What is it?
If you're a woman, chances are you've dealt with menstrual cramps — even if you've never heard of "dysmenorrhea," the medical term for them.
Menstrual cramps are dull, throbbing or cramping pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods. For some women, the discomfort is merely annoying. For others, it can be severe enough to interfere with everyday activities for a few days every month.
For some women, menstrual cramps are caused by identifiable problems, such as endometriosis or uterine fibroids. Treating the underlying cause is key to reducing the pain. Menstrual cramps that aren't caused by some underlying condition tend to lessen with age and often disappear once a woman has given birth.
Symptoms of menstrual cramps include:
- Dull, throbbing or cramping pain in your lower abdomen
- Pain that radiates to your lower back and thighs
Some woman also experience:
- Nausea and vomiting
- Loose stools
During menstrual periods, your uterus contracts to help expel its lining. Prostaglandins, hormone-like substances involved in pain and inflammation, trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more severe menstrual cramps.
Many experts believe that severe contractions constrict the blood vessels feeding the uterus. The resulting pain can be compared to the angina that occurs when blocked coronary arteries starve portions of the heart of food and oxygen.
Menstrual cramps may also be caused by:
- Endometriosis. In this painful condition, the type of tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.
- Uterine fibroids. These noncancerous tumours and growths in the wall of the uterus rarely may be the cause of pain.
- Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.
- Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
- Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.
Risk factors associated with dysmenorrhea include:
- Age younger than 20
- Early onset of puberty (age 11 or younger)
- Heavy bleeding during periods (menorrhagia)
- Never having delivered a baby
Complications may vary, depending on the underlying cause of your menstrual cramps. For example, endometriosis can cause fertility problems, while pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilised egg implanting in the tube (ectopic pregnancy) instead of in your uterus.
If your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may order one or more of the following tests.
This painless test uses sound waves to visualize internal organs. It is often used to check for abnormalities in the uterus, cervix and fallopian tubes. A wand, lubricated with jelly, is pressed against your lower abdomen and the resulting image shows up on a video screen. In some cases, the wand may be inserted into your vagina, to check your ovaries and the lining of your uterus.
Computerized tomography (CT)
A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body. This painless procedure can provide more detail than can regular X-rays. A technician positions you on a narrow table that slides into the machine. You must lie still during the test, or the images will be blurry. CT scans usually take about 30 minutes.
Magnetic resonance imaging (MRI)
MRIs use radio waves and a powerful magnetic field to produce detailed images of internal structures. This painless procedure may be used to check for tumours or signs of endometriosis. You lie on a narrow table that slides into a tunnel inside the MRI machine. You must lie very still during the scans to avoid blurring the images.
MRIs often take at least an hour to complete, but they are divided into individual scans that usually last only a few minutes. The machine is very noisy during the scans, so you may need earplugs to block the banging sounds. If you are claustrophobic, you should talk to your doctor about taking medicine to help you relax during the test.
In this procedure, your doctor inserts a thin, lighted tube through your vagina and cervix into your uterus. The hysteroscope works like a tiny telescope, allowing your doctor to look through it to check for such things as fibroids or polyps. Afterward, you may experience some cramping and spotting.
LaparoscopyIn this outpatient surgical procedure, your doctor views your abdominal cavity by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. Laparoscopy can check for:
- Ovarian cysts
- Ectopic pregnancy