Menstrual cramps normally start one to two days before a period, or just after the menstrual flow begins, and typically last for one to three days. For many women of reproductive age, menstrual cramps cause a mild pelvic ache, while others experience painful period cramps that are severe enough to disrupt their lives for a few days.
Painful menstrual cramps are medically referred to as dysmenorrhea and in this article, we discuss the symptoms and causes of this life-disrupting pain, as well as effective treatments you can use to ease the monthly discomfort.
Why Do Period Cramps Occur?
Period cramps occur because the muscles of the uterus tighten and release to shed the inner uterine lining during menstruation. Although the uterus contracts somewhat throughout the menstrual cycle, it intensifies in preparation for, and during menstruation.
In the days leading up to menstruation, cells within the uterine lining (endometrium) begin to break down and release chemicals called prostaglandins. The release of these chemicals prompts the uterine blood vessels to narrow, which instigates a contraction of the uterine muscles to release the endometrium.
If the uterine muscles contract too powerfully, the blood vessels can be pressed too tightly and temporarily stop the supply of oxygen to the uterine muscle tissue. When the oxygen supply to the uterine muscles is cut off, the pain of period cramps also increases temporarily.
As menstruation begins and progresses, however, prostaglandin levels drop, and period cramps as well as the accompanying symptoms begin to fade.
What is Dysmenorrhea?
Dysmenorrhea is the medical term for painful period cramps, which typically manifest in the lower abdomen and lower back before and during the menses. For further clarification, painful menstrual cramps are categorized as primary dysmenorrhea or secondary dysmenorrhea.
The pain associated with primary dysmenorrhea usually begins a day a two before menstruation and lasts for one to three days. Medical experts are not exactly sure why some women experience primary dysmenorrhea and others don’t, but research suggests it is linked to higher levels of prostaglandins.
Secondary dysmenorrhea is usually more severe or debilitating than primary dysmenorrhea. It normally begins a little earlier in the menstrual cycle and lasts longer, often until menstrual bleeding stops. The painful menstrual cramps associated with secondary dysmenorrhea are usually caused by an underlying medical issue affecting the reproductive system. Sometimes, the pain is also experienced outside of menstruation.
Symptoms of Dysmenorrhea
Symptoms of dysmenorrhea can include additional physical and psychological side effects. Not all women with dysmenorrhea will experience all of the symptoms outlined below, but most will identify with a few.
Physical symptoms can include headaches, fatigue, tender breasts, trouble sleeping, sore knees, pain in the inner thighs, and swollen legs. Bloating, constipation, diarrhea, an increase in appetite, nausea, and vomiting are also common with dysmenorrhea. Increased urination and perspiration are also linked to painful menstrual cramps.
Psychological symptoms of dysmenorrhea can involve mood swings, anxiety, depression, irritability, or an increased sense of nervousness. In fact, scientific studies have shown that women with dysmenorrhea are more prone to feeling depressed and anxious than those without the condition.
Symptoms of Secondary Dysmenorrhea
The symptoms of secondary dysmenorrhea are often similar to the symptoms of primary dysmenorrhea mentioned above. However, the pain in the lower back and lower abdomen is typically more severe, begins earlier, and lasts longer. Ongoing or chronic pelvic pain, discomfort during sex (dyspareunia), and difficulties getting pregnant are also common symptoms associated with secondary dysmenorrhea.
It can be helpful to speak with your healthcare provider for treatment options if your symptoms are severe enough to disrupt your life, sexual relationships, or ability to conceive. It’s also wise to engage the help of your healthcare provider if you notice that your symptoms are getting progressively worse with time, if you notice frequent or large blood clots, or if period cramps occur outside of menstruation.
What Causes Dysmenorrhea?
Described as painful menstrual cramping, dysmenorrhea can occur every 28 days before and during your period. Signaled by the release of chemicals known as prostaglandins, the uterine muscles contract at this time of the month to expel the uterine lining during menstruation. When menstrual cramping is painful, it is known as primary dysmenorrhea and it is thought to be caused by increased levels of prostaglandins.
Secondary dysmenorrhea is considered more painful than primary dysmenorrhea and is believed to last longer. It is caused by conditions that adversely affect the female reproductive system, such as endometriosis, cervical stenosis, pelvic inflammatory disease, ovarian cysts, uterine abnormalities, and uterine fibroids. Crohn’s disease and urinary issues can also contribute to the onset of secondary dysmenorrhea.
Lifestyle Factors that Contribute to Dysmenorrhea
Through research studies and patient feedback, medical experts caution that certain factors and lifestyle habits can contribute to the onset of more painful menstrual cramps.
Women living with stress, for instance, are believed to be more susceptible to dysmenorrhea, as are women who smoke, eat an unhealthy diet, or are overweight. Sexual abuse survivors are also more prone to developing the condition, as well as females who have a family history of heavy periods or painful menstrual cramping.
Does Dysmenorrhea Get Better On its Own?
Dysmenorrhea tends to subside as women age and usually stops once menopause occurs. Women who have given birth to more than two children also typically notice less menstrual cramping.
How to Treat Dysmenorrhea
Treatment options for painful menstrual cramps will depend on whether you are suffering from primary or secondary dysmenorrhea. Taking birth control can stop dysmenorrhea, however, this is not ideal for women who are trying to get pregnant and it can increase the risk of cervical cancer.
Treating Primary Dysmenorrhea
In place of birth control pills, women with primary dysmenorrhea often take nonsteroidal anti-inflammatory drugs (NSAIDs) which are known to inhibit the production of prostaglandins and reduce uterine cramping.
Unfortunately, the long-term use of NSAIDs is associated with gastrointestinal bleeding, diarrhea, headaches, and excess fluid retention so it’s not an ideal solution for dysmenorrhea that can last until menopause. In place of NSAIDs, a natural remedy known as Chasteberry (Vitex) significantly reduces symptoms of PMS like menstrual cramps, tender breasts, and mood swings.
If you suffer from primary dysmenorrhea, symptoms can also be reduced by practicing yoga and gentle exercise to reduce stress. Giving up smoking can also reduce the symptoms, and eating a more balanced diet that includes anti-inflammatory foods and less meat is also known to help.
Treating Secondary Dysmenorrhea
When it comes to treating secondary dysmenorrhea, the first step is to clarify what condition is causing it. This can be done by scheduling an appointment with an OB/GYN who will perform some tests to determine the underlying cause.
If uterine fibroids are the cause, surgery may be suggested to remove them. Pelvic inflammatory disease would be treated with antibiotics and a probiotic to rebalance the vaginal microflora after infection. Cervical stenosis, which is a blockage or narrowing of the cervix, is typically improved with the help of vaginal dilators to gently and slowly re-open the cervix.
Reducing your stress levels with yoga and gentle exercise will also help ease the symptoms of secondary dysmenorrhea. If you smoke, try to give it up, and consider switching to a more plant-based diet that includes anti-inflammatory foods and less red meat.
Treating Secondary Dysmenorrhea Caused by Endometriosis
When secondary dysmenorrhea is caused by endometriosis, hormone therapy is typically the first medical suggestion to reduce the pain. If patients are trying to get pregnant, however, surgery is sometimes recommended to remove the endometrial growths that contribute to menstrual pain. However, after surgery, the same growths are known to grow back within 3-5 years.
Women looking to naturally treat dysmenorrhea caused by endometriosis are advised to consult with a physical therapist and a nutritionist to develop a treatment plan that can be managed long-term. Physical therapists teach endometriosis patients how to use vaginal dilators and pelvic massage wands in the comfort of their own homes to reduce pain, treat dyspareunia, and improve their chances of getting pregnant, as well as their overall quality of life.
Nutritionists can help outline an endometriosis diet that reduces estrogen and inflammation. An endometriosis diet is typically plant-based, rich in fiber and whole grains, and low in fat, and foods that are known to trigger endometriosis flares are avoided. These include red meat, dairy, gluten, processed foods, caffeine, alcohol, soy products, sugar, and fatty foods.
Practicing yoga and meditation can help reduce the stress that the ongoing symptoms of endometriosis can cause. Some women also find it helpful to speak to a cognitive behavioral therapist to better manage the symptoms.
Conclusion
Painful period cramps are known medically as dysmenorrhea and can vary from a dull pelvic ache to severe life-disrupting pain. Although debilitating for some, the symptoms of dysmenorrhea can be relieved and treated naturally.
Should you suffer from severely painful menstrual cramps, schedule an appointment with an OB/GYN to decipher if you have primary or secondary dysmenorrhea. Depending on the outcome, your treatment might include natural hormone-balancing supplements, vaginal dilation, pelvic massage, medication, or surgery.
References
American College of Obstetricians and Gynecologists – Dysmenorrhea: Painful Periods - https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods
Womens Health – Your Menstrual Cycle - https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle
National Library of Medicine - Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/
National Library of Medicine - Factors predisposing women to chronic pelvic pain: systematic review - https://pubmed.ncbi.nlm.nih.gov/16484239/
National Library of Medicine - Effects of Nonsteroidal Anti-Inflammatory Drugs at the Molecular Level - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039135/
Endometriosis Foundation of America - The 10 Foods Endo Women Should Avoid - https://www.endofound.org/10-foods-endo-women-should-avoid