Menstrual Cramps 101

Highlights

• Most people who menstruate have experienced menstrual cramps, caused by uterine contractions as the uterine lining is expelled with menstruation
• Menstrual cramps can be primary, which are caused by the act of menstruation itself, or secondary, resulting from other conditions like PCOS, endometriosis, or others
• Some prescription and OTC drugs can help with menstrual cramps, as can complementary therapies like acupuncture and naturopathic or herbal medicine
• You can address menstrual cramps at home with remedies like dietary changes, hydrotherapy (warm baths or heating pads), and supplements

If you have a period, chances are you’ve experienced menstrual cramps. The formal name for pain that arrives in concert with your period is dysmenorrhea, and it can range in severity from a mild annoyance that you hardly notice to severe pain that makes it impossible to go to work.

There are two types of menstrual cramps: primary dysmenorrhea, which are confined to the time preceding and during menstruation, and secondary dysmenorrhea, which is pain with menstruation that is caused by another condition, like PCOS, endometriosis, ovarian cysts, or uterine fibroids.

What exactly are menstrual cramps?

During your period, your body releases chemicals called prostaglandins that trigger your uterus to contract so as to expel this unused uterine lining. Higher levels of prostaglandins are linked to more severe cramps and menstrual pain. 

In menstruation, your uterus sheds its endometrium, which is the lining that has built up over the preceding month (or time since your last cycle, if you have an irregular period). The bleeding from your vaginal canal that you experience during menstruation is the blood and tissue being expelled.

Your body builds endometrium with every cycle so that if you become pregnant, it can nourish a fetus until a placenta grows. If you don’t become pregnant, it releases the endometrium.

The sensations involved in menstrual cramps are different for different people, but they typically present as some version of cramping, throbbing, and/or twisting pain in the deep low abdomen. Some people also experience a dull, continuous ache in their low belly and sometimes lower back and thighs.

Most people who experience menstrual cramps get them before menstruation (during what’s known as the luteal phase of the menstrual cycle) or during menstruation itself. They can be accompanied by other symptoms, including diarrhea, nausea, headache, and dizziness, in what’s known as premenstrual syndrome, or PMS (which can extend into the menstrual cycle for some people). 

While scientists have identified some of the reasons why some people get severe menstrual pain and others get none at all, there is a lot that remains unknown. Some of the factors that are often present in people who get painful cramps are youth (being under twenty), having reached puberty early (before age eleven), never having given birth, having a family history of dysmenorrhea, having heavy or irregular periods, and smoking cigarettes.

As evidenced by this list, there is little that can be done in terms of prevention for menstrual cramps, but luckily there is a wide range of treatment options from a spectrum of providers. 

Conditions that can cause menstrual cramps

Secondary dysmenorrhea is the condition of having menstrual cramps that are caused by a uterine or other pelvic condition, and is notable for arriving “out of nowhere” in people who haven’t previously experienced menstrual cramping.

There are many conditions that can cause secondary dysmenorrhea, including;

• Endometriosis: In this condition, the lining of your uterus (the endometrium) spreads outside the uterine walls, and can implant on your fallopian tubes, ovaries, bladder, and/or bowels. Endometriosis can be extremely painful, and these organs can become adhered to each other. Surgery is sometimes required to remove this tissue. 

• Pelvic inflammatory disease: A bacterial infection in the uterus, fallopian tubes, or ovaries causes PID, and can cause inflammation and pain throughout the pelvic organs.

• Adenomyosis: A relatively rare condition, in adenomyosis the endometrium grows into the wall of the uterus, leading to pain, pressure, and inflammation as well as extremely heavy menstrual bleeding. 

• Cervical stenosis: In cervical stenosis, the cervix is too small to allow for adequate menstrual flow. This backlog of endometrial blood and tissue causes pressure and pain inside the uterus during menstruation. 

• Uterine fibroids: Uterine fibroids are benign tumors in the uterus. While they don’t carry risk of cancer, they can put pressure on the uterus and cause pain throughout the pelvic region. 

Treatments for menstrual cramps

According to one study, menstrual cramps cause up to 40% of people who have periods to miss work or school. Because they are a regular part of life for those who suffer from them, it’s important to find some go-to remedies to lean on during rough days.

There are lots of treatment options available for painful periods, from prescription drugs to home remedies to complementary therapies. Let’s check them out. 

• Prescription drugs: Many doctors will prescribe hormonal birth control for menstrual cramps. Birth control reduces cramps because it decreases the levels of prostaglandins your body produces—and those prostaglandins are what signals your uterus to contract, causing cramps. There are pros and cons to using hormonal birth control to treat cramps, and patients may wish to consider consulting with an alternative medicine provider (such as a naturopath or herbalist) to talk about other options before going on a hormonal regimen or if a hormonal regimen is causing complications. 

• Complementary therapies: In the natural-healing world, there are many options for treating cramps. Some of the practitioners who may be able to help include herbalists, naturopathic doctors, functional medicine doctors, and dietitians who specializes in hormonal conditions. 

• Home remedies: Supplements that balance hormones and are designed specifically to treat PMS and painful periods can bring relief to some people. You can also consult with an herbalist and put together your own custom mix of supplements—some go-tos for menstrual pain are vitamins B-6 and B-1, magnesium, and omega-3 fatty acids. Reducing your intake of caffeine and salty, fatty, or fried foods can improve symptoms, as can a heating pad or warm bath, mild exercise, and over the counter anti-inflammatory medications such as Advil or Motrin. Orgasm can also help soothe pain as well as speed the expulsion of menstrual blood and tissue from the uterus.

Living with cramps can be tough

Menstrual cramps can feel like a heavy yoke to walk around with if they affect you severely. Knowing that they are right around the corner every month can make them hard to live with even between episodes, and it can be frustrating to feel like your pain is minimized as being “just PMS.”

Finding a compassionate, curious provider who will work with you to get to the source of your cramps and to treat them can make a huge difference, so don’t assume that you just have to live with them. Starting with your gynecologist to eliminate other diagnoses and then exploring the world of complementary  medicine can be the first steps toward freedom from menstrual pain. 

If you’re experiencing painful menstrual cramps, the right provider can help you build a personalized plan to support your wellbeing. Connect with a credentialed expert who serves your area here.