By Patricia McLelland, M.D.
If you have experienced menstrual cramps, you are not alone. Most women experience cramping at some point in their lives. In fact, it is the most common cause of missed school or work in young women.
There are two types of menstrual cramps (dysmenorrhea). Primary dysmenorrhea is the same as common cramps that women feel during their period. Primary dysmenorrhea often begins within several years after a woman starts having her period. These cramps usually improve as a woman gets older or after having her first child. Secondary dysmenorrhea is when the cramping is due to an underlying problem in a woman's reproductive organs (uterus, tubes and ovaries). This type of pain may occur at any time in a woman's life.
Common menstrual cramps are due to contractions of the uterus. The uterus produces a substance called prostaglandins that cause the uterus to contract. The more prostaglandins being produced cause stronger contractions which make the period more painful.
Menstrual cramps may start 1-2 days before a woman starts her period and often subsides when the period stops. Menstrual cramps are often felt in the lower abdomen, low back and even in the thighs and hips. The pain can be felt as a dull ache, mild cramping, pressure or even severe pain. Some periods may be more painful than others without an obvious reason. Cramps can also be associated with dizziness, diarrhea, nausea and vomiting.
There are many ways to relieve painful periods. Medications including ibuprofen (Advil), naproxen (Aleve) relieve pain by blocking prostaglandins. Birth control pills and Depo-Provera stop ovulation (production of an egg) and that relieves pain as well.
Other measures include heating pads, exercise and adequate sleep. Diet changes should include limiting caffeine, alcohol, fat and simple sugars (sweets, candy, sugary drinks). Increasing calcium (1000 mg/day), magnesium (400mg/day), fiber, omega 3 fatty acids (consider flaxseed or olive oil) and complex carbohydrates such as whole grains, fruit and vegetables may be helpful. In some women, natural progesterone may reduce cramps. Acupuncture has been helpful for some women.
Secondary dysmenorrhea is often due to problems with a woman's reproductive organs. Some of the possible problems include endometriosis, fibroids (muscle tumors in the wall of the uterus), PID (pelvic inflammatory disease is an infection of the uterus, tubes and ovaries) and an IUD (intrauterine device is a device placed inside the uterus to prevent pregnancy). These problems may not respond to the above treatments and so diagnosing these problems will often require an evaluation by a doctor.
A woman should be evaluated by a doctor for the following reasons: cramps that are more severe or occur at other times of the month, pain that affects a woman's ability to do her normal activities or pain that doesn't respond to over the counter medications. Fevers or abnormal discharge should also prompt evaluation.
Most women do experience cramps but fortunately there are many options for treatment and most of the time cramps are not associated with more concerning medical problems.
Patricia McLelland, MD, board certified in obstetrics, and gynecology, is currently a practicing physician at Galen OB/GYN in East Brainerd, TN. She received her medical degree in 1994 from the Vanderbilt University School of Medicine in Nashville, TN. She has been a member of the Chattanooga & Hamilton County Medical Society since 2004.
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