What causes menstrual cramps?

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Menstrual cramps (also called primary dysmenorrhea) are caused by contractions of the uterus. These contractions are triggered by a substance normally produced by our body called prostaglandin. In some women, these prostaglandins are produced in excess.

 

What are the symptoms?

Pain in the low abdomen, sometimes very intense, occasionally with some of the following:

• Feeling of pressure in the abdomen
• Back pain, pain in the hips or thighs
• Headache
• Nausea or vomits
• Diarrhea (loose stools)

 

What can I do to to relieve menstrual cramps?

• Place a heating pad on your abdomen or back
• Take a warm bath
• Massage your abdomen and your back
• Rest
• Avoid caffeine and salt, that may worsen pain.

 

Medications

You may take painkillers such as acetaminophen (also called paracetamol), ibuprofen, mefenamic acid. Medications are more effective if taken as soon as cramping starts, or even better, before pain starts (if you have regular cycles and you know when pain is about to start).

 

Dietary changes

A low fat diet seems to reduces menstrual pain according to some studies. Other proposed dietary changes:

Increase consumption of :

• calcium: almonds, dark green leafy vegetables (spinach, kale), low fat diaries
• antioxidants: blueberries, cherries, tomatoes, squash, pepper
• proteins: lean meats, cold-water fish, tofu, beans

To avoid:

• “bad” carbohydrates: white bread, pasta, sugar, sweets
• “bad” fats: french fries, donuts, processed foods.

 

Herbal products and dietary supplements

These are the supplements that have proved to be effective in several studies:

• Omega-3 fatty acids
• Thiamine (vitamin B1)
• Vitamin B6
• Magnesium
• Vitamin E

 

Other interventions

The following help relieving menstrual cramps:

• Exercise
• Yoga
• Acupuncture
• Homeopathy (not much scientific evidence, but it seems to help some women)

 

What if nothing works?

You may discuss with your doctor the following:

• Oral contraceptives or other hormonal treatments
• Stronger painkillers
• Other possible treatments such as surgery (reserved for very severe cases).

 

Are menstrual cramps always normal?

Sometimes menstrual pains are not normal and indicate a medical problem; this is called secondary dysmenorrhea. Some conditions that can cause painful periods are:

• Endometriosis: a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus
• Pelvic inflammatory disease: an infection that starts in the uterus and spreads to other reproductive organs
• Narrowing of the cervix (stenosis), often caused by scarring
• Fibroids: benign tumors of the uterus
• Congenital (birth) abnormalities of the uterus or vagina (such as the presence of a diaphragm).

 

When should I see a doctor?

Most of the times menstrual cramps are not a cause for concern, especially if you started menstruating within the past few years. But you should see a doctor if menstrual cramps:

• Interfere with your everyday life every month
• Get increasingly worse
• Start after age 25
• Last more than 2 or 3 days
• Are accompanied by heavy bleeding, fever or foul smelling discharge.

Painful periods, whatever the cause, can be treated, so go ahead and get checked!

 

References

1. http://emedicine.medscape.com/article/253812-overview
2. http://www.aafp.org/afp/1999/0801/p489.html
3. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. May 13 2006;332(7550):1134-8.
4. Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):162-71
5. Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. 2006;51(6):402-9.