What Are The Causes And Symptoms of Menstrual Cramps?

Menstrual Cramps

When you experience cramping pains or palpitating in the lower abdomen, it is described as Dysmenorrhea (1) (menstrual cramps). Menstrual cramps occur a few days before and during menstrual periods in most of the women. Once you get your first period, you start to get cramps. Period cramps may vary from one woman to another based on their body conditions and stamina. Cramps might become less painful for many women as they age. Your womb muscles contract and relax during your period, which aids in shedding the built-up lining.

Causes of Menstrual Pain

Every month for a possible pregnancy, the inner lining of the uterus (endometrium) will develop. Post ovulation, if the sperm doesn’t come in contact with the egg, it will not be fertilized. Then no pregnancy will happen, which means the uterus lining is no longer needed. Hence it causes the hormones estrogen and progesterone levels to decrease, and the uterus lining swells, which sheds during the menstrual flow (2). The next monthly cycle replaces a new lining in the uterus.

Prostaglandin is a molecular compound liberated when the uterus lining begins to shed, and that causes the contraction of uterus muscles. The uterine muscle contraction restricts the blood supply to the endometrium.

These are the necessary process. If the contraction is too strong during your periods, it may press against nearby blood vessels. It will cut off the oxygen supply to the uterus for a brief time, and cramping pain occurs due to this reason.

Types of Dysmenorrhea and Symptoms

Primary Dysmenorrhea

It refers to the common period pain and not caused by any other medical condition. Your lower abdomen and back may feel cramp pain that ranges from mild to severe.

The mild symptoms at the initial stage,

  • Pain in lower back, hips, and inner thighs.
  • Abdomen pain (occasionally severe).
  • Feeling of pressure in the belly.

The signs of severe cramps pain are,

  • Upset stomach and vomiting.
  • Dizziness and headache.
  • Diarrhea or loose stools.
  • Constipation.
  • Sweating.

Secondary Dysmenorrhea

It usually occurs later in life, and reasons include infection in the uterus or other reproductive organs. Over time this pain gets severe, and it may begin before your period start and remain even after the end of your period.

Various medical conditions lead to secondary dysmenorrhea. Some of them are described below:


A gynecological condition in which the endometrium tissue appears outside the uterus. It also occurs on other structures throughout the pelvis, bladder, ovaries, and fallopian tubes. For severe cases, endometrium tissue is found in the liver, lungs, bowel, diaphragm, and brain. Symptoms include,

  • Pelvic pain (common symptom).
  • Massive bleeding (last for 7 days and more).
  • Heavy Periods.
  • Gastrointestinal pain.
  • Trouble in getting pregnant.
  • Pain during intercourse.
  • Painful bowel movements.

Polycystic Ovary Syndrome (PCOS)

It is a hormone disorder that affects 1 in 10 women of childbearing age. Androgen (male hormone) at a high level and irregular periods are general symptoms. Other signs are,

  • Prolonged and heavy periods.
  • Excessive facial and body hair.
  • Weight gain and trouble in weight loss.
  • Acne and hair loss.
  • Dark patches of skin.


It is the development of noncancerous growths inside or outside the uterus. Their size range varies from small to large, which causes an enlarged uterus. Even without the signs, people may have 1 or more fibroids. Identified symptoms may vary depending on their size, location, and the number of fibroids. Along with severe menstrual cramps, it also causes

  • Leg and lower back pain.
  • Pelvic pressure.
  • Frequent urination.
  • Heavy periods last more than a week.
  • Constipation.

Pelvic Inflammatory Disease (PID)

When female reproductive organs have a bacterial infection, PID occurs. Causes include sexually transmitted infections (STIs) such as chlamydia and gonorrhea. Apart from STI’s other infections can also be the cause.

Pelvic pain is the common symptom of PID, and other symptoms are,

  • Foul-smelling vaginal discharge.
  • Burning sensation while urinating.
  • Painful intercourse.
  • Bleeding during or after sex.
  • Spotting between periods.
  • Fever.

Cervical Stenosis

When the cervix opening is either thin or closed completely, cervical stenosis occurs, which is also named as a closed cervix. It prevents menstrual blood from leaving the body, causing very light or irregular periods.

Some people might be born with this condition, or it develops later. It also prompts fertility problems.


The thickening of the uterus is defined as Adenomyosis. Endometrial tissue that lines the uterus grows into the uterus muscle, which is the cause of this condition. 

However, the tissue function works normally – the lining of the uterus thickens, breaks down and leaves the body. But the uterus growth will be 2 to 3 times larger than the regular size.

Adenomyosis won’t cause symptoms all the time if it shows you might spot,

  • Severe menstrual cramps, which gets increasingly worse.
  • Prolonged or heavy menstrual bleeding. 

Intrauterine Device (IUD)

IUD (birth control device) is inserted into the uterus. Hormone-free or hormone-containing IUD device types are available. Safer but can cause side effects occasionally.

For most people it is safe, but occasional side effects are,

  • Irregular periods.
  • Heavy menstrual bleeding.
  • Severe menstrual cramps.

IUD can pierce the uterus, or the bacteria can enter into the uterus while inserting that can cause PID. Ejection of IUD is another rare possibility that makes the device move out of its place. These cases cause severe pelvic pain.

Difference Between Menstrual Cramps And Premenstrual Syndrome?

Menstrual cramps are pain experienced by women in the abdomen and pelvic areas during the menstrual period. Cramps pain ranges from mild to severe. Mild cramps are for a shorter time and barely noticeable. Sometimes it is felt as heaviness in the abdomen. But severe cramps will affect daily activities as it is quite painful. 

Premenstrual Syndrome (PMS) is the physical and emotional symptoms that a woman’s body encounter before and during their menstrual cycle. The hormonal changes in the body during periods cause PMS. Women endure these torments every month. Below are the physical and emotional symptoms of PMS (3):

Physical Symptoms

  • Bloated feeling.
  • Dizziness and Headaches.
  • Swelling of hands and feet.
  • Skin problems like pimples.
  • Cramps or belly pain.
  • Upset stomach.
  • Feeling more tired and sleepy than usual.
  • Pain in muscle and joints.
  • Food cravings or being hungrier.
  • Weight gain.
  • Tender and swollen breasts.

Emotional Symptoms

  • Mood swings.
  • Feeling irritated or angry.
  • Having trouble concentrating and falling asleep.
  • Change in desire for sex.
  • Crying suddenly.
  • Feeling depressed, sad, or anxious.

How to Manage Pain?

Every month, women will have an obnoxious feeling for more than 2 days (4). Here are a few tips for relieving pain:

  • Exercise daily.
  • Do yoga and meditation for relaxation.
  • Soak in a hot bath.
  • Apply heat to the lower abdomen with a heat bag (5).
  • Consume healthy foods like fruits, vegetables, and grains.
  • Reduce salt & sugar, fat, alcohol.
  • Transcutaneous electrical nerve stimulation (TENS). 


Over-the-counter medicines that control mild cramps are aspirin, acetaminophen (Tylenol), or acetaminophen plus a diuretic (Diurex MPR, Midol, Premsyn, FEM-1, pamprin, and others). However, aspirin is useful for less painful cramps as it has a limited effect on restraining prostaglandin production.

Nonsteroidal anti-inflammatory drugs (NSAID’S) reduce prostaglandin production, which helps treat moderate menstrual cramps. The NSAIDs (6) which do not need prescription includes, 

  • Ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others);
  • Naproxen sodium (Aleve, Anaprox); and
  • Ketoprofen (Actron, Orudis KT).

While the prescribed NSAIDs are meclofenamate (Meclomen) and mefenamic acid (Ponstel). 

NSAIDs intake is prohibited when you have stomach problems, ulcers, liver diseases, bleeding problems, and allergic to aspirin.

Risk Factors

People who are more likely to experience menstrual pain include (7):

  • Never given birth.
  • Menorrhagia (heavy bleeding during periods).
  • Metrorrhagia (irregular periods).
  • Puberty at a younger age (11 or below).
  • Age lesser than 20 years.
  • Dysmenorrhea (family history of menstrual cramps).
  • Smoker.


Consult your doctor when you period cramps are severe that lasts for more than 2 or 3 days. The doctor will question you about your menstrual cycles and symptoms. She will examine your pelvic by inserting a tool named speculum to see the vagina and cervix. A sample of vaginal fluid will be taken for testing. The doctor will use her fingers to check the uterus and ovaries. If the cause of menstrual cramps is not your period, you might need other tests for proper treatment.


Menstrual cramps occur at the abdomen, and the range of pain varies from mild to severe.

Women experience this torment every month. Period pain affects them physically and emotionally, which interferes with their routine activities.

If the pain is unbearable, then rush to the doctor immediately. They can help to run the tests to verify the cause of cramps and prescribe a few pain killers to keep the pain under control.

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