Menstrual Cramps: Symptoms & Causes

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

“The disappointed womb cries in menstrual cramps and blood when the egg is not fertilized and menses appear,” a mythology quote says. Menstrual bleeding is part of a woman’s life. It’s frustrating sometimes if it doesn’t show, and it can create anxiety at the same time.

Women are meant to menstruate, and all the problems women face during menses are well-known but only experienced by women. The most common of all are menstrual cramps, which almost every other woman has experienced. About 90% of women suffer from it monthly or sometime in their lives. So let’s look into the details.

In This Article

What are menstrual cramps?

Menstrual cramps are experienced during the first two or sometimes three days of menses. They are throbbing or cramping in nature in the lower belly, with discomfort and heaviness. It is also called “dysmenorrhoea.”

The uterus is a muscular structure with an endometrial lining. It thickens during periods due to hormones and sheds during periods. To expel the thickened endometrial lining, the uterine muscles contract. Prostaglandins are responsible for producing these contractions; they are chemicals released by the uterus itself during periods, and higher concentrations of this chemical can cause severe cramps.

Causes:

Before going into details about causes, let’s see what the types of menstrual cramps are and how the reasons and outcomes vary as per the types of dysmenorrhoea.

There are two types of dysmenorrhoea:

Primary dysmenorrhoea:

It is a menstrual cramp in females of the younger age group. If puberty appears earlier than age, around 10 to 12 years, they are more likely to suffer from menstrual cramps.

The menstrual cramps are not due to any underlying problems in the female genital tract like the uterus, vagina, or cervix, which is called primary dysmenorrhea. It is solely because of early puberty that a chemical produced by the uterus called prostaglandins is released in high amounts to cause the muscles of the uterus to contract and relax. It goes away with increasing age, after marriage, and after childbirth.

Secondary dysmenorrhoea:

Secondary dysmenorrhoea refers to the condition when menstrual cramps are due to any underlying condition, like problems in the uterus, vagina, or cervix.

What are those conditions? Let’s see:

Endometriosis: in this, the uterine tissue, like the endometrium, starts growing outside the uterus, like in the fallopian tubes or pelvic cavity.
Uterine fibroids are benign tumor-like growths, usually non-cancerous, in the walls of the uterus. They may also occur in fallopian tubes or outside the uterus, like in the cervix. Fibroids are made of muscular tissues of the uterus like myometrium, so they are also called myomas.
Adenomyosis occurs when the endometrial lining, normally shed off during periods, grows in the muscular tissues of the uterus, called the myometrium. The The endometrial lining in the muscular tissues thickens and sheds off during periods, but it thickens in such a way that it enlarges the size of the uterus. And to expel a thickened endometrium, the uterus contracts severely, which causes menstrual cramps.
Cervical stenosis is also called the stricture of the cervix. A narrowing of the cervical canal causes an interruption in the flow of periods, causing increased pressure in the uterus and resulting in menstrual cramps.
Pelvic inflammatory disease is an infection of the genital tract which can involve organs in the pelvic cavity, uterus, cervix, and vagina
Uterine or cervical cancer: cancer is an important cause of menstrual cramps.

Menstrual Symptoms:

NOT in all cases, but in a few cases.

The following menstrual symptoms can be seen:

Diagnosis:

Diagnosis is essential to differentiate and rule out primary or secondary dysmenorrhoea. Primary dysmenorrhoea doesn’t need any treatment.But secondary dysmenorrhoea should be ruled out for treatment.

Physical examination: this is done by the doctor with a speculum which is inserted in the vagina to see for cervical stenosis or inflammation
Ultrasound of the pelvis includes visualization of the uterus, fallopian tubes, ovaries, and cervix. It can help diagnose fibroids, endometriosis, and pelvic inflammatory diseases.
Laparoscopy is a small surgical procedure in which a small cut is made on the abdomen and a fiber optic telescope is inserted through it to visualize the female genital tract, uterus, fallopian tubes, ovaries, and cervix. It can detect any abnormality inside the pelvic cavity
Hysteroscopy: hysteroscope is a telescope-like device with a light and a camera at its tip. It is inserted through the vagina to visualize the uterus, fallopian tubes, cervix, and vagina. It helps to detect secondary dysmenorrhoea.
CT MRI to detect cancer, tumors, inflammations, or any associated medical conditions

Treatment:

1. Primary dysmenorrhoea needs no treatment. Preventive measures or home remedies are helpful to reduce menstrual cramps:

Avoidance of smoking: smoking is associated with painful cramping of the uterus due to the release of prostaglandins at high levels.
The application of heat to the lower belly can help relieve menstrual cramps to a certain extent by preventing muscle contractions and helping them relax.
Relaxation of the body is again a good mental exercise in which the person imagines that his body muscles are getting relaxed one by one. Here the focus is on uterine muscles, and the person has to focus on imagining the relaxation of uterine muscles. It can help relieve the pain to some extent
Exercise: It helps reduce the production of prostaglandins, reducing the intensity of menstrual cramps with time. It is also associated with the release of endorphins, which help keep a person active and happy

Secondary dysmenorrhoea:After diagnosing the underlying disease, the treatment of the disease can help relieve the painful cramping during periods.

Fibroids need surgical removal, which may help the patient get rid of menstrual cramps
Pelvic inflammatory disease treating infection can help reduce the symptoms. Broad-spectrum antibiotics may help treat the infection.
Adenomyosis Birth control pills are generally prescribed to reduce associated symptoms; surgery is needed in most cases.
Uterine or cervical cancer needs chemotherapy, radiotherapy, or surgery called hysterectomy or cervicectomy (removal of uterus or cervix), depending upon the stage of cancer.

Conclusion

About 70% of cases are curable, and women get rid of menstrual cramps completely. In most cases, the causes are not severe. It is said that menstruating every month is rejuvenating for a woman. Mild cramping can be a good sign sometimes, indicating a woman’s fertility is intact.

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