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What’s the Deal with Menstrual Cramps?

Menstrual cramps, called dysmenorrhea in medical speak, is one of the most common period problems across the world. Period pain can show up as throbbing, cramping, and aching in the lower abdomen before and/or during a period. It can last for a few hours or a few days; it can be constant or it can be intermittent; and, it’s cyclical in nature, making an appearance near or at menstruation. It can also be accompanied by other symptoms like pain radiating down the thighs and lower back, nausea, vomiting, diarrhea, headaches, migraines, fatigue, heavy bleeding, and clotting. And it can affect other areas of life like mood, sleep, and functioning.

Primary vs. Secondary Dysmenorrhea

Dysmenorrhea is divided into two kinds:

  • Primary: this is when period pain is not a result of an underlying condition, is more common in the first couple of years of menarche (first period ever). We’ll focus on this in this article.
  • Secondary: this is when period pain is a consequence of an underlying issue like endometriosis (which is the most common cause of severe secondary dysmenorrhea) or fibroids.

Why does it happen?

A period occurs when the body realizes that pregnancy didn’t happen and hormone levels drop. The drop in the hormone called progesterone causes the destabilization of the uterine lining that initiates a period. Part of having a period is having an inflammatory response which is carried out by immune system mediators called prostaglandins that bring more blood to the uterine lining, make our blood vessels more fragile, and are involved in clotting. As such, a bit of fluid retention, discomfort, and change is to be expected.

In primary dysmenorrhea, the leading theory is that there is a more pronounced inflammatory response in those alongside more uterine contractions. Researchers have found that there are more prostaglandins the menstrual discharge of people with dysmenorrhea than those who don’t. There may be other contributing factors to primary dysmenorrhea like heavy flow, nutritional deficiencies (which are also common in adolescence with irregular eating patterns), family history, and earlier age at menarche.

In secondary dysmenorrhea, the underlying issue is what’s causing the pain like endometriosis, fibroids, adenomyosis, etc.

What do I do?

Period pain, although normalized, should really be looked at more thoroughly, especially if it it’s moderate to severe, it does not respond to pain killers, and/or it’s getting in the way of life.

Where you can start is by tracking the pain. Here are some considerations:

  • What’s the intensity on a scale from zero to ten?
  • Where is the pain?
  • How long does it last?
  • When did it start?
  • What makes it better?
  • What makes it worse?
  • What have you tried that doesn’t seem to work?
  • What other symptoms are present?
  • How does the pain affect your life?

Talk to a doctor about period pain and ask them questions. There aren’t specific blood tests to test for period pain, but vitamin D deficiency is associated with dysmenorrhea. If there are other things going on in health, it also offers running basic blood markers and imaging should be offered to rule out a structural issue for pain.

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