Do you dread the onset of your period because of the pain you know it will bring? If so, you're not the only one. Menstrual cramps - the medical name is dysmenorrhoeal1 - is common. More than one in every two women suffers from it each month, and about one in four is so badly affected that she has to take time off work or school.
What causes cramps?Each month, the lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. If a pregnancy occurs, the fertilised egg attaches itself to the lining to be nourished as it develops into a baby. If the egg is not fertilised, the lining is not needed. It breaks down, and hormones called prostaglandins are released. These trigger the muscles of the uterus to contract and squeeze the lining out. The muscles are the same ones that push a baby out during childbirth, so they are extremely strong. Some women may have higher levels of prostaglandins, which is thought to be what causes painful muscle spasms called cramps.
What sort of pain is it?You may feel no more than a passing discomfort from your period, or you could be doubled up by it. Usually the pain comes in cramp—like spasms. It could start in the lower abdomen and radiate up the spine and down the legs, or center in your lower back. If you get it, you may feel dizzy or nauseous and get diarrhea or vomit. If this happens, you should go and see your doctor. Most women find the pain usually comes on a few hours before their periods start and begins to ease once the flow begins. But in a few, pain continues into the second and even the third day of their period.
What you can do for yourself to relieve the pain?There are many ways to help relieve menstrual cramps. The trick is to find one that works for you. Lie down, if possible, at the first sign of pain and place a warm heating pad on your abdomen. You may also try taking a nice, warm bath or placing a hot water bottle on your abdomen. For information on "dry" heating pads (warm wraps that will let you leave the house and participate fully in your life), go to www.thermacare.co.uk. Seek advice from your pharmacist about suitable painkillers. Over-the-counter medications may be helpful. For maximum relief, take painkillers before the pain gets too bad.
Massage can ease menstrual cramps. Gently rub your abdomen or ask your partner to massage your back. Exercise routines practiced throughout your cycle - particularly a few days before the onset of your period - may help to reduce pain by lowering your levels of prostaglandins. Exercise also helps to keep the blood flowing in your pelvis, easing that heavy, bloated feeling. Workouts that stretch your body - cycling with your legs up in the air, for example - are best.
What your doctor can do for youHormone treatments: Women who do not ovulate (that is produce a mature egg each month) will rarely have menstrual cramps. If, like most women, you do ovulate, your doctor may prescribe a hormone treatment to stop ovulation. The birth control pill is often used for this purpose.
Anti-prostaglandins: Available from your doctor, these drugs reduce the effect of prostaglandins.
Surgery: In the past, many women with menstrual problems had an operation known as a "D & C" (dilation and curettage) to remove some of the lining of the uterus. This particular operation is rarely performed today, but when a woman's periods are very heavy as well as painful, her doctor may recommend its modern equivalent, endometrial ablation, which involves treatment with a laser.
When to see a doctorMenstrual cramps are sometimes caused, or made worse, by other conditions. This is known as secondary dysmenorrhoea. If you suddenly start to experience more pain than usual or notice a change in your periods, you should contact your doctor. Older women in particular should consult their doctors if their pain does not respond to treatment.
EndometriosisEndometriosis occurs when cells from the uterine lining escape into other areas of the body where they cause irritation and pain.
Symptoms: Sharp abdominal pains as well as menstrual cramps; painful sexual intercourse.
Treatment: Hormone treatment is usual although your doctor may recommend surgery in severe cases.
FibroidsFibroids are non-cancerous growths inside the uterus.
Symptoms: Dull pain in the abdomen; swollen stomach; heavy and painful periods.
Treatment: Depends on where the fibroids are and how big they are. Sometimes no treatment is needed. Fibroids grow in response to the hormone estrogen, and when this hormone decreases after menopause, the fibroids often shrink and practically disappear. Removal of the fibroids or a hysterectomy (surgical removal of the uterus) may be considered if the symptoms are severe.
Pelvic Inflammatory Disease (PID)Pelvic Inflammatory Disease (PID) refers to long-term inflammation of any of the pelvic organs, usually caused by infection.
Symptoms: Painful intercourse; foul-smelling vaginal discharge; heavy and painful periods.
Treatment: Usually treated with antibiotics.
It is not possible for you to diagnose conditions like these yourself, so see your doctor if you have any of the symptoms. You could be referred to a hospital for a laparoscopy. This involves making a small incision in the abdomen and passing a tiny camera through it that is attached to a viewing tube. The doctor can then look around the pelvis to see what, if anything, is wrong.
Middle painMiddle pain is experienced by some women about halfway through their menstrual cycle - usually 12 to 16 days after a period. The pain is one-sided and sharp, low in the abdomen. It may last just a few minutes or, rarely, several hours. The pain is caused by the egg bursting out of the ovary. If necessary, a mild painkiller may help.
There is hopeYou can also take comfort in knowing that cramps tend to decrease in intensity as you get older and often disappear after pregnancy.¹
1 MayoClinic.com, "Menstrual Cramps (Dysmenorrhea)," Mayo Foundation for Medical Education and Research, 2005.
