Basically, period pain is pain or discomfort experienced in the tummy (belly) and pelvic area as a result of having a period. The pain can range from mild to quite severe, and differ from month to month in duration and severity. Severe menstrual cramps can be so painful that they interfere with a woman’s regular activities for several days.
It is estimated that more than 50% of women are affected to some degree by period pain and of these, up to 15% would describe their menstrual cramps as severe. Surveys of adolescent girls show that over 90% of girls report having menstrual cramps
Most period pain is not caused by an underlying gynecologic problem: rather they are a result of normal hormones in the female body causing the muscles of the uterus to contract, in part as a way of encouraging the release of the uterine lining as the monthly period.
Each month, the inner lining of the uterus (the endometrium) normally builds up in preparation for a possible pregnancy. After ovulation, if the egg is not fertilized by a sperm, no pregnancy will result and the current lining of the uterus is no longer needed. The woman’s estrogen and progesterone hormone levels decline, and the lining of the uterus becomes swollen and it is eventually shed as the menstrual flow and is replaced by a new lining in the next monthly cycle.
When the old uterine lining begins to break down, molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina. Other substances known as leukotrienes, which are chemicals that play a role in the inflammatory response, are also elevated at this time and may be related to the development of menstrual cramps.
- Doctors have discovered that women with an unusually narrow cervical canal tend to experience more severe cramps.
- Another anatomical factor thought to contribute to menstrual cramps is a backwards tilting of the uterus (a retroverted uterus).
- Lack of exercise is now recognized to contribute to painful menstrual cramps.
- It has long been thought that psychological factors also play a role. For example, it is widely accepted that emotional stress can increase the discomfort of menstrual cramps.
For some people the discomfort of period pain can extend to the lower back or legs. Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after the onset of the bleeding, and subside again after a day or two. They may be accompanied by a headache and/or nausea, which can lead, although infrequently, to the point of vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea because the prostaglandins which cause smooth muscles to contract are found in both the uterus and intestinal tract. Some women experience an urge to urinate more frequently.
Current recommendations include not only adequate rest and sleep, but also regular exercise (especially walking). Some women find that abdominal massage, yoga, or orgasm may bring relief. A heating pad applied to the abdominal area may relieve the pain and congestion and decrease symptoms.
A number of nonprescription (over-the-counter) drugs can help control the pain as well as actually prevent the menstrual cramps themselves. Talk to your chemist or doctor. A woman should start taking one of these medications before her pain becomes difficult to control. This might mean starting medication 1 to 2 days before her period is due to begin and continuing taking medication 1-2 days into her period. The best results are obtained by taking medication on a scheduled basis and not waiting for the pain to begin.
If a woman’s menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low doses of birth control pills (oral contraceptives) containing estrogen and progestin in a regular or extended cycle. This type of approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins which, in turn, reduces the severity of cramping and causes a light menstrual flow.
Use of an IUD that releases small amounts of hormones directly into the uterine cavity has been associated with a 50 percent reduction in the prevalence of menstrual cramps. In contrast, IUDs that do not contain hormones, such as those containing copper, may worsen menstrual cramps.