Menstrual cramps of some degree affect more than an estimated 50% of women, and among these, up to 15% would describe their menstrual cramps as severe. Surveys of adolescent girls show that over 90% of girls report having menstrual cramps.
What causes menstrual cramps?
Each month, the inner lining of the uterus (the endometrium) normally builds up in preparation for a possible pregnancy. After ovulation, if the egg is not fertilized by a sperm, no pregnancy will result and the current lining of the uterus is no longer needed. The woman’s estrogen and progesterone hormone levels decline, and the lining of the uterus becomes swollen and is eventually sheds as the menstrual flow and is replaced by a new lining in the next monthly cycle. When the old uterine lining begins to break down, molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina.
Why are some cramps so painful?
Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman’s cervical canal is narrow. The difference between menstrual cramps that are more painful and those that are less painful may be related to a woman’s prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in the endometrium (uterine lining) when compared with women who do not experience cramps.
What if the cramps are very severe?
If a woman’s menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low doses of birth control pills containing estrogen and progestin in a regular or extended cycle. This type of approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins which, in turn, reduces the severity of cramping and causes a light menstrual flow. Use of an IUD (Mirena) that releases small amounts of the hormone progestin directly into the uterus reduces strength of severe menstrual cramps. In contrast IUDs that do not contain hormones, such as those containing copper, may worsen menstrual cramps.
What should I do to make my cramps less painful?
Current recommendations include not only adequate rest and sleep, but also regular exercise, especially walking. Some women find that abdominal massage, Yoga and Pilates may bring relief. A heating pad applied to the abdominal area also may relieve the pain and congestion and decrease symptoms. A number of nonprescription (over-the-counter) drugs can help control the pain. For mild cramps, aspirin or acetaminophen (Tylenol), diuretic (Diurex MPR, Midol, Pamprin and others) may be sufficient. However, aspirin has limited effect in curbing the production of prostaglandin and is only useful for less painful cramps. The main agents for treating moderate menstrual cramps are the nonsteroidal anti-inflammatory drugs (NSAIDs), which lower the production of prostaglandin and lessen its effect. The NSAIDs that do not require a prescription are:
- Ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others)
- Naproxen sodium (Aleve, Anaprox)
- Ketoprofen (Actron, Orudis KT)
A woman should start taking one of these medications before her pain becomes difficult to control. This might mean starting medication 1 to 2 days before her period is due to begin and continuing taking medication 1-2 days into her period. The best results are obtained by taking one of the NSAIDs on a scheduled basis and not waiting for the pain to begin.
What is the long-term outlook (prognosis) for menstrual cramps?
In general, a woman’s menstrual cramps do not worsen during her lifetime. In fact, the menstrual cramps (dysmenorrheal) usually diminish with age and/or after pregnancy. As women have learned more about their bodies and how to maintain them in optimal health, menstrual cramps have become less of a debilitating illness, and more often, merely a minor monthly inconvenience.