What causes menstrual cramps?

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?


Dear Reader,

Menstruation (often referred to as a period) is a part of the ovulatory cycle and involves monthly shedding of the uterine lining that is accompanied by menstrual blood. While the bleeding itself generally isn’t painful, many people find that they experience pain in their lower abdomen before and during their period. This pain may come in the form of cramping or throbbing, and is referred to as dysmenorrhea. Additionally, certain conditions may contribute to the pains. While some may find it just a bit annoying, for others these pains can be debilitating and interfere with their usual activities. There are a number of ways to alleviate the pain associated with menstrual cramps, and they're often determined based on the cause of the menstrual cramps. Want to know more about these pesky pains? Keep on reading!

There are two kinds of dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs due to the process of menstruation in the body. During a period, the uterus is contracting in order to shed its lining. The chemical that causes this is called prostaglandin, which causes the contractions to occur. It's 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. Some other common symptoms of dysmenorrhea include vomiting, nausea, and diarrhea. These types of cramps may lessen as a person ages. Pain from primary dysmenorrhea usually begins a day or two before or the day a person's period begins and can last from 12 to 72 hours. On the other hand, secondary dysmenorrhea occurs when menstrual cramps are due to a condition related to the reproductive organs. For example, conditions such as endometriosis, adenomyosis, pelvic inflammatory disease, cervical stenosis, and uterine fibroids may all lead to pain during menstruation. Pain from these conditions may last longer and begin earlier in the menstrual cycle.

There are a number of ways to relieve mild menstrual cramps at home. Over-the-counter pain relievers such as ibuprofen or acetaminophen may be helpful for some, especially when taken as soon as pain is felt. Additionally, placing a heating pad on or massaging the lower back and abdomen may provide relief. Some may find being physically active improve their cramps, while others find it beneficial to rest during their period. For those that find that their menstrual cramps aren’t relieved by methods they can do at home and seek the assistance of a health care provider. Depending on the situation, prescription nonsteroidal anti-inflammatory drugs (NSAIDS) may be prescribed. Hormonal birth control may also be an option for reducing cramps. Additionally, for those whose cramps are caused by a health condition, treatments for that condition may help alleviate the cramps. This may include different medications as well as surgery to remedy what may be causing the pain.

Here's to hoping both you (and your students) are more informed about the potential pains of periods!

Last updated Sep 28, 2018
Originally published Oct 17, 2003

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