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Menstrual cramps

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Being a woman is not always easy. From the age of puberty until she reaches menopause, a woman has to deal with her monthly menstrual flow and the cramps that usually go with it. Menstrual cramps affect over 50% of menstruating women. Of these number, around 15% experience severe cramping.

The medical term for menstrual cramps is “dysmenorrhea,” usually characterized by dull and throbbing discomfort, and sometimes even pain in the lower abdominal and pelvic area. Menstrual cramps may be experienced within six months to a year upon reaching the menarche, the time when a girl first begins to menstruate.

MENSTRUAL CRAMPS SIGNS AND SYMPTOMS

Menstrual cramping typically starts just before the menstrual period arrives and reaches its peak 24 hours after they start. They normally subside after a day or two. The level of pain or discomfort can vary. In some women, dysmenorrhea can simply be an annoying and inconvenient soreness to put up with each month. Sometimes the sensation may simply comprise of a mild heaviness in the abdomen that lasts for a short period of time. For others, menstrual cramping can be severe and seriously restrict normal activities each time their menstrual period occurs.

There are two classifications of menstrual cramps. One is primary dysmenorrhea, which comes about as a normal symptom of the menstrual period and not due to any underlying cause. Secondary dysmenorrhea, on the other hand, is brought about by other conditions, like endometriosis (a painful condition where the uterus lining grows outside the uterus), uterine fibroids (non-cancerous tumors protruding from the uterus lining), adenomyosis (tissues lining the uterus start growing within the uterus muscle walls), ovarian cysts (fluid-filled sacs within the ovary), pelvic inflammatory disease or PID (from sexually transmitted bacteria), and the use of a small, plastic, T-shaped intrauterine device (IUD) inserted into the uterus for the purpose of birth control.

MENSTRUAL CRAMPS COMPLICATIONS

Secondary dysmenorrheal can bring about complications depending on what causes it. If you have pelvic inflammatory disease, for instance, your fallopian tubes can develop scars that may affect your ability to reproduce. This scarring can result in an ectopic pregnancy, where the fertilized egg fails to travel through the fallopian tubes to implant itself in the uterus, instead settling outside the uterus itself. If you have endometriosis, on the other hand, it may affect your ability to become pregnant.

Apart from the continuous or periodic throbbing in the lower abdomen, some of the other symptoms of dysmenorrhea can include a heaviness in the crotch area, and pain that spreads down to the lower back and thighs. Women suffering from menstrual cramps are also liable to experience lethargy, sweating, headaches or dizziness and nausea or vomiting. Dysmenorrhea can also trigger constipation or diarrhea due to contractions of the smooth muscles of the uterus and intestinal tract. The urge to urinate frequently, as well as water retention and an increase in appetite is also experienced.

The reason behind the symptoms of dysmenorrhea can be explained by the process of the menstrual period itself. Every month, the uterus lining, or endometrium, thickens in order to prepare for pregnancy. If the egg remains unfertilized by a sperm after ovulation and no pregnancy occurs, the uterus lining swells up, shrivels, and dies. The uterus then contracts in order to shed the unused lining.

As soon as the old lining starts to break away from the uterus walls, hormone-like prostaglandins (compounds are associated with pain and inflammation) cause the muscles of the uterus to contract. These contractions push the old uterine tissue out of the body via the vagina, and are responsible for the painful throbbing of menstrual cramps. When clots of tissue or bigger pieces of bloody matter makes its way down the cervix, the cramping is likely to increase.

The difference in the level of pain and discomfort experienced by each woman may have to do with the amount of prostaglandins in her uterine lining. The more prostaglandins there are, the higher the level of pain. Scientists have theorized that prostaglandins may be the main cause of primary dysmenorrhea, while leukotrienes (chemicals involved in inflammation) which reach high levels during menstruation, also play a role in menstrual cramping.

Women who are apt to experience dysmenorrhea during their monthly period usually fall under the following categories: they are younger than 20; they have experienced puberty at an earlier age (usually at age 11 or younger); they bleed heavily during their periods (menorrhagia); women who are prone to anxiety or depression; women who take measures to lose weight at an early age (between age 14 – 20); women who smoke, and women who have not experience pregnancy and given birth.

MENSTRUAL CRAMPS RISK FACTOR

Other factors that bring about menstrual cramps can be related to a woman having a very narrow cervix. The contractions that expel old uterine tissue are harder against the walls of the narrow cervical canal, causing more pain. Lack of exercise and emotional stress can also contribute to dysmenorrhea.
Menstrual Cramps
Image: Menstrual Cramps


When a woman starts menstruating and first experiences cramps, there is normally no cause for concern. These cramps are generally brought about by primary dysmenorrhea which is part and parcel of each menstrual period. But when the menstrual cramps are so severe in intensity that they interfere with daily activities for several days each month, or if the woman is older and has started suddenly experiencing painful dysmenorrhea, chances of an underlying cause are possible. Consulting a doctor to determine the cause of severe cramping is the first step towards treating the source of the pain.

MENSTRUAL CRAMPS TREATMENT

An obstetrician-gynecologist will interview you to determine your perception of the pain. After evaluating your medical history, the doctor will perform a physical examination which will include a pelvic exam. The doctor will be looking for the presence of any abnormalities or infection in your reproductive organs.

To further rule out other symptoms and to determine the existence of secondary dysmenorrhea, several diagnostic tests can be recommended. These tests include imaging tests using ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) to check for any abnormalities. The doctor can also perform a laparoscopy, a surgical procedure where small incisions are made in the abdomen and a fiber optic tube with a small camera lens is inserted into the abdominal cavity to search for the underlying cause of severe cramping. The doctor may also subject you to a hysteroscopy, where an instrument for direct viewing is inserted through the vagina and into your cervix for a better view of your cervical canal and uterus.

There are many measures a woman can take for pain management or to ease the discomfort of primary dismenorrhea.

Adequate sleep, regular exercise, and abdominal massage can help alleviate dysmenorrheal throbbing. Some doctors recommend taking a soak in a hot bath, or applying a heating pad to the lower abdominal area to lessen pain due to congestion. Alternative remedies like yoga, meditation, acupuncture, and even orgasmic sexual activity has been proven to work.

To relieve the pain or discomfort caused by monthly cramps, some women resort to taking over-the-counter NSAIDs, or nonsteroidal anti-inflammatory drugs, like aspirin, ibuprofen (Advil, Motrin, Midol), naproxen sodium (Anaprox, Aleve), ketoprofen (Actron, Orudis KT), or acetaminophen (Tylenol). Taking these NSAIDs on a fixed schedule just before the pain actually starts can give the best results.

Your doctor may also prescribe mefenamic acid (Ponstel), or even a type of low-dose oral contraceptive pills to prevent ovulation and decrease the amount of prostaglandins in the uterus, which in turn lessen the pain of menstrual cramps.

The good news is, primary dismenorrhea diminishes as a woman gets older. It has been known to dwindle down and even fade away completely after pregnancy. The reason behind this lies in the fact that uterine nerves degenerate with age, and disappear during the later stages of a pregnancy. After childbirth, only a small portion of these nerves are able to regenerate.

With secondary dysmenorrhea, the underlying cause has to be dealt with to successfully get rid of the menstrual cramps. Treatment can range from antibiotics to eliminate an infection, or undergoing a surgical procedure to get rid of polyps, fibroid tumors, or to remove abnormal tissue caused by endometriosis. An endometrial ablation may also be recommended, in which some of the uterus lining is burned or vaporized using an instrument that generates heat.

Recent research in 2007 has cited behavioral interventions, which include “physical and psychological coping strategies” to deal with both primary and secondary dysmenorrheal pain, without having to resort to placebos, NSAIDs or other medical treatments. These strategies involved resting and relaxation techniques which were found to be effective, although more research was recommended due to inconclusive results.


New drugs are also coming out in the market. Lumiracoxib, a COX-2 inhibitor, targets inflamed tissues and provides pain relief for up to 24 hours. It has been recommended for people suffering from osteoarthritis, rheumatoid arthritis, and primary dysmenorrhea. A combination of caffeine and paracetamol (an analgesic) has also been the subject of another study. In this 2007 study, a gram of paracetamol taken with 130 grams of caffeine resulted in significant pain relief. This is because caffeine stimulates the efficacy of the analgesic when taken in specific doses.

Some other studies involve taking zinc supplements prior to the menstrual period to slow down prostaglandin metabolism and reduce prostaglandin production. There is also research being done on surgery to “interrupt pelvic nerve pathways”, and new dietary recommendations (less animal fat, more fruit, vegetable and fish oil intake) to relieve the pain of dysmenorrhea caused by endometriosis

At present, there is an increasing number of women who are choosing to learn more and be in tune with their own bodies in order to maintain optimum health. In today’s fast-paced and health-conscious world, a woman’s menstrual cramps have become a mere inconvenience that occurs once a month, and not the incapacitating illness that it used to be.
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