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Symptoms of menstrual cramps include:

• Dull, throbbing or cramping pain in your lower abdomen
• Pain that radiates to your lower back and thighs

Some woman also experience:

• Nausea and vomiting
• Loose stools
• Sweating
• Dizziness

When to see a doctor
If you've started menstruating within the past few years and are experiencing cramps, chances are your menstrual pain is not a cause for concern. However, if menstrual cramps disrupt your life for several days a month or if you're older and just started experiencing severe menstrual cramps, see your doctor.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

During menstrual periods, your uterus contracts to help expel its lining. Prostaglandins, hormone-like substances involved in pain and inflammation, trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more severe menstrual cramps.

Many experts believe that severe contractions constrict the blood vessels feeding the uterus. The resulting pain can be compared to the angina that occurs when blocked coronary arteries starve portions of the heart of food and oxygen.

Menstrual cramps also may be caused by:

• Endometriosis. In this painful condition, the type of tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.
• Uterine fibroids. These noncancerous tumors and growths in the wall of the uterus rarely may be the cause of pain.
• Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.
• Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
• Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Risk factors associated with dysmenorrhea include:

• Age younger than 20
• Early onset of puberty (age 11 or younger)
• Heavy bleeding during periods (menorrhagia)
• Never having delivered a baby

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Complications may vary, depending on the underlying cause of your menstrual cramps. For example, endometriosis can cause fertility problems, while pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting in the tube (ectopic pregnancy) instead of in your uterus.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

While you may initially consult your family physician, he or she may refer you to a gynecologist.

What you can do
You may want to write a list that includes:

• Detailed descriptions of your symptoms
• The dates when your last two menstrual periods began
• Information about medical problems you've had
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor
Your doctor will review your medical history and perform a physical examination, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for signs of infection.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may order one or more of the following tests.

Ultrasound
This painless test uses sound waves to visualize internal organs. It is often used to check for abnormalities in the uterus, cervix and fallopian tubes. A wand, lubricated with jelly, is pressed against your lower abdomen and the resulting image shows up on a video screen. In some cases, the wand may be inserted into your vagina, to check your ovaries and the lining of your uterus.

Computerized tomography (CT)
A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body. This painless procedure can provide more detail than can regular X-rays. A technician positions you on a narrow table that slides into the machine. You must lie still during the test, or the images will be blurry. CT scans usually take about 30 minutes.

Magnetic resonance imaging (MRI)
MRIs use radio waves and a powerful magnetic field to produce detailed images of internal structures. This painless procedure may be used to check for tumors or signs of endometriosis. You lie on a narrow table that slides into a tunnel inside the MRI machine. You must lie very still during the scans to avoid blurring the images.

MRIs often take at least an hour to complete, but they are divided into individual scans that usually last only a few minutes. The machine is very noisy during the scans, so you may need earplugs to block the banging sounds. If you are claustrophobic, you should talk to your doctor about taking medicine to help you relax during the test.

Hysteroscopy
In this procedure, your doctor inserts a thin, lighted tube through your vagina and cervix into your uterus. The hysteroscope works like a tiny telescope, allowing your doctor to look through it to check for such things as fibroids or polyps. Afterward, you may experience some cramping and spotting.

Laparoscopy
In this outpatient surgical procedure, your doctor views your abdominal cavity by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. Laparoscopy can check for:

• Endometriosis
• Adhesions
• Fibroids
• Ovarian cysts
• Ectopic pregnancy

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Medications

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in relieving the pain of menstrual cramps. Your doctor may initially suggest taking over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), at regular doses starting the day before your period begins. Prescription NSAIDs, such as mefenamic acid (Ponstel), are also available.
• Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered by injection, a patch you wear on your skin, or in a flexible ring that you insert into your vagina.

Surgery
If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, the surgical removal of the abnormal tissue may help reduce your symptoms.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Soaking in a hot bath or using a heating pad on your lower abdomen appears to be just as effective as over-the-counter pain medication for relieving menstrual cramps.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Alternative therapeutic approaches to menstrual cramps include:

• Stress reduction. Activities that reduce stress — such as yoga, massage and meditation — may help ease the pain of menstrual cramps.
• Acupuncture. Acupuncture has been used in China to relieve pain for more than 2,000 years. A practitioner places hair-thin needles into the skin at specific places on your body. Most people feel no pain when the needles are inserted.
• TENS. Transcutaneous electrical nerve stimulation (TENS) has been found to be more effective than placebo in relieving the pain associated with menstrual cramps. A TENS device raises the threshold for pain signals and stimulates the release of endorphins, your body's natural painkillers.
• Dietary supplements. Some studies have indicated that vitamin E, thiamin and omega-3 supplements may help reduce menstrual cramps.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.