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menstrual cramps

Alternative Names
cramps, dysmenorrhoea , menstrual pain, painful menstruation, painful menstrual periods

Painful cramps or pain in the lower abdomen may occur during a woman's monthly periods. The term dysmenorrhoea is usually reserved for cases of pain and cramps severe enough to prevent normal activity.

What is going on in the body?
Many women feel mild discomfort and cramps during their period. The severe pain and cramping known as dysmenorrhoea may be:
  • primary, which means there is no physical cause for it other than chemicals made by the body
  • secondary, which means it stems from another health problem in a woman's body
Menstrual pain is linked to a hormone that prompts ovulation. Women who ovulate, or release an egg during monthly cycles, make the hormone progesterone. This hormone boosts the body's level of prostaglandins, which cause contractions and cramping. Prostaglandins are found in much higher levels in women who have dysmenorrhoea.

What are the signs and symptoms of the condition?
Menstrual pain usually does not become severe until late in the teen years, when ovulation occurs more regularly. Symptoms can begin on the first day of a period. These can include:
  • nausea and vomiting
  • diarrhoea
  • headache
  • lower abdominal tenderness
  • pelvic cramping
  • heavy flow
What are the causes and risks of the condition?
Experts do not know what triggers the high prostaglandin levels in some women that are linked to primary dysmenorrhoea.

Secondary dysmenorrhoea may be caused by certain health problems and other factors, such as: What can be done to prevent the condition?
Over-the-counter drugs called antiprostaglandins, such as mefenamic acid or naproxen, may prevent a severe episode of dysmenorrhoea.

Birth control pills may be used to treat a young woman with a family history of endometriosis.

Practicing safer sex will help reduce a woman's risk of getting a sexually transmitted disease (STD), which can cause PID.

Exercise and a healthy diet may also help lower prostaglandin levels and reduce stress.

How is the condition diagnosed?
Primary dysmenorrhoea is diagnosed by ruling out possible physical causes. A detailed medical history and physical examination are completed. The doctor will ask questions about:
  • the pain
  • when the pain first started
  • sexual activity
  • menstrual patterns
  • what eases the pain
  • other symptoms
Tests to rule out physical causes can include: If physical causes are found, secondary dysmenorrhoea is diagnosed.

What are the long-term effects of the condition?
Primary dysmenorrhoea has no known long-term effects. After a woman has given birth to a child, it often gets better or goes away.

The cause of secondary dysmenorrhoea determines its long-term effects. These may include:
  • chronic pelvic pain
  • painful sexual intercourse
  • infertility
  • side effects from medications taken to prevent loss of work and normal physical activities
What are the risks to others?
Generally, there is no risk to others.

What are the treatments for the condition?
Treatment depends on the severity and cause of the pain. Mild cases can be treated with non-steroidal anti-inflammatory drugs like mefenamic acid and naproxen, which can be bought over the counter. If this does not help, new, stronger, and faster-acting medications, such as celecoxib, may be prescribed.

Birth control pills prevent monthly pain in most women. They do so by blocking ovulation. This lowers prostaglandin levels and lightens menstrual flow.

Surgery may be used to treat certain conditions.

What are the side effects of the treatments?
Side effects depend on the treatment used.

Drugs that block prostaglandin may cause:
  • nausea
  • ringing in the ears
  • stomach upset
  • bowel spasms
Birth control pills may cause
  • nausea
  • abdominal bloating
  • weight gain
  • swelling
Antibiotics used to treat STDs have individual side effects, such as:
  • diarrhoea
  • stomach upset
  • sensitivity to the sun
Drugs used to treat endometriosis and fibroids may cause:
  • hot flushes
  • headaches
  • a loss of menstrual periods
  • mood swings
  • bone loss
All types of surgery have their own risks, such as:
  • infection
  • bleeding
  • rarely, death
What happens after treatment for the condition?
A woman should be reassured that primary dysmenorrhoea has no serious long-term effects. Possible problems arising from endometriosis, pelvic scarring, adenomyosis, or fibroids should be discussed with a doctor.

How is the condition monitored?
If the cramps or pain grow worse, a doctor should be consulted. Other disorders may develop over time and need surgery.

Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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