What causes menstrual cramps?

Originally Published: October 17, 2003
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Dear Alice,

I teach a sex education class and received the following question from a student in our question box. My students are 13-years-old.

Why does it hurt to have your period? I don't know if this is a male or a female asking. I can only assume they are speaking about cramping. Why do women have cramping with periods? What can alleviate the pain?

Thanks

Dear Reader,

Menstruation, or a period, is a monumental rite of passage for girls, signaling their physical development and maturation toward womanhood. A period is a part of the ovulatory cycle and involves monthly shedding of the uterine lining that is accompanied by menstrual blood. The blood that flows as a part of menstruation totals about half-of-a-cup and can vary in rate of flow dependent on where a woman is in her cycle. Although bleeding is often associated with pain, the physiological processes that contribute to menstrual flow do not hurt.

About 50 percent of women, however, have painful menstruation, referred to medically as dysmenorrhea. Usually this takes the form of cramping that begins within three years of a girl's first period and decreases in intensity as she gets older. Some believe that cramping is caused by excessive amounts of prostaglandin, a hormone-like substance typically involved in pain and inflammation processes. Prostaglandins make their big appearance at the onset of labor, when they cause the powerful contractions that push the baby out. But even outside of the delivery room, prostaglandins still initiate contractions of the uterus. It is these muscle twistings that can, when severe and prolonged, contribute to menstrual discomfort by temporarily cutting off the blood supply to the uterus, depriving the muscle of oxygen and causing pain.

Indeed, some women's cramps are so bad that they're debilitating. If this is the case, a woman needs to see a gynecologist or women's health care provider for an examination, to rule out other possible causes for the cramping.

At home remedies are available that can help with the discomfort or pain. Some women find that soaking in a hot bath does the trick, while others prefer directly applying a heating pad to the abdomen. Others try either exercising the aches away (at the gym or in the bedroom), or hitting the bed for some R&R till they subside. Still others opt for over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin (some of which also function as prostaglandin inhibitors).

Finally, some women find that certain supplements are helpful in alleviating some of their menstrual symptoms, including premenstrual syndrome (PMS), but most have gone unproven in their effectiveness. For more information about these suggested remedies, read the Related Q&As listed below.

Alice