Menstrual Cramps

Topic Overview

Most women have painful menstrual cramps (dysmenorrhea) from time to time. Menstrual cramps are one of the most common reasons for women to seek medical attention. The pain from menstrual cramps can range from mild to severe and can involve the lower abdomen, back, or thighs. You may also have headaches, nausea, dizziness or fainting, or diarrhea or constipation with your cramps.

During the menstrual cycle, the lining of the uterus produces a hormone called prostaglandin. This hormone causes the uterus to contract, often painfully. Women with severe cramps may produce higher-than-normal amounts of prostaglandin, or they may be more sensitive to its effects.

Cramping is common during the teen years, when a woman first starts having periods. Primary dysmenorrhea is a term used to describe painful menstrual cramping with no recognized physical cause. It is seen most commonly in women between the ages of 20 and 24. It usually goes away after 1 to 2 years, when hormonal balance occurs.

Secondary dysmenorrhea is a term used to describe painful menstrual cramping caused by a physical problem other than menstruation. Physical problems that can cause this type of cramping include:

• A condition in which cells that look and act like the cells of the lining of the uterus (endometrium) are found in other parts of the abdominal cavity (endometriosis) or grow into the muscular tissue of the uterine wall (adenomyosis). Pain usually occurs 1 to 2 days before menstrual bleeding begins and continues through the period.
• Growths that are not cancerous (benign growths) in the pelvis, such as ovarian cysts, cervical or uterine polyps, or fibroids.
• Pelvic infections. Your risk for developing an infection is higher after menstrual bleeding has begun because the opening to the uterus (cervical canal) widens during menstruation. But pelvic infections, especially those caused by sexually transmitted diseases, can occur at any time.
• Using an intrauterine device (IUD). An IUD may cause increased cramping during your period for the first few months of use. If menstrual cramping persists or gets worse, you may need to consider having the IUD removed and choosing another birth control method.
• Problems with pregnancy.
• Structural problems that were present at birth (congenital), such as narrowing of the lower part of the uterus that opens into the vagina (cervix).

Menstrual-type cramps may occur after a medical procedure, such as cautery, cryotherapy, conization, radiation, endometrial biopsy, or IUD insertion.

Other menstrual symptoms, such as weight gain, headache, and tension, that occur before your period begins, can be caused by premenstrual syndrome (PMS). For more information, see the topic Premenstrual Syndrome (PMS).

Review the Check Your Symptoms section to determine if and when you need to see your doctor.

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	Menstrual cycle: Dealing with cramps

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first:

• You are pregnant and have cramps: Go to the topic Pregnancy-Related Problems.
• Unexpected vaginal bleeding: Go to the topic Abnormal Vaginal Bleeding.
• Abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.

	Yes	Do you think you are pregnant? When to See a Doctor See significance of pregnancy if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe cramping lower abdominal pain? Call your health professional today if you answer "Yes" to the following question. Yes Have you had moderate cramping lower abdominal pain for 4 hours or longer? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild cramping off and on or localized lower abdominal pain for longer than 24 hours? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Has sudden pain occurred with menstrual bleeding? When to See a Doctor See significance of severe pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain that is different than your usual menstrual discomfort? Call your health professional today if you answer "Yes" to the following question. Yes Have you had moderate pain or cramping for longer than 24 hours? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild pain or cramping for longer than 5 days? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had menstrual cramps for 3 cycles in a row that could not relieved with home treatment? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your menstrual cramps may be caused by sexual abuse? When to See a Doctor See significance of menstrual cramps that may be caused by sexual abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you think your menstrual cramps may be caused by sexual abuse? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have menstrual cramps and a fever? When to See a Doctor See significance of fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have symptoms of a pelvic infection, do not have sexual intercourse until you see your doctor. This will reduce the risk of spreading a possible infection to your partner. Your partner may need to be treated as well. If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you developed a rash that looks like a sunburn within 2 days of the start of a fever of 102 °F (39 °C) or higher? Yes Have you developed a rash that looks like a sunburn within 2 days of the start of a suspected high fever but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have an intrauterine device (IUD) in place? Yes Do you have a fever of 102 °F (39 °C) or higher? Yes Have you had a fever of 101 °F (38.3 °C) and lower abdominal pain for 24 hours? Yes Do you think that you have a moderate fever but you are unable to measure your temperature? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a fever of 100 °F (37.8 °C) to 101 °F (38.3 °C) for 24 hours or longer? Yes Do you think that you have had a mild fever for 24 hours or longer, but you have been unable to measure your temperature? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have an intrauterine device (IUD) in place? When to See a Doctor See significance of having an intrauterine device (IUD) if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have symptoms of a pelvic infection, do not have sexual intercourse until you see your doctor. This will reduce the risk of spreading a possible infection to your partner. Your partner may need to be treated as well. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have low back pain? Yes Do you have a vague feeling of body weakness or discomfort (malaise)? Yes Does having sex cause pain? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Are your menstrual cramps so severe that you are thinking about having your IUD removed? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do cramps begin 5 to 7 days before your period starts or continue after your period stops? When to See a Doctor See significance of cramps that begin 5 to 7 days before your period starts or continue after your period stops if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have symptoms of a pelvic infection, do not have sexual intercourse until you see your doctor. This will reduce the risk of spreading a possible infection to your partner. Your partner may need to be treated as well. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have low back pain? Yes Do you have a vague feeling of body weakness or discomfort (malaise)? Yes Does having sex cause pain? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had prolonged menstrual cramps for 3 or more menstrual cycles, but you do not have other symptoms? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Have you had a change in the pattern of your menstrual cramps? When to See a Doctor See significance of a change in the pattern of menstrual cramps if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If there has been a sudden change in your pain, return to the Check Your Symptoms section of this topic and evaluate your pain. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has the pattern of your menstrual cramps continued to get worse for 3 months in a row? Yes Have your menstrual cramps not improved with home treatment for 3 cycles? Yes Are cramps interfering with your normal activities, such as school or work? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• A vaginal problem: Go to the topic Vaginal Problems.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Try the following home treatment to help relieve your menstrual cramps:

• Use heat, such as hot water bottles, heating pads, or hot baths, to relax tense muscles and relieve cramping. Be careful not to burn yourself.
• Drink herbal teas, such as chamomile, mint, raspberry, and blackberry, which may help soothe tense muscles and anxious moods.
• Exercise. Regular workouts decrease the severity of cramps. For more information, see the topic Fitness.
• Empty your bladder as soon as you have the urge to urinate.

For more information on managing menstrual cramps, see:

Menstrual cycle: Dealing with cramps.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• You become pregnant.
• Pain is getting worse despite home treatment.
• Menstrual cramps are lasting longer than your period.
• Other symptoms develop, such as fever, nausea, vomiting, or vaginal discharge.
• Symptoms become more severe or frequent.

Prevention

You may be able to prevent menstrual cramps.

• Eat a balanced diet that includes plenty of fruits and vegetables and is low in fat. Limit your intake of alcohol, caffeine, salt, and sweets. For more information, see the topic Healthy Eating.
• Begin or maintain a moderate exercise schedule. Try to work up to at least 30 minutes, 4 to 5 times each week. For more information, see the topic Fitness.
• Reduce stress in your life. Although stress does not cause menstrual cramps, reducing stress can make your symptoms less severe. For more information, see the topic Stress Management.
• Do not smoke or use other tobacco products.
• Try biofeedback or yoga. Both therapies teach relaxation skills.
• Try acupuncture or acupressure.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What were the dates of your last two menstrual periods?
  • If you are a teen, do you have regular cycles, such as a period every 21 to 45 days?
  • If you are an adult, do you have regular cycles, such as a period every 21 to 35 days?
  • If you have been through menopause, how long ago was your last menstrual period?
• Has your menstrual flow been heavier bleeding than usual?
• What is your menstrual pattern?
  • Is it regular, with approximately the same number of days in between periods?
  • Is it irregular? What is the range from the longest to the shortest time interval between your periods?
• What method of birth control do you use? It is especially important to tell your doctor if you use an intrauterine device (IUD).
• Have you done a home pregnancy test? If so, when did you do the test and what was the result?
• Have you been under increased psychological or physical stress?
• Have you recently gained or lost more than 10 pounds for no known reason?
• What prescription and nonprescription medications are you taking?
• How does your pain differ from your typical menstrual cramps?
• Do you engage in high-risk sexual behaviors?
• Do you have any health risks?

Related Information

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Abnormal Vaginal Bleeding
• Birth Control
• Endometriosis
• Fitness
• Functional Ovarian Cysts
• Healthy Eating
• Missed or Irregular Periods
• Pelvic Inflammatory Disease
• Premenstrual Syndrome (PMS)
• Shock
• Stress Management
• Uterine Fibroids
• Vaginal Problems

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