Menstrual Cramps: What They Are, Why They Occur, And When You Should See A Doctor

Menstrual Cramps: What They Are, Why They Occur, And When You Should See A Doctor
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Most women who experience menstrual cramps find it mild and bearable. However, the pain is so severe for some that it negatively affects their daily routine. “A 2005 Canadian study of 1,546 menstruating women reported that 60% had primary dysmenorrhea. 60% reported their pain as moderate or severe. Similarly, 17% missed school or work,” says Dr. Janmarie Sandoval, an obstetrician-gynecologist.

What is the best way to handle severe menstrual cramps? First, we must understand why they occur.

Why do we get menstrual cramps?

According to obstetrician-gynecologist Dr. Mads Echavez-Martin, “Menstrual cramps, also known as dysmenorrhea, is the pain associated with your period. It can be described as cramping, dull, throbbing, or heavy pressure at the lower hypogastric area, but can also radiate to the lower back.”

However, symptoms of dysmenorrhea are varied. “Aside from cramping pain in the lower abdomen and lower back, it may also include sweating, increased heart rate, pain radiating down the legs, diarrhea, nausea, vomiting, fatigue, headache, and dizziness,” says Dr. Sandoval.

Dysmenorrhea can either be primary or secondary.

Primary dysmenorrhea

This refers to pain with no obvious pathologic pelvic disease. Dr. Sandoval says, “The pain is due to the production of prostaglandins in the endometrium or the lining of the uterus. This natural chemical causes the contraction of the muscles and blood vessels of the uterus.” It decreases the blood flow, which then causes ischemia and sensitization of pain fibers, as well as nausea, vomiting, and diarrhea.

Secondary dysmenorrhea

 “Secondary dysmenorrhea, on the other hand, is caused by a disorder in the reproductive organs. This should be considered in patients who do not respond to therapy for primary dysmenorrhea,” explains Dr. Sandoval. “It should be considered when symptoms appear after many years of painless menses. It occurs at any age and the pain is secondary to the pathologic process of the condition.”

Examples of these conditions include cervical stenosis, endometriosis, adenomyosis, fibroids, pelvic inflammation, pelvic congestion, congenital obstructive malformations, diseases of the gastrointestinal tract, and mental health conditions.

How can we know if we have “severe” menstrual cramps?

While we have different levels of pain tolerance, our dysmenorrhea can be considered severe if it is not relieved by pain relievers, or if the severity of the pain progresses to a point that you are unable to perform your daily activities, says Dr. Echavez-Martin.

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What causes severe dysmenorrhea?

According to Dr. Sandoval, factors that may reduce the risk of developing dysmenorrhea include younger age at first childbirth, higher parity or number of children, and physical exercise. However, there are also factors that increase the risk of dysmenorrhea, such asa body mass index (BMI) that is less than 20, pelvic inflammatory disease, sterilization, history of sexual assault, age (less than 30), and heavy smoking.

Secondary dysmenorrhea caused by underlying conditions can also cause severe menstrual cramps.

What are safe and effective ways to manage dysmenorrhea?

“Treatment for primary dysmenorrhea begins with providing patient education and reassurance,” explains Dr. Sandoval. “Individualized and supportive therapy can then be tailored to the patient’s specific symptoms, degree of disability from those symptoms, and other health considerations such as the need for contraception.”

According to Dr. Echavez-Martin, taking over-the-counter NSAIDs (Non Steroidal Anti-Inflammatory Drugs), placing warm compress, acupuncture, and nerve stimulation therapies are among the safe and effective ways to manage dysmenorrhea. However, it is best to consult your ob-gyn for a proper diagnosis and treatment.

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Are there instances that would require surgery or hormone replacement?

Taking combined contraceptives containing estrogen and progesterone hormones can relieve symptoms in 90% of patients, as it suppresses ovulation, endometrial proliferation, and blocks precursors of prostaglandin formation.

“There are cases wherein surgery is recommended, especially if the primary medications did not or can no longer relieve the pain,” says Dr. Sandoval. “But before recommending surgery, your attending ob-gyn will evaluate your medical history and do a complete physical and pelvic exam. Images of your internal organs may be taken using ultrasound or magnetic resonance imaging (MRI). If needed, visual examination of your pelvic and abdominal area may be done using laparoscopy or hysteroscopy to check for abnormal growths.”

If the cause of pain is cervical stenosis, fibroids, or endometriosis, Dr. Sandoval says that surgery can be done. However, it is usually the last resort.

What lifestyle changes can we make to help manage menstrual cramps?

Dr. Echavez-Martin emphasizes the need for regular exercise, such as yoga, biking, and swimming, as it helps in reducing the pain. When we exercise, our body also releases endorphins which are good for the body and are natural pain relievers too!

“Lessening stress is also helpful in decreasing pain. Longer sleep during menstrual periods were found out to lessen menstrual cramps too,” says Dr. Echavez-Martin. “Meditation also helps, a low-fat vegetarian diet also was noted to lessen it. Limited studies also show that essential oils especially lavender, clary sage, and marjoram also help as well.”

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