Most women have painful menstrual cramps (dysmenorrhea) from time to time. Menstrual cramps are one of the most common reasons for women to seek medical attention. The pain from menstrual cramps can range from mild to severe and can involve the lower belly, back, or thighs. You may also have headaches, nausea, dizziness or fainting, or diarrhea or constipation with your cramps.
During the menstrual cycle, the lining of the uterus produces a hormone called prostaglandin. This hormone causes the uterus to contract, often painfully. Women with severe cramps may produce higher-than-normal amounts of prostaglandin, or they may be more sensitive to its effects.
Cramping is common during the teen years, when a young woman first starts having periods. Primary dysmenorrhea is a term used to describe painful menstrual cramping with no recognized physical cause. It is seen most commonly in women between the ages of 20 and 24. It usually goes away after 1 to 2 years, when hormonal balance occurs.
Secondary dysmenorrhea is a term used to describe painful menstrual cramping caused by a physical problem other than menstruation. Physical problems that can cause this type of cramping include:
- A condition in which cells that look and act like the cells of the lining of the uterus (endometrium) are found in other parts of the abdominal cavity (endometriosis) or grow into the muscular tissue of the uterine wall (adenomyosis). Pain usually occurs 1 to 2 days before menstrual bleeding begins and continues through the period.
- Growths in the pelvis that are not cancerous (benign growths), such as ovarian cysts, cervical or uterine polyps, or fibroids.
- Pelvic infections. Your risk for developing an infection is higher after menstrual bleeding has begun because the opening to the uterus (cervical canal) widens during menstruation. But pelvic infections, especially those caused by sexually transmitted infections, can occur at any time.
- Using an intrauterine device (IUD). An IUD may cause increased cramping during your period for the first few months of use. If menstrual cramping persists or gets worse, you may need to consider having the IUD removed and choosing another birth control method.
- Problems with pregnancy.
- Structural problems that were present at birth (congenital), such as narrowing of the lower part of the uterus that opens into the vagina (cervix).
Menstrual-type cramps may occur after a medical procedure, such as cautery, cryotherapy, conization, radiation, endometrial biopsy, or IUD insertion.
Other menstrual symptoms, such as weight gain, headache, and tension, that occur before your period begins, can be caused by premenstrual syndrome (PMS). For more information, see the topic Premenstrual Syndrome (PMS).
Check your symptoms to decide if and when you should see a doctor.
Health Tools help you make wise health decisions or take action to improve your health.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Try the following home treatment to help manage your menstrual cramps:
- Use heat, such as hot water bottles, heating pads, or hot baths, to relax tense muscles and relieve cramping. Be careful not to burn yourself.
- Drink herbal teas, such as chamomile, mint, raspberry, and blackberry, which may help soothe tense muscles and anxious moods.
- Exercise. Regular workouts decrease the severity of cramps. For more information, see the topic Fitness.
- Empty your bladder as soon as you have the urge to urinate.
Try a nonprescription medicine to help treat your fever or pain:
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- You become pregnant.
- Pain is getting worse.
- Menstrual cramps are lasting longer than your period.
- Other symptoms develop, such as fever.
- Symptoms become more severe or frequent.
You may be able to prevent menstrual cramps.
- Eat a balanced diet that includes plenty of fruits and vegetables and is low in fat. Limit your intake of alcohol, caffeine, salt, and sweets. For more information, see the topic Healthy Eating.
- Begin or maintain a moderate exercise schedule. For more information, see the topic Fitness.
- Reduce stress in your life. Although stress does not cause menstrual cramps, reducing stress can make your symptoms less severe. For more information, see the topic Stress Management.
- Do not smoke or use other tobacco products.
- Try biofeedback or yoga. Both therapies teach relaxation skills.
- Try acupuncture or acupressure.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What were the dates of your last two menstrual periods?
- If you are a teen, do you have regular cycles, such as a period every 21 to 45 days?
- If you are an adult, do you have regular cycles, such as a period every 21 to 35 days?
- If you have been through menopause, how long ago was your last menstrual period?
- Has your menstrual flow been heavier bleeding than usual?
- What is your menstrual pattern?
- Is it regular, with approximately the same number of days in between periods?
- Is it irregular? What is the range from the longest to the shortest time interval between your periods?
- What method of birth control do you use? It is especially important to tell your doctor if you use an intrauterine device (IUD).
- Have you done a home pregnancy test? If so, when did you do the test and what was the result?
- Have you been under increased psychological or physical stress?
- Have you recently gained or lost more than 10 pounds for no known reason?
- What prescription and nonprescription medicines are you taking?
- How does your pain differ from your typical menstrual cramps?
- Do you engage in high-risk sexual behaviors?
- Do you have any health risks?
Current as of: October 19, 2020
Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine