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1797 Pitkin Avenue

Brooklyn, NY 11212

347-955-3465

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1797 Pitkin Avenue

Brooklyn, NY 11212

347-955-3465

24/7 Customer Support

Dysmenorrhea, Menstrual Cramps

• Menstrual cramps are periodic abdominal and pelvic pains experienced by women.
• More than half of all menstruating women have cramps.
• The cramps are severe in at least one in four of these women.
• Medically, menstrual cramps are called dysmenorrhea.
• Primary dysmenorrhea is a common menstrual cramp without an identifiable cause.
• Secondary dysmenorrhea results from an underlying abnormality that usually involves the woman’s reproductive system.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat cramps.
• Physical exercise can help alleviate menstrual cramps.
• Menstrual cramps tend to improve with age. 

What are menstrual cramps? What is premenstrual syndrome (PMS)?

Menstrual cramps are pains in the abdomen and pelvic areas that women can experience because of the menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual syndrome (PMS), although the symptoms of both disorders can sometimes be experienced as a continuous process. Many women suffer from both PMS and menstrual cramps. Menstrual cramps can range from mild to quite severe. Mild menstrual cramps may be barely noticeable and of short duration. They are sometimes felt like just a sense of heaviness in the abdomen. Severe menstrual cramps can be so painful that they interfere with a woman’s normal activities for several days.

What are the symptoms of menstrual cramps?

1. Menstrual cramps usually begin before the onset of menstrual period, peak within 24 hours after the start of the bleeding, and subside again after a day or two.
2. Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs.
3. Menstrual cramps can be quite painful or merely a dull ache.
4. The pain can be periodic or continuous.
5. Pain may be felt in the inner thighs or hips.
Menstrual cramps may be accompanied by a headache and or nausea, which can lead, although infrequently, to vomiting. Either constipation or diarrhea can also accompany menstrual cramps because the prostaglandins, which cause smooth muscles to contract, also affect the intestinal tract. Some women experience an urge to urinate more frequently. 

How long do menstrual cramps last? Why do they cause severe pain?

Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman’s cervical canal is narrow. The difference between more painful menstrual cramps and those that are less painful may be related to a woman’s prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in the endometrium (uterine lining) compared to women who do not experience cramps. Menstrual cramps are very similar to those a pregnant woman experiences when she is given prostaglandins as medication to induce labor. Usually, the strength of menstrual cramps is not measured. Researchers have demonstrated that menstrual cramps can be scientifically documented by measuring the pressure within the uterus and the number and frequency of uterine contractions. During a standard menstrual period, the average woman has contractions of low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions every 10 minutes. When a woman with dysmenorrhea has menstrual cramps, her contractions are usually of higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.

What causes menstrual cramps?

Each month, the inner lining of the uterus (the endometrium) typically builds up in preparation for a possible pregnancy. After ovulation, if sperm does not fertilize the egg, 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 is eventually shed as the menstrual flow. It is replaced by a new growth of lining during the next monthly cycle. When the 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 (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium, which then breaks down and dies. After the death of this tissue, the uterine contractions 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.

What other factors cause severe pain with menstrual cramps?

• An unusually narrow cervical canal tends to increase menstrual cramps.
• Another anatomical factor that may contribute to menstrual cramps is a retroverted uterus (the uterus tilts backward instead of forwarding).
• Lack of exercise is now recognized to contribute to painful menstrual cramps because exercise releases endorphins that relieve pain.
• 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.
• Adenomyosis and endometriosis can increase the severity of menstrual cramps
• Having uterine fibroids can worsen menstrual cramping 

How common are menstrual cramps?

Menstrual cramps of some degree affect an estimated 84% of women, and up to 25% would describe their menstrual cramps as severe. Surveys of adolescent girls show that over 90% report having menstrual cramps.

How are menstrual cramps diagnosed?

The diagnosis of menstrual cramps is usually made by the woman herself and reflects her perception of pain. Once a woman has experienced menstrual cramps, often with the adolescent onset of her monthly menstrual flow (menses), she becomes aware of the typical symptoms. If other medical conditions contribute to menstrual cramps (secondary dysmenorrhea), the doctor may suggest diagnostic testing, including imaging studies.

What are the conventional treatments for menstrual cramps?

Every woman needs to find a treatment that works for her. There are several possible remedies for menstrual cramps.
Current recommendations include not only adequate rest and sleep but also regular exercise (especially walking). Some women find that abdominal massage, yoga, or orgasmic sexual activity may bring relief. A heating pad applied to the abdominal area may relieve the pain and congestion.
Several nonprescription (over-the-counter) agents can help control the pain as well as prevent the menstrual cramps altogether. For mild cramps, aspirin, acetaminophen (Tylenol), or acetaminophen plus a diuretic (Diurex MPR, FEM-1, Midol, Pamprin, Premsyn, and others) may be sufficient. However, aspirin has a limited effect in curbing the production of prostaglandin, and it is only useful for less painful cramps.
The main agents for treating moderate menstrual cramps are nonsteroidal anti-inflammatory drugs (NSAIDs), which lower the production of prostaglandin and lessen its effect. The NSAIDs that do not require a prescription are:
• ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others);
• naproxen sodium (Aleve, Anaprox); and
• ketoprofen (Actron, Orudis KT).

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 anticipated period is due, and then continuing taking the drug for the first one to two days of her period. The best results are obtained by choosing one of the NSAIDs on a scheduled basis and not waiting for the pain to begin.

Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic acid (Ponstel) and meclofenamate (Meclomen). 

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